WomensPal Health Guide · Updated July 2026

Ovarian Reserve: What It Is, How to Test It & What Low Levels Mean

You were born with all the eggs you'll ever have — roughly 1–2 million at birth, declining to around 300,000 by puberty, and continuing to decrease through your reproductive years. Ovarian reserve refers to the quantity (and to some extent the quality) of your remaining eggs. It's one of the key factors doctors assess when evaluating fertility potential.

How Ovarian Reserve Declines

Egg loss is continuous and accelerates with age. The decline is gradual until around age 37–38, when it steepens noticeably. By menopause, only about 1,000 eggs remain — but all are too aged to be viable. Unlike sperm (which are continuously produced), eggs cannot be regenerated. The goal of fertility evaluation is to understand where you are on this curve.

Tests for Ovarian Reserve

AMH (Anti-Müllerian Hormone) Blood Test

AMH is secreted by the small antral follicles developing in your ovaries each month. It's the most widely used ovarian reserve test because it:

• Can be tested at any point in your cycle (not cycle-day dependent)
• Provides a direct measure of the pool of remaining follicles
• Predicts how you'll respond to fertility medications (IVF stimulation)

AMH reference ranges:

• Above 3.0 ng/mL: High (may indicate PCOS)
• 1.0–3.0 ng/mL: Normal
• 0.5–1.0 ng/mL: Low-normal
• Below 0.5 ng/mL: Low ovarian reserve
• Below 0.16 ng/mL: Very low (often correlates with poor IVF response)

Antral Follicle Count (AFC)

A transvaginal ultrasound performed on days 2–5 of your cycle counts the number of small antral follicles visible in each ovary. These follicles represent the pool ready to respond to FSH stimulation. AFC of 15–30 total is considered normal; below 7 suggests diminished reserve.

Day 3 FSH and Estradiol

Older tests, but still useful. High FSH on day 3 (above 10 mIU/mL) indicates the brain is working harder to stimulate the ovaries — a sign of declining reserve. Elevated day 3 estradiol can suppress FSH and mask a high reading.

What Low Ovarian Reserve Means

Diminished ovarian reserve (DOR) means:

• Fewer eggs available per cycle
• Potentially less time before natural fertility declines further
• Potentially lower IVF success rates due to fewer eggs retrieved
• Higher FSH required to stimulate remaining follicles

What it doesn't necessarily mean: that you cannot conceive. Many women with low AMH have conceived naturally. The test is about probability and timing, not absolute outcome.

Can You Improve Ovarian Reserve?

You cannot increase your egg count — eggs lost are gone permanently. However, evidence suggests that egg quality can be supported:

• CoQ10 (ubiquinol form, 400–600mg/day): Supports mitochondrial function in eggs; particularly relevant for women over 35. Multiple studies show improved egg quality and embryo development.
• DHEA (25–75mg/day): Some evidence for improving response to IVF stimulation in women with poor ovarian reserve; requires medical supervision
• Avoid smoking: Smoking significantly accelerates ovarian reserve decline
• Reduce endocrine disruptors: BPA and phthalates are associated with reduced ovarian reserve

Frequently Asked Questions