Ovarian Reserve Testing: Who Is It For & How Is It Done?

Did you know, that at birth, you have millions of tiny, primordial follicles in your ovaries?

Now, these stay dormant until you hit puberty.

Then, once the hormonal signals from the brain start, they mature in groups, with one "egg of the month" being responsible for your menstrual cycles.

But here's the thing: as you age, those millions of follicles slowly become thousands, hundreds, and then a few.

And throughout this process, you would still be having regular menstrual cycles, with no clue of the rate at which the decline is happening.

Unless you get an ovarian reserve test done.

This can help you gauge or estimate the number of follicles left, and make informed decisions while trying to conceive or going for assisted reproductive treatments.

Simply put, ovarian reserve testing can help you know your fertility at any given age.

So how exactly does it work, and can you take one to know your fertility status?

In this article: 📝

What is ovarian reserve testing?

Ovarian reserve testing is the process of testing and knowing how many of these follicles are left in our ovaries.

There's no way to know a direct number, but we can best estimate it through blood tests and indirect methods, like an ultrasound, to have a better idea of your ovarian reserve.

Which tests are done for ovarian reserve?

Ovarian reserve testing typically involves a combination of blood tests and ultrasound imaging.

Here’s a breakdown of the most common ones:

1. FSH (follicle stimulating hormone) test

This is a common ovarian reserve test, where FSH levels are measured in the morning hours on days 2-4 of your menstrual cycle.

Your FSH levels increase progressively as the number of follicles declines.

💪 Pros: It's easy and relatively inexpensive.

😮‍💨 Cons: The results can vary with menstrual cycles, there aren't universally accepted ways to gauge the results in the medical community, and it requires very high FSH levels to accurately diagnose a low ovarian reserve.

2. Anti-Mullerian hormone (AMH)

This is a hormone secreted by growing follicles (cells that house the eggs until they mature), and is a good indicator of the remaining eggs in the ovaries.

In fact, as we age and as the follicle pool declines, AMH becomes almost undetectable — like at menopause.

💪 Pros: It's a sensitive marker, more dependable than other ovarian reserve tests (less variability within cycles), and can be measured on any day of your menstrual cycle.

😮‍💨 Cons: It can't be used as a sole, conclusive predictor of ovarian reserve — you'd have to do it alongside other ovarian reserve tests.

3. Antral Follicle Count

Antral follicles are those that are about 2-10mm in diameter in the ovaries, and counting these is another ovarian reserve test to determine how many eggs you have left.

Using an ultrasound probe, the measurements of the follicles are taken, and the follicles in both ovaries are added for your total AFC.

💪 Pros: Your AFC has a strong correlation to AMH (they're often done together), and there's limited variability within your menstrual cycle.

😮‍💨 Cons: The observation from your AFC may differ slightly from one ultrasound specialist to another.

What is the normal range for ovarian reserve testing?

The normal range for ovarian reserve testing can depend on two things: which test is done, and the reference values of the laboratory.

In general, a marker of a "good" ovarian reserve is higher AMH and lower FSH levels.

Based on the tests, as well as studies, the general normal ranges include:

• FSH: An FSH level below 10 mIU/ml is indicative of a healthy ovarian reserve.
• AMH: An AMH level of 1.0 to 3.0 ng/ml is considered normal. Levels within 0.5-1.26ng/ml indicate perimenopause within 3-5 years.
• AFC: An AFC level of 8-16 is considered normal.

How do you know if you have poor ovarian reserve?

There's no way you can really tell that you have a poor ovarian reserve unless you have a proper diagnostic test carried out by a medical professional.

Then, if the results of your ovarian reserve test indicate that your levels fall outside or below the normal range, a diagnosis of poor ovarian reserve can be made.

Apart from blood tests, some other indicators include reduced antral follicle count on an ultrasound or irregular menstrual cycles.

If you or your healthcare provider notice either of these things, it's worth discussing your next stages, if you're either trying to conceive or looking to preserve your fertility.

How common is low ovarian reserve?

Low ovarian reserve is more common than you think!

Given that it's affected by various things like lifestyle, genetics, and environmental factors, studies estimate that around 10-30% of women of reproductive age experience some degree of diminished or reduced ovarian reserve.

What causes a woman to have a low egg reserve?

There can be several causes that can lead to a low egg reserve.

In fact, studies also mention how there's a wide variation in the rate of decline in egg reserve, among women across different ages.

Some of the reasons for a low egg reserve include:

• Age: Our ovarian reserves naturally diminish as we age. Studies also show how, despite the diversity in populations and ethnicities, the decline in egg reserve becomes more significant after the age of 37.
• Genetics: Hereditary factors, like Fragile X syndrome, can affect your ovarian reserve. Some women may inherit a reduced number of eggs or an increased chance of early menopause.
• Lifestyle: Smoking, excessive alcohol consumption, poor diet, and exposure to environmental toxins can all negatively impact ovarian reserve.
• Ovarian surgery or conditions: Previous ovarian surgeries, endometrial surgeries, or medical conditions like genital tuberculosis and polycystic ovarian syndrome (PCOS), can reduce ovarian reserve.
• Radiation or chemotherapy: Cancer treatments, like radiation and chemotherapy, can affect your ovarian reserve. This is why many patients are advised to freeze their eggs as a way to preserve their fertility before chemotherapy.

At what age does ovarian reserve diminish?

Our ovarian reserve begins to diminish gradually as we reach our late 20s (pretty early, we know!), but it's a more significant decline after the age of 37.

By the age of 40 (around menopause or perimenopause), many women experience a significant decrease in the quantity and quality of their eggs.

This is where ovarian reserve tests can help to bridge the gap in information early, so you can work towards the best treatment plan, if you're planning to conceive.

Can stress reduce ovarian reserve?

Stress is a common part of our lives, but chronic stress can have more pronounced effects on our bodies.

This study found that chronic stress is related to decreased AMH levels — stress can negatively affect the hormonal signals from our brains that signal the follicle cells to grow, which impacts our fertility.

But there was no direct correlation of stress with a reduced ovarian reserve — more on ovarian reserve markers, like AMH and AFC.

Can you get pregnant with poor ovarian reserve?

Yes, pregnancy is still possible for women with poor ovarian reserve, but it may be a little harder to navigate and it could take longer.

Ultimately, even if your reserve is low, the quality of your eggs matters.

Based on your age and the cause of low ovarian reserve, methods like natural conception, medicated cycles, and even assisted reproductive technologies (like IVF), can help.

What is the best fertility treatment for low ovarian reserve?

Well, there's no single best fertility treatment for low ovarian reserve — your age, medical history, and the cause of your diminished ovarian reserve.

But there are a few fertility treatments that could be available to you:

• IVF or ICSI with donor eggs: Egg donors go through genetic and physical screening tests that ensure the genetic health of the cells. In the case of a very low ovarian reserve, this alternative may be recommended.
• IVF with pre-implantation genetic screening (PGS): For IVF with your own eggs and a low ovarian reserve, egg pooling will likely be carried out, which involves multiple cycles to retrieve eggs. After IVF (or ICSI), PGS can be done to select the most viable embryos for transfer, which can help reduce the chances of pregnancy loss.
• Ovarian reserve enhancement: Some treatments, like ovarian PRP (platelet-rich plasma) can help revive AMH levels. This involves inserting platelet-rich plasma into your ovaries, with the aim of increasing AMH levels after 1-3 months. After this, based on your AMH levels, either natural conception or IVF can be the next step.

How successful is IVF with low ovarian reserve?

The success of IVF with low ovarian reserve varies from person to person — but generally, the clinical pregnancy rate is around 11.5% per IVF cycle.

It's also important to remember that success rates are dependent on a lot of factors — your age, the quality of your remaining eggs, and your chosen IVF protocol.

While the chances of success may be lower compared to women with a normal ovarian reserve, many with a low ovarian reserve can still have successful pregnancies through IVF.

Should I freeze my eggs if I have low ovarian reserve?

Egg freezing can be a great option for women with low ovarian reserve.

You may have to go through multiple cycles to pool and freeze eggs, but it also means that the quality of the eggs is preserved at the age you do it.

If you freeze your eggs at a younger age, you can increase your chances of genetically healthy embryos later.

This can be especially beneficial for women who are not yet ready to start a family or are about to start (or at risk of undergoing) treatments that may impact their ovarian reserve.

How can I improve my poor ovarian reserve?

Honestly, there's not much you can do to improve or restore your ovarian reserve, since the causes are not often something you can control.

But there are some things that can help maintain the quality of your eggs, like:

• Maintain a healthy lifestyle: Whatever that means for you — a balanced diet, regular exercise, avoiding smoking, and reducing alcohol consumption can generally help.
• Consult a fertility specialist: Seeking guidance from a reproductive specialist can be useful so you know where you stand in your fertility, and so you can explore fertility treatment options, medications, and supplements, like folic acid, and discuss potential interventions.
• Manage underlying conditions: Address any medical conditions that may be affecting your ovarian reserve, like PCOS or endometriosis.

Is ovarian reserve testing painful?

No, ovarian reserve testing is generally not painful.

The blood tests involved only require a simple blood draw, so the pain would be from a needle prick.

And the transvaginal ultrasound used to assess antral follicle count may cause mild discomfort.

Most women don't experience any pain from either of these, but it's worth letting your healthcare provider know about your preferences and needs, so you're as comfortable as possible during the testing process.

In the end, there are lots of reasons why you might choose to have an ovarian reserve test done.

You could be planning to preserve your fertility, better understand your chances of conceiving, or simply want to routinely check up on your reproductive health.

Either way, an ovarian reserve test isn't a panic button, but something that equips you with the information you need to make the right choices.

And whatever your choice is — to freeze your eggs, go for natural conception, or IVF — you'll find support from other women who get it on Peanut.

You do you. ❤️