Finding out you have low ovarian reserve can elicit quite a bit of anxiety and sometimes even panic. Before you go down a research rabbit hole, we pulled some of the data around ovarian reserve and how it translates to your ability to conceive.
What Is Low Ovarian Reserve?
Your ovarian reserve is the medical term used to describe how many eggs are left in your ovaries. Your ovarian reserve naturally goes down over time as you approach menopause. The two main ways to estimate ovarian reserve are drawing an anti-müllerian hormone (AMH) blood level and doing an antral follicle count (AFC) ultrasound.
A low level of AMH and/or a low AFC indicates that you have a low ovarian reserve, which means you have a lower quantity of eggs remaining in your ovaries.
Low ovarian reserve on its own does NOT mean:
You’re infertile
You have poor egg quality
You need fertility treatment to conceive
You don’t have enough eggs to do IVF or other assisted reproductive technologies
Antral Follicle Count (AFC)
An antral follicle count refers to the number of small antral follicles in each ovary visible through ultrasound at the beginning of your menstrual cycle. The number of antral follicles in this group each month is predictive of how many total follicles are remaining in the ovaries. For example, if your AFC is low, you can also expect your ovarian reserve to be low.
According to Dr. Meera Shah, on average “a typical AFC for a woman in her 20s and early 30s may range between 10-20 follicles, in her late 30s around 8-15 follicles, and by her 40s, it could further decline to under 10 follicles.” It's normal for your AFC to vary slightly month to month and gradually decrease over time as your ovarian reserve naturally declines.
The AFC ultrasound is typically conducted on cycle day 2 or 3 before your body selects one of the antral follicles to continue growing in preparation for ovulation that month. Your clinic will help you schedule appropriately to get the most accurate results.
Anti-Müllerian Hormone (AMH)
Anti-müllerian hormone is produced by the cells surrounding each of the immature follicles in the ovaries. Each of these follicles contains one immature egg. So, a higher AMH level indicates more follicles, which therefore means more eggs left in your ovaries. As you approach menopause, your AMH will gradually decline as fewer and fewer eggs remain.
According to Cleveland Clinic, AMH levels are categorized into average, low, and severely low.
Average: Between 1.0 ng/mL to 3.0 ng/mL
Low: Under 1.0 ng/mL
Severely low: 0.4 ng/mL
Low and severely low AMH levels are associated with low ovarian response. Ovarian response refers to the number of eggs retrieved after undergoing ovarian stimulation during fertility treatment. Most doctors will use a more aggressive treatment protocol with higher medication doses during ovarian stimulation for patients with low ovarian reserve to encourage the best response possible.
AMH levels do not fluctuate much during your menstrual cycle, which means you can have an accurate AMH level drawn at any time throughout your menstrual cycle.
Limitations of Low Ovarian Reserve Diagnosis
It's important to remember that AMH and AFC can be used to predict the quantity of eggs remaining in the ovaries but not the quality of those eggs. For women without a history of infertility, a low AMH on its own does not predict their ability to conceive. According to the American Society of Reproductive Medicine (ASRM), “AMH and AFC have only a weak association with qualitative outcomes such as oocyte (egg) quality, clinical pregnancy rates, and live birth rates.”
We know that being told you have low ovarian reserve can feel scary, but it's important to focus on the facts. A low ovarian reserve on its own doesn’t mean you are infertile or that you’ll need fertility treatments to get pregnant. If you’ve been diagnosed with low ovarian reserve, talk to your doctor about what that means for you, your treatment, and your chances of success.
To read a more in-depth explanation of ovarian reserve, check out ASRM’s explanation here.
Your Questions, Answered
How quickly does my AMH or AFC change?
AMH and AFC levels can fluctuate slightly from month to month but generally decline slowly over time, with a more rapid decrease as you age. A short delay of a month or two in trying to conceive or starting treatment won’t significantly impact your ovarian reserve or chances of success. However, postponing for a year or more—especially in your late 30s or 40s—can reduce both egg quantity and quality.
Consulting your doctor about your AMH and AFC levels can help determine the best timeline for treatment. In general, starting sooner rather than later increases the chances of success.
Can I increase my AMH?
There is no definitive method to increase AMH, but some studies have found that taking certain supplements may help. Evidence suggests that for some patients with low ovarian reserve, taking vitamin D, DHEA, selenium, and vitamin E supplements may lead to an increased AMH level. More studies are needed to confirm these findings.
Note: Always talk to your doctor before starting any new medications or supplements.
Why isn’t this a measure of my egg quality?
Currently, there are no routine tests to directly measure egg quality. The most reliable indicator is an egg’s ability to be fertilized and develop into a healthy pregnancy. The good news is that even with a low ovarian reserve, the remaining eggs may still be of good quality. This is why having a low ovarian reserve does not necessarily mean infertility.
What should I ask my doctor as a follow-up if I have a low AMH or AFC?
A few questions to ask your doctor as a follow-up to a low AMH or AFC:
What do these levels mean for my fertility?
What are my chances of conceiving naturally with these levels?
Should I consider fertility preservation, such as egg or embryo freezing?
How urgently should I move forward with fertility treatments or start trying to conceive?
What do you recommend as my next steps based on my medical history and these AMH and AFC results?