Ovarian reserve

(oh-VAYR-ee-un reh-SERV) – The total number of healthy, immature eggs in the ovaries. Ovarian reserve is often checked in women who want to have children and are having problems getting pregnant.

As a fertility community, we have come to rely on ovarian reserve testing in order to identify a patient’s chance of becoming pregnant prior to IVF treatment.

Why do we check ovarian reserve?

The goal of IVF treatment is to get several good-quality eggs and a healthy uterine environment for optimal transfer. Ovarian reserve refers to the ease at which an individual’s ovaries can be successfully stimulated with fertility drugs. The most consistent variable affecting ovarian reserve is age. This is because a woman is born with all the eggs she will ever have. The older a woman is, the fewer high-quality eggs she has left to become successfully pregnant as egg quality and quantity continue to decline with age.

Healthy women over age 35 are less fertile than their younger counterparts. Women 40 and over statistically have a 20% live birth rate, even with IVF treatment, if using their own eggs. Due to this donor egg usage has become popular in this age group and older.

Things that may cause low ovarian reserve:

  • Age
  • Damage to the ovaries by smoking, drugs, and alcohol
  • Certain anticancer treatments (such as chemotherapy or radiation therapy)
  • Surgery to the ovaries or other organs in the pelvis
  • Certain diseases or genetic conditions

How is ovarian reserve tested?

There are several markers used to determine ovarian reserve. The most common are follicle-stimulating hormone (FSH) and anti-mullerian hormone (AMH) blood tests. Ultrasounds are the follow-up step to confirm follicle count and better understand results.

An FSH test is a blood test drawn on the second or third day of the menstrual cycle. FSH released from the pituitary gland stimulates the ovaries to recruit and select eggs so that one will grow and eventually ovulate. When there are few eggs available the pituitary gland has to send a much stronger signal so the FSH level will be higher in those circumstances.

AMH is also a blood test used to check a woman’s ability to produce eggs that can be fertilized for pregnancy. AMH levels help show how many potential egg cells a woman has left.

Ultrasound screening for ovarian volume and antral follicle count is a promising approach. With this technology patients are assigned to an anticipated ovarian response group based on follicle number. Clinically, women with very low numbers will have very few eggs at oocyte retrieval. Those patients with adequate follicle numbers may have a reasonable quantity of oocytes at retrieval despite abnormal pre-treatment blood test results.


A young patient with few oocytes may still have one or two eggs capable of resulting in a live birth. Ovarian reserve testing identifies patients that have a lower probability of conceiving. Such tests address averages and not individuals. Many IVF patients with a low ovarian reserve are still able to respond positively to treatment and conceive. If you learn you have a low ovarian reserve under the age of 35 it might be beneficial to consider preservation methods such as egg freezing.

New Hope next steps:

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