What is Ovarian Reserve? How to Test It. Can You Improve Your Egg Quality?

Ovarian reserve refers to a woman's reproductive potential based on the quantity and quality of her eggs (oocytes). As women age, both egg quantity and quality decline, affecting fertility. A diminished ovarian reserve doesn’t mean you can’t conceive naturally or predict when you’ll enter menopause. However, it does indicate that you have fewer eggs, which poses a risk to your fertility. If you undergo ovarian stimulation, you will likely retrieve fewer eggs. This article explains: • What ovarian reserve is and why it matters. • The most accurate tests to assess ovarian reserve. • Lifestyle factors that support overall reproductive health. Descrição do post.

FERTILITY AND INFERTILITY

3/17/20253 min read

1. What is Ovarian Reserve?

A woman is born with 1–2 million eggs, but by puberty, only about 300,000–400,000 remain. With each menstrual cycle, a number of eggs is lost, and only one matures for ovulation. By the time a woman reaches her late 30s and early 40s, the number and quality of her eggs decline significantly​.

Why is Ovarian Reserve Important?

· It helps predict natural fertility potential.

· It determines the likelihood of success with fertility treatments.

· It indicates the timing of menopause.

Does Low Ovarian Reserve Mean Infertility?
Not necessarily. A woman with a low ovarian reserve can still conceive, but her chances decrease with age, especially after 35 years old​.
2. How to Test Ovarian Reserve?

A. Hormonal Blood Tests

Test What It Measures Optimal Range

Anti-Müllerian Hormone (AMH). Ovarian reserve 1.0–4.0 ng/mL (ideal fertility)

Follicle-Stimulating Hormone (FSH). Ovarian function <10 mIU/mL (tested on Day 3 of the cycle)

Estradiol (E2) Egg development response. 25–75 pg/mL (Day 3 test)

Inhibin B. Ovarian activity. >45 pg/mL suggests good reserve

  • AMH is the most reliable marker, as it remains stable throughout the menstrual cycle.

  • FSH and estradiol levels are useful but may fluctuate from cycle to cycle​.

B. Ultrasound Tests

  1. Antral Follicle Count (AFC) – Measures the number of small follicles in both ovaries via transvaginal ultrasound.

    • High AFC (>12 follicles) = Good ovarian reserve.

    • Low AFC (<5 follicles) = Diminished reserve.

  2. Ovarian Volume – Women with larger ovarian volume tend to have better fertility outcomes​.

3. Factors That Affect Ovarian Reserve

A. Aging

· Egg count declines naturally after 30 and rapidly after 35.

· Egg quality decreases, increasing the risk of chromosomal abnormalities such as Down syndrome.

B. Lifestyle Factors

  • Smoking – Reduces ovarian reserve and advances menopause by 1–4 years.

  • Obesity – Alters hormonal balance, impacting egg quality.

  • Excessive alcohol – Lowers AMH and damages egg DNA​.

C. Medical Conditions

  • Polycystic Ovary Syndrome (PCOS) – Can result in higher AFC but poorer egg quality.

  • Endometriosis – Causes ovarian damage, reducing egg supply.

  • Autoimmune diseases – May lead to early ovarian failure​.

D. Family History

· A family history of early menopause increases the likelihood of low ovarian reserve.

4. Can You Improve Ovarian Reserve?

The Truth About Supplements and Egg Quality

· There is no proven way to increase the number of eggs a woman has.

· Some studies suggest that Coenzyme Q10 (CoQ10) may help mitochondrial function in eggs, but it does not reverse genetic aging​.

· No supplement can prevent chromosomal abnormalities in eggs caused by age​.

Best Strategies for Protecting Egg Quality

  1. Lifestyle modifications – Avoid smoking, excessive alcohol, and maintain a balanced diet.

  2. Consider egg freezing at a younger age – If planning delayed pregnancy.

  3. Fertility assessment – Regular testing to understand reproductive health​.

5. Fertility Treatments for Low Ovarian Reserve
  • Mild ovarian stimulation – Lower doses of fertility drugs for better egg quality.

  • Egg freezing (oocyte cryopreservation) – A great option for women with declining ovarian reserve who wish to conceive later.

  • IVF with preimplantation genetic testing (PGT-A) – Helps select chromosomally healthy embryos​.

6. Conclusion: Why Ovarian Reserve Testing Matters

Ovarian reserve is a key factor in fertility, but a low reserve doesn’t mean pregnancy is impossible.

· AMH and AFC are the best predictors of ovarian reserve.

· Egg quality is just as important as quantity for successful conception.

· No supplement has been proven to increase egg quantity or reverse age-related decline.

Women considering pregnancy—especially after 30—should undergo fertility testing early to explore their options for natural conception or fertility preservation.

Would you like to assess your ovarian reserve? Book a consultation with a fertility specialist today!

References
  1. Cardim, H.J.P. Vencendo a Dificuldade de Engravidar. Editora Pensamento-Cultrix Ltda, 2009​.

  2. American Society for Reproductive Medicine (ASRM). "Ovarian Reserve Testing: What You Need to Know." Fertility and Sterility, 2023.

  3. Nelson, S.M. "Antimüllerian Hormone and Ovarian Reserve Assessment." Endocrinology and Metabolism Clinics of North America, Vol.50, No.3, 2021, pp. 485-500.

  4. Wallace, W.H.B., & Kelsey, T.W. "Human Ovarian Reserve from Conception to Menopause." PLoS ONE, 2010.