IVF — General Information › Low Ovarian Reserve
Low Ovarian Reserve
This page is provided for general information. IVF treatment is not carried out at this practice; it is provided only in assisted reproduction (ART) centres licensed by the Turkish Ministry of Health.
Ovarian reserve describes the number and quality of eggs remaining in the ovaries. That reserve is set at birth and only declines through life. A low reserve does not mean pregnancy is impossible; it means that time is more valuable.
How it is measured
- AMH (Anti-Müllerian Hormone) blood test — can be taken on any day of the cycle
- Antral follicle count on ultrasound
- FSH and oestradiol on day 2 or 3 of the cycle
- Age — the single strongest indicator on its own
Causes
- Age — the commonest and unavoidable cause
- Ovarian surgery, particularly for endometrioma
- Chemotherapy and radiotherapy
- Smoking
- A family history of early menopause
- Certain genetic conditions
- In a substantial proportion no identifiable cause is found
What it does and does not mean
A low AMH does not mean that the chance of conceiving this month is zero; many women with low reserve conceive naturally. What it indicates is that fewer eggs will be collected in an IVF cycle.
AMH reflects the number of eggs, not their quality. The principal determinant of quality is age.
Approach
- Not delaying assessment where pregnancy is wanted
- Stopping smoking — its effect on reserve is established
- Correcting vitamin D and thyroid function
- Moving to IVF earlier where appropriate
- Choosing reserve-sparing techniques if ovarian surgery is needed
- Considering egg freezing where pregnancy is planned for a later date
