What is ovarian reserve?
Women are born with a limited number of eggs: about 1-2 million at birth, falling to 300,000-400,000 by puberty and continuing to decline each cycle. After 35, both the rate of loss and egg quality change more quickly.
What is AMH?
Anti-Müllerian hormone is produced by small follicles in the ovary, and its blood level reflects the number of remaining follicles. It can be measured on any day. The antral follicle count is measured by transvaginal ultrasound on days 2-5. Together they give more reliable information.
What AMH does and does not show
AMH reflects egg quantity and helps predict the response to IVF medication and choose the dose. It does not measure egg quality and does not by itself predict natural conception. Pregnancy is possible with low AMH, especially in younger women.
What affects ovarian reserve?
- Age: the most important factor.
- Genetic predisposition: reserve may decline earlier in women whose mother or sister had early menopause. The role of genetics in ovarian reserve is an area of research in medical genetics.
- Ovarian surgery: especially surgery for endometriomas.
- Chemotherapy and radiotherapy
- Smoking: accelerates egg loss and may bring menopause forward.
- Autoimmune and some genetic conditions such as fragile X premutation
What to do with low reserve
Time matters for women with reduced reserve who want to conceive, so assessment and treatment should not be delayed. Expectant management, insemination or IVF are planned according to age and other factors. Egg freezing can be discussed with women not yet planning pregnancy. With marked decline at a young age, chromosome analysis and fragile X testing may be considered.
Frequently Asked Questions
What should my AMH be?
Can AMH be increased?
What does high AMH mean?
Sources
- ESHRE Guideline: Ovarian Stimulation for IVF/ICSI.
- ASRM Practice Committee. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril, 2020.
The information on this website is for general information only and does not replace a medical consultation.
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