What is Ovarian Reserve?

If you are considering starting a family or have concerns about your fertility, understanding the concept of ovarian reserve is essential. Ovarian reserve refers to the quantity of eggs (oocytes) available for fertilization. It serves as a key indicator of your reproductive potential and can play a crucial role in fertility treatment decisions. 

In this guide, we will delve into the topic of ovarian reserve, exploring its significance, how it is assessed, factors that affect it, available options for optimizing fertility, and emotional considerations related to fertility journey.

First off, what does your ovarian reserve mean?

Simply put, your ovarian reserve is your fertility potential, which is influenced by a variety of factors, including age, genetics, and certain medical conditions.

As we age, our fertility naturally declines. This is totally normal, and due to fewer eggs in the ovaries, a decrease in egg quality, and an increase in chromosomal abnormalities of the remaining eggs. These collective factors contribute to lower pregnancy rates and higher miscarriage rates as we approach age 40.

While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than we expected.

To assess your fertility potential, including your ovarian reserve, several tests are available that can give us clues to our reproductive capabilities. These tests can also help fertility doctors, like myself, evaluate the likelihood of successful pregnancy, and guide you in making informed decisions regarding family planning and fertility treatments.

How do I know my ovarian reserve?

If you want to know your ovarian reserve, it’s best to set up time for a fertility assessment with a fertility doctor (reach out – we can help with this!). 

There are two ways a doctor can help assess your ovarian reserve, including:

Blood hormone tests

Hormone tests, including follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), anti-Müllerian hormone (AMH), and estradiol, provide valuable information about ovarian function and egg supply. While AMH can be taken any time, FSH and LH are typically performed on specific days of the menstrual cycle to obtain accurate results.

Antral follicle count

Transvaginal ultrasound is used to visualize the ovaries and count the number of antral follicles present. Antral follicles are small, fluid-filled sacs that contain immature eggs. The count of antral follicles serves as an indirect indicator of ovarian reserve.

By combining the results of hormone tests and ultrasound assessments, we can estimate your ovarian reserve and provide insights into fertility potential.

What is a normal ovarian reserve?

Determining what constitutes a “normal” ovarian reserve involves comparing your results to established reference ranges for your age. Age-specific reference ranges serve as benchmarks to evaluate your ovarian reserve relative to peers of the same age group. Keep in mind that ovarian reserve will gradually decline for everyone – it’s the timing and pace of change that differs. 

For example, in younger women, a higher number of antral follicles (small fluid-filled sacs containing immature eggs) and lower levels of certain hormones like FSH may be considered within the normal range. However, as a woman ages, it is expected that the number of antral follicles will decrease and hormone levels, such as FSH, may increase.

While age is a significant factor, other individual factors should also be taken into account when interpreting ovarian reserve results. Factors such as medical history, previous fertility experiences, underlying medical conditions, and fertility goals play a role in assessing the overall fertility potential. These additional factors can influence the interpretation of ovarian reserve results and help guide fertility treatment decisions tailored to the specific needs of the individual.

What causes decreased ovarian reserve?

Decreased ovarian reserve can result from various factors, including:

• Age: As we age, the quantity and quality of eggs naturally decline. The aging process gradually reduces the quality of eggs and ovarian reserve, making it more challenging to conceive.
• Smoking: Cigarette smoking has been linked to a higher rate of diminished ovarian reserve. Chemicals in tobacco smoke can accelerate the depletion of eggs and negatively impact ovarian function.
• Cancer treatment: Some cancer treatments, such as chemotherapy and radiation therapy, can have damaging effects on the ovaries. These treatments may cause a decrease in ovarian reserve and compromise fertility.
• Pelvic Surgery: Surgical procedures involving the ovaries or other pelvic organs can inadvertently damage or remove ovarian tissue. This can lead to a decrease in ovarian reserve and potentially affect fertility.
• Autoimmune diseases: Certain autoimmune conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis, can impact ovarian function and diminish ovarian reserve.
• Genetic conditions: Certain genetic disorders, such Fragile X syndrome, and other chromosomal abnormalities, can be associated with decreased ovarian reserve. These conditions may affect the development and function of the ovaries.

While these factors are known to contribute to diminished ovarian reserve, individual experiences vary. You may have none of the above conditions, and still face premature ovarian failure (POF). Or you may have one of the above factors, and have no problems at all getting pregnant. Sometimes, it just comes down to luck.

What does it mean if I have a high ovarian reserve?

A high ovarian reserve refers to a situation where there is an abundant number of eggs in the ovaries. While ovarian reserve naturally declines with age, certain factors can contribute to a higher ovarian reserve in some people.

One factor associated with a high ovarian reserve is younger age. Those in their 20s and early 30s generally have a higher number of eggs compared to those in their 40s, resulting in a larger ovarian reserve. Additionally, genetic factors can influence ovarian reserve, and some may have a naturally higher number of follicles and eggs in their ovaries.

Another factor that can contribute to a higher ovarian reserve is polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that can lead to the development of multiple small follicles on the ovaries. Those diagnosed with PCOS often have a higher number of immature follicles in their ovaries, which can translate into a higher ovarian reserve.

While a high ovarian reserve can be advantageous for fertility, it does not guarantee successful conception or a higher chance of pregnancy. Other factors, such as egg quality and hormonal balance, also play significant roles in achieving pregnancy.

At-home ovarian reserve tests

There are at-home options for ovarian reserve testing. However, keep in mind that most fertility doctors will want to re-do these tests. So taking a test at home, may mean paying for a test twice.

Here are some options:

• Natalist Women’s Fertility Test ($149) measures 5 hormones: estradiol, LH, FSH, TSH, and total testosterone
• LetsGetChecked Ovarian Reserve Test ($139) measures 1 hormone, AMH
• Modern Fertility Hormone Test ($179) measures 7 hormones: AMH, TSH, FSH, estradiol, prolactin, fT4, and LH

Ovarian reserve and egg freezing

Ovarian reserve plays a significant role in the process of egg freezing, also known as oocyte cryopreservation. Egg freezing involves the retrieval and freezing of your eggs for future use, preserving your fertility potential at a younger age. 

Assessing ovarian reserve before undergoing egg freezing is crucial for determining the quantity of eggs available for freezing. Those with a higher ovarian reserve generally have a greater number of eggs suitable for freezing, increasing their chances of successful future pregnancy. 

On the other hand, those with diminished ovarian reserve may have fewer eggs available for freezing, necessitating careful consideration of the potential outcomes and options. Understanding your ovarian reserve provides valuable information to help guide the egg freezing process and optimize the chances of achieving successful future pregnancies when the frozen eggs are thawed and used in assisted reproductive techniques.

Freeze your eggs with Cofertility

We’d love the opportunity to support you on your egg freezing journey.

Cofertility is a human-first, tech-enabled fertility ecosystem that provides people agency over if, how, and when they have babies — today or someday. We have two programs for egg freezers:

1. The Split program, which offers women a chance to both freeze their own eggs and donate half the eggs to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.
2. Our self-pay Keep program allows women to freeze their eggs and keep them all for their future use. Through Keep, we offer our members partnerships and discounts to lighten the financial load of egg freezing, as well as access to our member community.

The benefits for of working with Cofertility include:

• Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive.
• Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
• Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality.
• Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility.
• Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.

Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.