Why do I keep hearing about “ovarian reserve?”

In online searches about fertility, you’ve probably come across the terms “ovarian reserve” or “diminished ovarian reserve,” along with confusing acronyms like “AMH” and “FSH.” An evaluation of ovarian reserve is always part of your workup with your fertility doctor, but can be difficult to understand. At RFC we want you to fully understand this testing so you can actively participate in your care.

The definition of “ovarian reserve” is quite simply, “how well a woman can be expected to respond to the medications used for fertility treatments.” Let me explain this further.

We all have thousands of eggs in our ovaries, but they are microscopic and “sleeping” or in long-term hibernation. Every month a small group of eggs wakes up from sleeping and starts to mature just a little bit—these eggs make fluid around them and we can see them on ultrasound. These are the eggs that may respond to your body’s signals every month, your “pool of eggs.” In a normal menstrual cycle, your brain talks to your ovaries and your ovaries talk back to your brain and ONE of those eggs is chosen randomly to grow, mature fully, and ovulate. The rest of that group (think of them as the “supporting cast”) dies. The next month you’ll have a new group of eggs that wakes up.

It is the size of this pool that makes up the “ovarian reserve,” and it is this pool that may respond to the fertility medications your doctor is prescribing, no matter what your underlying fertility problem or treatment plan. A high ovarian reserve means that more eggs will grow in response to lower dosages of medications and vice versa—if your testing indicates low reserve, you will need higher doses of medications to grow eggs for your treatment and you will likely not get as many eggs to grow as someone with higher reserve. The results of your ovarian reserve testing can therefore help to guide your conversations with your doctor and your doctor’s treatment plan for you, especially medication protocol and dose.

Therefore ovarian reserve is a measure of QUANTITY, not quality. The best predictor of egg quality is simply age.

Ovarian reserve always declines with age. But at every age, there is a range of ovarian reserve, meaning that some young women can have low ovarian reserve and some women in their late 30s/early 40s may have higher than expected reserve. At RFC, our assessments and recommendations will be highly personalized to deal with your specific infertility diagnosis, while taking both age and ovarian reserve into account.