Ovarian Reserve Testing


Ovarian reserve testing determines the number of eggs a person has. Females are born with a finite number of eggs, and this number decreases with age. The quality of the eggs decreases as well. So, with age, the probability of getting pregnant also decreases.

When females are having difficulty getting pregnant, ovarian reserve testing is recommended.


There is a range of tests that are done, some of them being:

Blood tests:

  • The antral follicle count counts the number of follicles up to 10 mm in lengthThe greater the number of follicles, the greater the egg count.
  • Follicle-stimulating hormone (FSH) is a hormone produced by the pituitary gland. It regulates the release of eggs every month during the menstrual cycle. The last 3rd of the period is the best time to draw blood for tests. It is not very reliable because its levels keep fluctuating.
  • Estradiol is a hormone that fluctuates throughout the menstrual cycle. It is done on the 3rd of the period cycle. Elevated levels suggest a decrease in reserve.
  • Antimullerian hormone (AMH)-These are present in small sacks of liquid contained in ovarian follicles. It gives an estimate of the number of eggs.

This test is the best predictor of menopause. Through this test, the person knows how much longer they can delay getting pregnant.

Transvaginal ultrasound test:

This is done to check for antral follicles measured between 2 and 10 mm in both ovaries. Each follicle contains one egg. The follicle count allows the doctor to estimate the total number of eggs available.

How Does The Ovary Reserve Test Work?

There is a delicate interplay between the brain and hormonal release. This plays a crucial role in the reproductive cycle throughout a person's life. Some of these actions include:

  • Follicular growth activation
  • Encourage egg release
  • preparing the uterus for implantation.

When Should the Ovary Reserve Test Be Done?

Doctors recommend this test for people:

  • Those who are over the age of 35 and have been unable to conceive for more than 6 months
  • Who are under the age of 35 and have been unable to conceive for more than a year.
  • They want to know how much longer they can delay getting pregnant.
  • Have conditions such as POCS or thyroid-related symptoms.
  • Who is planning for IVF or egg freezing or both

Possible Results of the Ovarian Reserve Test

Females are born with all the eggs they will ever produce. Age is the strongest predictor for egg supply. Females lose 2-3 eggs every period cycle. Hence, with advancing age, the number of eggs decreases. Studies indicate that the rate of egg loss increases above 35 years of age. The actual numbers vary from one person to another. These are the average number of eggs:

  • Birth: 1 - 2 million
  • Puberty: 300,000- 400,000
  • Age 40: 25,000
  • Menopause: <1,000

Limitations associated with the test

There are no known risk factors associated with this test. However, there are certain limitations, those being:

  • It cannot provide definitive answers as to how many eggs a person possesses.
  • When a person is able to get pregnant.
  • At what age will they no longer be able to get pregnant.
  • It cannot assess the quality of eggs.
  • A person under the age of 35 can have fluctuating hormonal levels. One test result cannot give the full picture.


Ovarian reserve testing is the first measure of assessing an individual's fertility. Doctors recommend people above the age of 35 opt for this test if they have not fallen pregnant. Also for people under the age of 35 who have conditions such as PCOS and other related hormonal issues. Some commonly used tests include AMH, AFC, and estradiol. While these tests are useful, they do not tell people about the quality of eggs. A person with low reserves can have good-quality eggs and vice versa. Hence, the deficient reserve does not mean infertility.

A person should discuss with a doctor which tests may be best for them.

1. Can a woman get pregnant with a decreased ovarian reserve?

Yes, they can still get pregnant. The odds of conceiving could be smaller, but only one egg is needed to get pregnant. There are other factors other than egg count to getting pregnant. The factors are egg quality, sperm quality, and the overall function of the uterus and fallopian tubes.

2. What causes diminished ovarian reserve?

o Genetic problems o Cancer treatment o Surgery of ovaries o infection in the ovaries o Losing one or both ovaries.

3. Can stress cause the number of eggs to be reduced?

No, stress does not affect the number of eggs. Smoking and tobacco use are the only two lifestyle factors that affect the reserve.

4. Does a folic acid supplement improve the reserve?

Yes, prenatal vitamins contain folic acid and it helps maintain egg quality. It should be started 3 months before conceiving. Diet and lifestyle play a role in the quality of the egg and not the quantity.

5. When should FSH and AMH tests be done?

The best time to measure it is at the beginning of the cycle. If the test is being done via blood, it is best done on the 3rd day of the cycle. Request an appointment at Apollo Fertility, Varthur, Bangalore Call 1860 500 4424 to book an appointment.

Book an Appointment




Ovulation Calculator