Low Ovarian Reserve: Understanding, Causes, Diagnosis, and Treatment

Low Ovarian Reserve

The term “low ovarian reserve” refers to a situation where a woman’s ovaries have a diminished quantity of eggs and, often, reduced egg quality. This condition can significantly impact a woman’s fertility and her ability to conceive. Ovarian reserve essentially represents the quantity and quality of eggs a woman has available for fertilization and pregnancy.

As women age, their ovarian reserve naturally declines. Women are born with a certain number of eggs, and this number decreases as they go through their reproductive years. This decline becomes more significant as a woman approaches her late 30s and 40s. Low ovarian reserve doesn’t necessarily mean infertility, but it can make it more challenging to achieve a successful pregnancy

What is Low Ovarian Reserve?

Low ovarian reserve occurs when the number of eggs remaining in a woman’s ovaries is lower than expected for her age. This can happen due to various factors, including age, medical treatments, or certain health conditions. The quality of the eggs also tends to decline with age, making them less likely to result in a healthy pregnancy.

Age is one of the most critical factors in low ovarian reserve. Women are born with their lifetime supply of eggs, and as they age, the quantity and quality of these eggs naturally diminish. By the time a woman reaches her 30s and 40s, the likelihood of having a lower ovarian reserve increases. Medical treatments like chemotherapy or radiation therapy can accelerate this decline.

In some cases, low ovarian reserve can occur earlier in life due to genetic factors or specific health conditions. Premature ovarian insufficiency (POI), for example, is a condition where the ovaries stop functioning normally before the age of 40, leading to low ovarian reserve

It’s important to note that a low ovarian reserve doesn’t guarantee infertility, but it does make it more challenging to conceive. Women with low ovarian reserve might still have occasional ovulatory cycles and could become pregnant, but their chances of doing so are reduced compared to women with healthier ovarian reserves.

Understanding these concepts is essential for individuals and couples who are trying to conceive, as it helps manage expectations and informs decisions about fertility treatments and family planning. If someone suspects they might have a low ovarian reserve or is concerned about their fertility, consulting a reproductive specialist can provide valuable insights and guidance.

Causes of Low Ovarian Reserve:

Causes of Low Ovarian Reserve

Several factors can contribute to low ovarian reserve, affecting the quantity and quality of eggs available for fertilization. While age is a primary factor, other influences can play a role as well:

Age: Age is the most significant factor influencing ovarian reserve. As women age, the number of eggs in their ovaries naturally declines. This decline accelerates as women approach their late 30s and 40s. Older eggs are also more likely to have chromosomal abnormalities, affecting their potential for successful fertilization and pregnancy.

Genetics: Family history and genetics can play a role in ovarian reserve. Some women may have a genetic predisposition for early menopause or reduced ovarian function.

Medical Treatments: Certain medical treatments, such as chemotherapy and radiation therapy, can damage ovarian tissue and reduce ovarian function. These treatments are often used for cancer patients, but they can negatively impact fertility by affecting the ovaries’ ability to produce healthy eggs.

Ovarian Surgery: Surgical procedures involving the ovaries, such as ovarian cyst removal or surgery for endometriosis, can potentially damage ovarian tissue and reduce the ovarian reserve.

Autoimmune Disorders: Some autoimmune disorders, such as Hashimoto’s thyroiditis and lupus, can affect ovarian function and lead to a decline in ovarian reserve.

Environmental Factors: Exposure to environmental toxins and chemicals, including certain pesticides and pollutants, may impact ovarian health and contribute to low ovarian reserve.

Signs and Symptoms:

Signs and Symptoms

Low ovarian reserve is often asymptomatic, meaning there might not be noticeable signs until a woman experiences difficulty conceiving. However, some women with low ovarian reserve might notice irregular menstrual cycles, shorter menstrual cycles, or even occasional skipped periods. These changes can reflect hormonal imbalances related to reduced ovarian function.

It’s essential to understand that while these signs can indicate potential issues with ovarian reserve, they are not definitive indicators. Some women with seemingly normal ovarian function might still face challenges with fertility, while others with low ovarian reserve might conceive without significant difficulty. Therefore, if a woman is actively trying to conceive and experiencing challenges, it’s advisable to consult a reproductive specialist who can conduct thorough tests and assessments to determine the underlying cause and provide appropriate guidance.

Diagnosis and Testing for Low Ovarian Reserve:

Diagnosing low ovarian reserve involves a series of tests and evaluations that assess the quantity and quality of a woman’s remaining eggs. These tests help fertility specialists understand the woman’s fertility potential and guide treatment decisions:

Anti-Müllerian Hormone (AMH) Test: This blood test measures the levels of AMH, a hormone produced by developing follicles in the ovaries. Lower AMH levels typically indicate a lower ovarian reserve.

Follicle-Stimulating Hormone (FSH) Test: Elevated levels of FSH, a hormone that stimulates the ovaries to produce eggs, can indicate reduced ovarian function. FSH levels are typically tested on the third day of the menstrual cycle.

Antral Follicle Count (AFC): Using an ultrasound, doctors count the number of small follicles present in the ovaries at the beginning of the menstrual cycle. A lower AFC suggests a diminished ovarian reserve.

Ovarian Reserve Testing Panel: This panel combines multiple tests, including AMH, FSH, and AFC, to provide a comprehensive assessment of ovarian reserve.

Ovarian Imaging: Transvaginal ultrasound and other imaging techniques can help visualize the ovaries and assess their size, shape, and overall health.

Treatments Available for Low Ovarian Reserve:

While low ovarian reserve can present challenges for fertility, there are several treatment options available to improve the chances of conception:

In Vitro Fertilization (IVF): IVF treatment involves stimulating the ovaries to produce multiple eggs, retrieving the eggs, fertilizing them with sperm in a laboratory, and transferring the resulting embryos to the uterus. IVF can help maximize the chances of conception by overcoming the limitations of low ovarian reserve.

Donor Eggs: Using donor eggs from a younger, more fertile woman can significantly increase the chances of successful fertilization and pregnancy.

Fertility Preservation: Women diagnosed with low ovarian reserve who are not yet ready to conceive may consider fertility preservation methods, such as egg freezing, to preserve their eggs for future use.

Hormonal Therapy: Hormonal medications, such as gonadotropins, can stimulate the ovaries to produce more eggs for IVF.

Preimplantation Genetic Testing (PGT): PGT involves screening embryos for chromosomal abnormalities before embryo transfer, increasing the likelihood of a healthy pregnancy.

Optimizing Lifestyle Factors: Maintaining a healthy lifestyle, managing stress, and ensuring proper nutrition can contribute to better reproductive health, although these lifestyle changes might not directly reverse low ovarian reserve.

It’s crucial for individuals with concerns about their ovarian reserve to consult a fertility specialist. A comprehensive evaluation and personalized treatment plan can help them make informed decisions about the best course of action to achieve their desired family-building goals.

Fertility Options and Considerations for Low Ovarian Reserve:

When dealing with low ovarian reserve, individuals and couples have a range of fertility options to explore. It’s important to consider these options in light of their personal circumstances, preferences, and goals:

IVF with Donor Eggs: Using donor eggs from a younger, more fertile woman can greatly improve the chances of successful pregnancy. This option is especially relevant for women with significantly diminished ovarian reserve.

IVF with Own Eggs: Depending on the severity of ovarian reserve decline, some individuals may still have a chance of success with their own eggs through IVF. However, realistic expectations are crucial, and the fertility specialist can guide them based on their test results.

Fertility Preservation: If low ovarian reserve is detected at a relatively young age, fertility preservation techniques like egg freezing can be considered. Preserving eggs when they are of better quality can increase the odds of success in the future.

Related- Egg Freezing Right for You? – The Pros and Cons

Exploring Adoption: For individuals or couples who may not be able to achieve pregnancy through assisted reproductive technologies, adoption is a rewarding alternative that can fulfill the desire to become parents.

Surrogacy: In cases where carrying a pregnancy is not feasible due to other medical conditions, surrogacy provides an option for having a biological child by using a gestational carrier.

Emotional and Psychological Support: Coping with the challenges of low ovarian reserve can be emotionally taxing. Seeking support from therapists, support groups, or counselors can help individuals navigate their emotional journey.


Low ovarian reserve presents unique challenges for individuals seeking to build a family. It’s essential to approach this situation with a realistic understanding of the available options and the potential outcomes. Consulting a fertility specialist is the first step toward developing a personalized treatment plan that aligns with an individual’s medical history, age, and overall health.

While the journey may involve obstacles, advancements in assisted reproductive technologies provide hope and opportunity. The landscape of fertility treatment continues to evolve, and individuals should be encouraged to explore the various paths available to them. With the right guidance, support, and expert care, many people with low ovarian reserve can achieve their dream of parenthood.