Low Ovarian Reserve: What It Means for Your Fertility

A low ovarian reserve affects the quantity of eggs, but conception remains possible. We ask Dr. Yeong Cheng Toh, our fertility specialist, about the causes, symptoms, and when to seek fertility support.

What Is Low Ovarian Reserve?

Ovarian reserve refers to the number of eggs remaining in a woman's ovaries. A low ovarian reserve means fewer eggs are available, potentially making conception more challenging. Fertility specialists assess this condition through several key tests:

• Anti-Müllerian Hormone (AMH) levels - a blood test measuring ovarian reserve.
• Follicle-stimulating hormone (FSH) - elevated levels may indicate diminished ovarian function.
• Antral Follicle Count (AFC) - an ultrasound examination counting visible follicles.

However, it's crucial to understand that ovarian reserve tests primarily measure egg quantity, not quality. Egg quality is equally important for successful conception and pregnancy. Many women with diagnosed low ovarian reserve still conceive naturally, even though others face difficulties.

8 Common Causes of Low Ovarian Reserve

There are many factors contributing to diminished ovarian reserve:

1. Age is a significant factor, as women over 28 naturally experience a decline in both egg quantity and quality.
2. Genetics - Family history of early menopause increases risk.
3. Medical Conditions - Including:
   • Premature ovarian failure (POF)
   • Endometriosis
   • Polycystic ovary syndrome (PCOS)
   • Thyroid disorders
4. Cancer Treatments - Chemotherapy and radiation can damage ovaries.
5. Surgical Procedures - Ovarian surgery may reduce egg reserves.
6. Lifestyle Factors such as smoking and alcohol reduce fertility. Extreme weight fluctuations also affect hormonal balance.
7. Environmental Toxins - Exposure to endocrine disruptors in pesticides or plastics
8. Autoimmune Diseases - Conditions like lupus may affect ovarian function[1].

Signs of Low Ovarian Reserve You Shouldn't Ignore

Low ovarian reserve often presents no visible symptoms, making testing essential. However, these warning signs may indicate potential issues:

1. Irregular Menstrual Cycles - Changes in period frequency or duration
2. Difficulty Conceiving - Inability to get pregnant after 6-12 months of trying.
3. Hot Flashes or Night Sweats - Signs of hormonal changes
4. Decreased Libido - Reduced sex drive related to hormonal shifts.

Why Good Ovarian Reserve Doesn't Guarantee Easy Conception

Having excellent ovarian reserve isn't a guarantee for quick conception. Multiple factors influence fertility beyond egg count:

• Egg Quality vs. Quantity

While ovarian reserve tests measure egg quantity, quality becomes increasingly important with age. Diminished egg quality can affect fertility even with normal ovarian reserve.

• Other Fertility Factors That Matter
  • Male Factor Infertility - Sperm quality issues account for approximately 30% of infertility cases.
  • Fallopian Tube Blockages - Prevent eggs from meeting sperm.
  • Endometriosis - Affects 10% of reproductive-age women.
  • Hormonal Imbalances - Disrupts ovulation and implantation.
  • Age-Related Factors - Women over 35 face more challenges regardless of ovarian reserve
  • Unexplained Infertility - Affects 30% of couples seeking fertility treatments.[2].

When to Consult a Fertility Specialist About Ovarian Reserve

You should consider seeking a consultation as soon as there's a desire to start a family—especially if you're over 35 and have been trying for more than six months or under 35 and trying for over a year without success. Early guidance can make a meaningful difference in your fertility journey. It’s also advisable to consult a specialist if you experience irregular periods, have a family history of early menopause, or have undergone cancer treatments or ovarian surgery.

Consult Your Fertility Specialist to Get a Complete Fertility Picture

While a low ovarian reserve presents challenges for conception, it is just one piece of your fertility puzzle. Many women with diminished reserves conceive naturally or with assistance. A comprehensive fertility assessment with a specialist can provide personalised guidance and treatment options tailored to your specific situation.

[1] Xu M, Tian LL, Li XL, Bao C, Zhang HW, Chen HW. Ovarian function in patients with systemic lupus erythematosus: Pathogenesis, drug application and prospective therapies. World J Exp Med. 2024 Jun 20;14(2):88867. doi: 10.5493/wjem.v14.i2.88867. PMID: 38948422; PMCID: PMC11212741. https://pmc.ncbi.nlm.nih.gov/articles/PMC11212741/

[2] Sadeghi MR. Unexplained infertility, the controversial matter in management of infertile couples. J Reprod Infertil. 2015 Jan-Mar;16(1):1-2. PMID: 25717428; PMCID: PMC4322174. https://pmc.ncbi.nlm.nih.gov/articles/PMC4322174/