The Biology of Ovarian Reserve
Unlike men, who produce new sperm continuously throughout adult life, women are born with their entire lifetime supply of eggs. Ovarian reserve refers to the remaining quantity of eggs within a woman's ovaries at any given time.
Women lose approximately 1,000 eggs each month through a natural degenerative process (atresia). At approximately age 37, the rate of egg loss accelerates significantly. By age 43–44, natural conception rates drop dramatically. ASRM guidelines recommend that women age 38 or older move more quickly to IVF treatment.
Ovarian Reserve Testing Components
Both Dr. Sharara and the American College of Obstetricians and Gynecologists (ACOG) recommend ovarian reserve testing for any woman experiencing infertility, regardless of age. Standard testing includes three primary pillars:
Anti-Mullerian Hormone (AMH) Testing
AMH is produced by granulosa cells surrounding immature microscopic follicles in the ovaries. Because AMH levels remain relatively stable throughout the menstrual cycle, this blood test can be drawn on any day of the cycle.
Key Insight: Normal AMH indicates a robust egg reserve and favorable response to IVF medications. A low AMH indicates diminished ovarian reserve (DOR), but does NOT mean pregnancy is impossible. Dr. Sharara designs customized ovarian stimulation protocols specifically tailored to help low-AMH patients succeed.
Antral Follicle Count (AFC) Ultrasound
Performed via transvaginal ultrasound (typically on Cycle Day 3), the AFC directly visualizes and counts the resting fluid-filled sacs (2–10mm follicles) in both ovaries.
Low reserve; predicts lower egg yield in stimulation.
Normal healthy ovarian reserve range.
High reserve / hyper-response risk (common in PCOS).
Day 2–5 Baseline FSH, LH & Estradiol
Follicle Stimulating Hormone (FSH) released by the pituitary gland rises as ovarian reserve drops, signaling the pituitary is working harder to stimulate egg recruitment. Combined with Estradiol testing, baseline hormone levels confirm accurate cycle status.
Understand your ovarian reserve with Dr. Sharara
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