Pregnancy requires only one viable egg, meaning conception remains possible even with a diagnosis of Low Ovarian Reserve (LOR). LOR is defined as a reduction in the number of eggs available compared to what is expected for a person’s age. While LOR makes conception more challenging and may shorten the window of fertility, it is not an absolute barrier to having a child. LOR reflects a diminished quantity of eggs, which is distinct from the quality of the remaining eggs.
How Low Ovarian Reserve Is Diagnosed
The diagnosis of Low Ovarian Reserve relies on objective measurements that estimate the remaining egg supply. The most reliable indicator is the Anti-Müllerian Hormone (AMH) blood test, which can be performed at any time during the menstrual cycle. AMH is produced by small follicles in the ovaries. A low level, typically below 1.0 nanogram per milliliter (ng/mL), suggests a reduced egg count.
The Antral Follicle Count (AFC) is another diagnostic tool, performed via a transvaginal ultrasound during the early follicular phase. This count tallies the number of small, resting follicles visible in both ovaries. An AFC totaling between three and ten follicles indicates LOR.
A third marker is the Follicle-Stimulating Hormone (FSH) level, measured on the second or third day of the menstrual cycle. A high FSH level, often above 10 mIU/mL, suggests the body is working harder to recruit an egg. These diagnostic tests primarily indicate how the ovaries will respond to fertility medications, not the ability to conceive naturally.
Factors Determining Natural Conception Success
The most significant factor determining natural conception success is the difference between the quantity of eggs (LOR) and the quality of eggs. LOR measures only the number of eggs remaining. However, the egg’s chromosomal health, or quality, dictates its ability to be fertilized and develop into a healthy pregnancy. If the single egg released during ovulation is chromosomally normal, it has the same potential for conception as an egg from someone with a normal reserve.
Egg quality is determined primarily by the individual’s age, not by AMH or AFC test results. A younger person, such as someone in their early thirties with low AMH, still possesses eggs statistically more likely to be genetically normal than those of an older person with the same low AMH. Therefore, a younger person with LOR often has a higher chance of natural pregnancy success than an older individual with LOR.
A 35-year-old with LOR has a better prognosis than a 42-year-old with LOR because the younger person’s remaining eggs are more likely to be viable. The decline in egg quality accelerates significantly after age 37. Age is consistently considered the most important predictor of fertility outcome, and studies show that a low AMH level alone does not predict a lower chance of natural conception.
Treatment Pathways for Low Ovarian Reserve
When natural conception does not occur, several medical treatments are available to mitigate the impact of Low Ovarian Reserve. The least invasive option is Controlled Ovarian Hyperstimulation (COH) combined with Intrauterine Insemination (IUI). This approach uses mild hormonal stimulation to encourage the development of one or two mature follicles before sperm is placed directly into the uterus.
For many with LOR, In Vitro Fertilization (IVF) is the most effective treatment, though success rates may be lower than for those with a normal ovarian reserve. Specialized IVF protocols maximize the quality of the few eggs retrieved, rather than attempting to retrieve a large quantity. These protocols, such as the Antagonist or Flare protocols, involve lower doses of stimulation medication to support the selection of the best eggs.
Supplements like Coenzyme Q10 (CoQ10) and Dehydroepiandrosterone (DHEA) may be recommended to improve egg quality and enhance the ovarian response to stimulation. If repeated IVF cycles yield few or low-quality eggs, or for individuals over 42, using donor eggs is often the most successful pathway to pregnancy. Egg donation bypasses the issue of both quantity and quality by using eggs from a younger, screened donor, leading to significantly higher live birth rates.