Updated by the Progyny Editorial Team — October 2025.
Your ovarian reserve is an important way to understand your fertility potential. It refers to the number of eggs that remain in your ovaries at any given time. We talked with Eduardo Hariton, MD, a reproductive endocrinologist (fertility specialist) at Reproductive Science Center of the San Francisco Bay Area, to understand more.
How is ovarian reserve tested?
The first step in checking your ovarian reserve often involves a blood test. This test is typically done on the third day of your menstrual cycle and measures reproductive hormones, including:
- Follicle-stimulating hormone (FSH)
- Estradiol (a hormone produced by the ovaries)
- Anti-Müllerian hormone (AMH), which is linked to fertility
If FSH levels are high, and/or AMH levels are low, it may suggest a reduced ovarian reserve. AMH can be tested at any point in the menstrual cycle, including while using birth control. However, contraceptives may lower the measured levels because of their hormonal effects.
If your test results suggest a lower ovarian reserve, you may wonder what could be causing it.
What causes diminished ovarian reserve (DOR)?
Dr. Hariton said, “A woman’s (person’s) egg count naturally diminishes with age, however, diminished ovarian reserve can occur at any age due to genetics, medical treatments, environmental factors, or prior surgeries.”
It can happen when you are born with fewer eggs than average, lose eggs more quickly than expected, or experience more egg damage than typical. If you are in your mid- to late 30s or older and having trouble conceiving, DOR may be one reason.
“During each menstrual cycle, several follicles, which house the eggs in the ovaries, start to develop, but ultimately usually only one follicle grows and leads to the release of an egg,” shares Dr. Hariton. “All the other eggs in that cycle die during a natural process called atresia. In fact, the majority of a woman’s (person’s) eggs eventually disintegrate. This process occurs whether a woman (person) is cycling regularly, takes oral contraceptive pills, becomes pregnant, or gives birth.”
Other risk factors include smoking, prior ovarian surgery, family history, and environmental exposures.
DOR is only one factor that can affect fertility. Ovulation issues, sperm quality, fallopian tube or uterine conditions, and overall health can also play a role. Your specialist will look at your full reproductive health picture before recommending treatment.
Fertility treatment options for DOR
Your chances of conceiving without treatment may be lower if you’re diagnosed with DOR. Still, there are fertility treatments that can help.
Ovarian stimulation with high-dose hormones
If test results suggest you have some ovarian reserve, your specialist may recommend medications that stimulate ovulation using FSH and luteinizing hormone. This can produce more eggs than usual and may be used for intrauterine insemination or in vitro fertilization (IVF). IVF is generally more effective.
Egg donation and IVF
If your ovarian reserve is very low or you do not respond well to stimulation, your specialist may recommend using donor eggs with IVF. Donor eggs are fertilized with sperm from your partner or a donor in the embryology lab. The resulting embryo is transferred into your uterus with the goal of achieving pregnancy.
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Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.