Ovarian Reserve

Ovarian reserve refers to both the number of remaining eggs (quantity) and their developmental potential (quality). Quantity declines steadily from birth and accelerates after age 37. Quality — how likely eggs are to be chromosomally normal — also declines with age but cannot be measured directly before fertilization.

The three main markers of ovarian reserve are AMH (most reliable, cycle-day independent), AFC on transvaginal ultrasound, and day-3 FSH (with day-3 estradiol). Together they guide stimulation dosing, counseling about prognosis, and decisions about moving to donor egg. Diminished ovarian reserve (DOR) does not mean conception is impossible, but it does reduce the number of eggs available per retrieval cycle.