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Understanding Ovarian Reserve
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DUKE MEDICINE
Susannah D Copland, MD, MS posted:
Understanding your egg supply, both origins and ways in which egg number declines, can help you to decide your next steps on the pathway to parenthood.

Women have their lifetime supply of eggs when they are babies inside their mother. Eggs are a time-limited and time-released supply: time-limited because all women will someday go through menopause, and time-released because each month only a small group of eggs gain the ability to compete to ovulate. As egg number declines with aging, the group of eggs competing to ovulate each month gets smaller. With a smaller group of eggs competing each month, women tend to ovulate sooner and have fewer days between periods. Eventually there are periods of time where an egg is not available, and women will start skipping periods. Eventually there is not an egg available to ovulate, and a woman will no longer have periods.

Fertility testing includes tests for egg number and egg release. Test of egg number include FSH (follicle stimulating hormone) and AMH (antimullerian hormone). FSH is the hormone that pushes eggs to move toward ovulation. When egg supply is low, FSH goes up. FSH is high in menopause. AMH is made by eggs at an earlier stage in their journey toward ovulation. AMH is higher in women with more eggs and lower in women with fewer eggs. AMH is undetectable in menopause.

Tests of egg release include progesterone. Progesterone is a hormone that is made by the ovary after ovulation. If a woman has an elevated progesterone one week before her period, she is ovulating. If she does not, she needs to see her doctor to find out why she is not ovulating. The group of eggs that have the ability to ovulate will only compete if they receive the correct signals. A physician will test hormone levels and make the necessary adjustments to induce ovulation.

Egg number tests like AMH and FSH predict how well you will respond to fertility drugs, because they reflect the number of eggs competing to ovulate. If FSH is high and AMH is low, a woman does not have many "extra eggs" to respond to medication. If she has regular menstrual cycles with a progesterone proving ovulation, she is getting at least one egg out. If we try fertility medications and still get only one egg, fertility drugs are not helping to improve chances of pregnancy. As long as she continues to ovulate, she has a chance for pregnancy. If she wants to improve her chances after fertility drugs with her own eggs are not helping to increase the number of eggs released, she can consider using donated eggs.

One percent of women will go through premature ovarian failure (before age 40). A reproductive endocrinologist will test to see why egg number declined early and test to see if other glands (thyroid, parathyroid, pancreas, adrenal) are showing signs of low hormone production. Women with POF have a 5-10% lifetime chance of pregnancy if an egg remaining in the ovary gains the ability to ovulate, ovulates, and meets with sperm. Currently there is no way to know when or if this post-ovarian failure ovulation will occur.

Hearing that egg number is low can be devastating. A second opinion can help increase comfort with the diagnosis. A reproductive psychologist can help to discuss the feelings that arise. Egg donation, embryo donation, and adoption can help women with ovarian failure to build their family.
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An_191488 responded:
Just read your article and had a question about AMH measurements. What is a good number to have? I had a 1.3 but the nurse that called me to tell me did not tell me anything about it. Thanks in advance for any help you could give me.
 
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An_191489 replied to An_191488's response:
I too would like to know about AMH measurements. What is a good number to have? Thank you


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