At one point or another, every woman or couple who’s tried to have a baby will learn about the importance of her egg count – and of something called an anti-Müllerian hormone (AMH). But what does one have to do with the other – and why does it all matter to fertility?
Egg count, or ovarian reserve, refers to the number of eggs a woman has in her ovaries. The more eggs she has when she’s ready to conceive, the higher her chances of getting pregnant. So, egg count is a good indicator of female fertility.
Unfortunately, egg count is one fertility factor that women have almost no control over. Why?
The human body is capable of many amazing things, but unfortunately, it’s not capable of producing new eggs. The “starter pack” is the whole set!
Women then lose eggs throughout their lives, and that includes more than just the one egg they ovulate during their monthly menstrual cycle. Many eggs never make it past the first stage of activation, or die off naturally. Some women have ovulation disorders, like PCOS, or physical problems in the uterus that can cause them to lose eggs at a faster rate. Some genetic disorders can lower egg count. Treatments like chemotherapy or radiation, or ovarian surgery can reduce egg count. So can some lifestyle choices, like smoking.
However, diminished ovarian reserve is often idiopathic, meaning no apparent cause is present. And the rate at which eggs are lost will vary by individual.
But eventually (typically around age 44), every woman’s egg quality and count will be too low to have reasonable success having her own baby, even with IVF.
So how do you know whether your own egg count is high or low? That’s where that hard-to-pronounce word comes in: anti-Müllerian hormone (AMH).
Doctors have two methods for measuring egg count: an anti-Müllerian hormone (AMH) blood test and an antral follicle count, which is done by ultrasound or sonogram.
It’s more common to hear about the AMH test, because it tends to be more accurate.
AMH is a special protein hormone produced by the follicle cells inside the ovaries. Each follicle contains an egg that is immature with the potential to mature and ovulate. More follicles equal more eggs.
Higher AMH levels in the bloodstream indicate that there are more follicles, and therefore more eggs, in the ovaries. Lower AMH level means fewer follicles, and fewer eggs.
The AMH blood test can be performed at any point during your menstrual cycle, so it’s also a convenient test that quickly gives doctors and their patients a better idea of how many eggs they’re working with.
With an ultrasound or sonogram, doctors actually count the follicles that are visible within each ovary. Fewer follicles detected via imaging mean fewer eggs.
But not every follicle is large enough to be seen on an ultrasound. These smaller follicles can be missed. That’s why an AMH blood test is more accurate.
Egg counts (and corresponding AMH levels) will only diminish with time, but looking at AMH levels alongside a patient’s age can reveal more about her chances and her window of opportunity.
For example, a 27-year-old woman with a low AMH is more likely to conceive than a 42-year-old woman with the same AMH level. However, the younger woman’s fertility window is likely to close quickly – at a faster rate than the older woman’s did when she was younger.
This is why tracking AMH levels early offers clarity that helps patients make decisions about their future families before that window of opportunity closes.
No matter how it’s measured, a woman’s egg count is not the only factor that determines how fertile she is. But it does offer some insight into her overall reproductive health – and it can help with planning the most effective course of action, whether that involves freezing her eggs for later or proceeding with fertility treatments.
Because every woman is born with all the eggs she’ll ever have, there is no treatment (or supplement, or diet change, or other lifestyle choice) that will increase egg count. And since AMH is just a measure of your egg count, there’s no way to raise your AMH levels, either. (Yes, we do get this question!)
However, that doesn’t mean you don’t have options. Patients with infertility due to low ovarian reserve can undergo treatments that help them conceive with their own eggs.
In most cases, in vitro fertilization (IVF) is the recommended treatment for patients with low egg count.
IVF involves the use of fertility drugs that stimulate the ovaries to produce multiple eggs. Those eggs are harvested, fertilized with sperm from a partner or donor, and incubated. Of the resulting embryos, one is chosen to be transferred to the patient’s uterus, and the rest are frozen for future use.
Some patients are intimidated by IVF, and might want to continue trying naturally or use less effective methods.
All of this takes not just money, but time – time that patients with low ovarian reserve simply don’t have. That’s why we recommend that older patients and patients with low AMH levels go straight to IVF.
IVF has the highest success rate of all fertility treatments, and gives women with low egg count their greatest shot at conceiving a baby with their remaining eggs.
But only if they start the process as early as possible – beginning with testing to identify ovarian reserve, then freezing eggs if they’re not ready to start a family.
Once a woman's egg count drops below a certain level or she runs out of viable eggs, she will need a donor egg.
The race against the biological clock is a very real thing, particularly for women with low egg count. If you suspect you may have diminished ovarian reserve and want to have biological children at some point in the future, time is not on your side.
It can feel intimidating to get started, but remember, information is power – power that can help you maintain your options for building your family, now or when you’re ready.
The first step is simply to schedule a telehealth consultation with one of our doctors. We can review your history, discuss diagnostic testing and treatment options, and answer any questions you may have.