Patients often ask me if they can have their “eggs checked.” Or you may hear people say that a woman has “low ovarian reserve” or “low egg count.” This is referring to the measurement of predicted eggs based on a blood level of anti-Mullerian hormone (AMH) or through counting the available eggs released from the ovary via ultrasound, called antral follicle count (AFC). Let’s discuss what this means and whether it’s something to ask your provider about.

Anti-Mullerian Hormone (AMH)

AMH is produced by the ovarian granulosa cells, which line the ovarian follicles (sacs around each of your eggs). Every month, anywhere from 8-20 eggs will be released from the egg “storage” in each of your ovaries (often depending on your age). They progressively grow in the early menstrual cycle, and one dominant egg from one of your ovaries will be chosen to ovulate. (You can read more about this process in our TTC blog). AMH is measured in the blood serum and its level is based on production of the hormone from granulosa cells surrounding the follicles (sacs around the egg cell) released from the storage that month. In general, if you have more eggs remaining, you will release more eggs each month. If you have less, you will release less eggs each month. A higher AMH indicates more eggs out of the storage vault, while a lower AMH indicates less. This can generally be used to measure the available eggs you have remaining. A high AMH, generally greater than 6 (however each lab differs in its reference ranges), may indicate PCOS because there are more immature follicles lining the ovary than average. Low AMH, generally less than 1.0, indicates low ovarian reserve. This is seen in women in menopause, early menopause, or premature ovarian insufficiency (POI). It can also be seen as a result of other health conditions. AMH is a test used in fertility clinics by fertility specialists but also by OB/GYNs in the setting of infertility. It is not formally recommended by the American College of Obstetricians and Gynecology (ACOG) as a screening test in fertile women with regular menstrual cycles or as a screening test for fertility. The single best indicator of fertility is female age.  However, there are some caveats, let’s talk about it.

Benefits of AMH:

• It is a simple blood test
• In general it does not vary significantly from cycle to cycle or over the course of one cycle (may vary up to 1.0 ng/mL), while other hormones like FSH, LH, estradiol, and progesterone will vary over the course of the cycle
• Strong correlation with antral follicle count (AFC) measured by ultrasound
• It can be a helpful marker when evaluating ovarian reserve or “egg count”
• It is used to determine ovarian response for egg retrieval (“freezing your eggs”) and/or for advanced reproductive technology (IVF), as low levels can predict low oocyte yield or ovarian response
• If you are wanting to have children in the future, it can be a great test to ensure levels are normal and give you time to dive in deeper and/or start trying to conceive sooner if your ovarian reserve is abnormally low
• Detection of primary ovarian insufficiency (POI) if your hormone labs (FSH, estradiol) point towards early menopause. You may also have symptoms including absent periods or hot flashes, night sweats, difficulty concentrating, low libido, or vaginal dryness. 
• if the level is lower than expected for your age, you may consider testing for autoimmune disease, thyroid disease, or other potential causes
• Has now been established as part of the diagnostic criteria for PMOS if it is elevated (generally > 6 ng/mL)

Cons of AMH:

• It assesses ovarian quantity, but not the quality of the eggs you carry (more on this below)
• Does not indicate your ability to get pregnant
  • They did a study called the Time to Conceive study, which included a cohort of 750 women aged 30–44 years without known history of or risk factors for infertility and had been trying to conceive for 3 months or less were observed from 2008 to 2016, and found that “women with low AMH levels (<0.7 ng/mL) or high FSH values (>10 IU/L) had similar cumulative pregnancy rates after 6 and 12 cycles of attempting pregnancy compared with women with normal levels.” (4)
• Does NOT predict live birth rate. Meaning even if your AMH is low, this does not indicate you are infertile, however the rate at which you have a positive pregnancy test may be lower
• Not routinely recommended for predicting time to pregnancy, pregnancy loss, or to predict time to menopause
• It is transiently reduced if you are on the birth control pill, thus this test would not accurately measure ovarian reserve

Antral Follicle Count (AFC) 

If you are seeing a fertility specialist or reproductive endocrinologist (REI) they may accompany this test with transvaginal ultrasound, where they can visualize and measure some of these available eggs. This is called the antral follicle count (AFC). They will assess available eggs to determine if you will respond to ovarian stimulation medications.

In Summary

Based on ACOG recommendations, AMH can be a helpful test if you are struggling with infertility, think you may have PMOS, or early menopause. In general, it is not routinely recommended for premenopausal women with regular menstrual cycles. This logic was put in place because as mentioned above this test does not necessarily indicate chance of pregnancy. However, it can be a great test if you are on the fence about starting a family soon, want a family in the future, and want to ensure your ovarian reserve is in a normal range. It is more so helpful if it is abnormal rather than if it is normal. Therefore, it may be worth discussing with your medical provider.

Despite testing for ovarian reserve, female age is still considered the most important factor in live birth rate. However, it is important to consider that at least one third of infertility cases are due to male reproductive issues or male infertility. This is why a sperm analysis is essential in the work up of infertility. You can ask your healthcare provider for a referral for sperm analysis at a fertility clinic. There is also a platform called Mate Health that will complete a sperm analysis from home rather than in the clinic setting. Sperm parameters begin declining at age 35, contrary to popular public belief. Sperm are also heavily sensitive to environmental factors, diet and exercise, alcohol or substance use, or high temperatures from saunas or hot tubs.

Remember, there is a 20-30% chance of pregnancy each month up to age 35, peaking at age 30, with a drop to 10-15% at age 35 and to 5% or less in your 40s. Therefore, it can be normal for it to take up 6-12 months to conceive. If you don’t get pregnant right away, this does not automatically warrant a work up. If it has been longer than 12 months, or greater than 6 months if you are above the age of 35, you should consult your provider for a deeper dive. If you have absent or irregular, very heavy, or painful menstrual cycles you should consult a healthcare provider now.

Can you increase your ovarian reserve?

Ovarian reserve is thought to be related to age predominantly, with the number of eggs available progressively declining throughout the life span. Read our blog post on trying to conceive for an in depth explanation of ovarian reserve and ovulation. There are however some ways to protect the quality of your eggs, and potentially enhance your ovarian reserve. This includes:

• Eating a balanced whole foods diet, reducing intake of processed foods and foods exposed to pesticides or preservatives that can strip away the food’s nutrients
• Regular, consistent exercise 
• Reducing exposure to environmental toxins such as plastics, parabens, strong artificial fragrances. Consider switching to dishwashing, laundry detergent, beauty and cleaning products that are free of harsh chemicals and fragrances
• Supplementing with Coenzyme Q10 (link to all our recommended supplements for fertility here.)
  • There are two forms of coenzyme Q10: ubiquinone and ubiquinol (active form).
    • Ubiquinone
      • often more affordable
      • converted to ubiquinol in the body
      • may have lower levels in the blood than ubiquinol, however this has not been robustly proven in studies and clinical significance has not been proven
      • more chemically stable
    • Ubiquinol
      • active form, often more expensive
      • possibly higher absorption (more bioavailable)
      • is more sensitive to oxidation when exposed to air (less shelf stable)
    • Coenzyme Q10 is synthesized in the body, and can also be consumed in some foods (such as animal meat, organ meats, fatty fish, broccoli, soybeans, peanuts, strawberries).
    • Studies show synthesis declines over the lifespan, beginning at age 30
    • Functions of CoQ10
      • it is an antioxidant, protecting cells from damage
      • supports mitochondrial function in egg cells, which is the part of the cell that drives egg synthesis and energy utilization
      • shown to improve sperm mobility and shape (your husband should take it too!)
      • has also been shown to improve metabolic health, reduce cardiovascular disease, reduce cholesterol levels, and support kidney function
      • How to take it
        • studied dosing is 30-600 mg daily, with possibly better absorption when taken with food
          • an exact most effective dose has not been established. Generally higher doses are well tolerated though
          • a meta analysis in 2024 found that lower doses (30 mg/day) had the greatest benefit, which conflicts with other studies recommending higher doses up to 600 mg, particularly in those with diminished ovarian reserve and are less than age 35 (6)
          • generally most supplements come at 100-200 mg daily
        • for patients undergoing IVF or experiencing infertility, 600 mg has been recommended (7)
      • A 2025 meta-analysis of 16 studies with 2,773 participants found that CoQ10 and supplements containing CoQ10 improved anti-mullerian hormone (AMH), antral follicle (egg) counts, retrieved eggs in advanced reproductive technology, and clinical pregnancy rate (8).
      • Another meta analysis in 2024 including 20 studies and over 2,000 participants revealed CoQ10 is superior to melatonin, vitamin D, inositol, and other supplements for women with diminished ovarian reserve (low AMH) (9)
• Supplementing Vitamin D3, B vitamins, and folic acid (400-600 mcg is recommended)

Best,

The PA Sisters

Disclaimer: this is not medical advice, but for informational and educational purposes only. Please consult your medical provider for unique medical guidance tailored to you.

References

1. Santoro, N., & Polotsky, A. J. (2025). Infertility Evaluation and Treatment. New England Journal of Medicine, 392(11), 1111–1119. https://doi.org/10.1056/nejmcp2311150
2. Penzias A, Azziz R, Bendikson K …
   Fertility evaluation of infertile women: a committee opinion
   Fertility and Sterility, 2021; 116, 1255-1265
3. La Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS; ESHRE Special Interest Group for Reproductive Endocrinology–AMH Round Table. Anti-Mullerian hormone (AMH): what do we still need to know? Hum Reprod. 2009 Sep;24(9):2264-75. doi: 10.1093/humrep/dep210. Epub 2009 Jun 11. PMID: 19520713.
4. Steiner AZ, Pritchard D, Stanczyk FZ, Kesner JS, Meadows JW, Herring AH, Baird DD. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA. 2017 Oct 10;318(14):1367-1376. doi: 10.1001/jama.2017.14588. PMID: 29049585; PMCID: PMC5744252.
5. Miles MV, Horn PS, Tang PH, Morrison JA, Miles L, DeGrauw T, Pesce AJ. Age-related changes in plasma coenzyme Q10 concentrations and redox state in apparently healthy children and adults. Clin. Chim. Acta. 2004;347:139–144. doi: 10.1016/j.cccn.2004.04.003)
6. Lin G, Li X, Jin Yie SL, Xu L. Clinical evidence of coenzyme Q10 pretreatment for women with diminished ovarian reserve undergoing IVF/ICSI: a systematic review and meta-analysis. Ann Med. 2024 Dec;56(1):2389469. doi: 10.1080/07853890.2024.2389469. Epub 2024 Aug 12. PMID: 39129455; PMCID: PMC11321116.
7. Li X, Zhao Q, Lin G, Xu L. The auxiliary effect of oral nutritional supplements on fertility in women with diminished ovarian reserve: a systematic review and meta-analysis. Ann Med. 2025 Dec;57(1):2583330. doi: 10.1080/07853890.2025.2583330. Epub 2025 Nov 4. PMID: 41185971; PMCID: PMC12599008.
8. Shang Y, Song N, He R, Wu M. Antioxidants and Fertility in Women with Ovarian Aging: A Systematic Review and Meta-Analysis. Adv Nutr. 2024 Aug;15(8):100273. doi: 10.1016/j.advnut.2024.100273. Epub 2024 Jul 15. PMID: 39019217; PMCID: PMC11345374.
9. Ben-Meir A, Burstein E, Borrego-Alvarez A, Chong J, Wong E, Yavorska T, Naranian T, Chi M, Wang Y, Bentov Y, Alexis J, Meriano J, Sung HK, Gasser DL, Moley KH, Hekimi S, Casper RF, Jurisicova A. Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging Cell. 2015 Oct;14(5):887-95. doi: 10.1111/acel.12368. Epub 2015 Jun 26. PMID: 26111777; PMCID: PMC4568976.
10. Cueto HT, Riis AH, Hatch EE, Wise LA, Rothman KJ, Sørensen HT, Mikkelsen EM. Folic acid supplementation and fecundability: a Danish prospective cohort study. Eur J Clin Nutr. 2016 Jan;70(1):66-71. doi: 10.1038/ejcn.2015.94. Epub 2015 Jun 17. PMID: 26081493.
11. Miles MV, Horn PS, Tang PH, Morrison JA, Miles L, DeGrauw T, Pesce AJ. Age-related changes in plasma coenzyme Q10 concentrations and redox state in apparently healthy children and adults. Clin. Chim. Acta. 2004;347:139–144. doi: 10.1016/j.cccn.2004.04.003