Low Ovarian Reserve

What it is

Ovarian reserve is the number of eggs a woman still has in her ovaries, set from birth and naturally reduced over time. When this reserve is lower than expected for her age, it's called low ovarian reserve. The condition is more common from age 35 onward, but can appear earlier due to genetic factors, ovarian surgery, chemotherapy, or with no defined cause. It doesn't prevent pregnancy, but it reduces the chance with each cycle and shortens the time available to plan a pregnancy. The gynecology team at Femi Saúde assesses ovarian reserve, interprets results according to each woman's age and plans, and guides the next steps.

Most common symptoms

• Menstrual cycles shorter than usual
• Periods that become irregular or lighter
• Difficulty conceiving after months of trying
• Poor response to ovarian stimulation during treatment
• Hot flashes and sleep changes, in some cases
• No symptoms, found incidentally on routine tests

Causes and risk factors

• Age, with a natural decline from age 35
• Ovarian surgery, such as removal of cysts and endometriomas
• Chemotherapy and radiation therapy
• Endometriosis and autoimmune diseases
• Genetic factors, such as a family history of early menopause
• Smoking

How it is diagnosed

The evaluation begins with the clinical history: age, cycle regularity, time spent trying to conceive, prior surgeries, cancer treatments, and family history of early menopause. Anti-Müllerian hormone (AMH) testing can be done at any point in the cycle and is the main marker of ovarian reserve. Transvaginal ultrasound counts the antral follicles in both ovaries, usually early in the cycle. FSH and estradiol, measured between the second and fifth day of the cycle, complete the analysis. Results are interpreted together and always in relation to age, since no single test accurately predicts the chance of pregnancy.

How we treat it at Femi Saúde

There's no treatment that increases the number of eggs, but there are ways to make the most of the existing reserve. The gynecology team at Femi Saúde advises on the right time to try to conceive, on managing factors such as smoking and weight, and on treating associated conditions such as endometriosis. When a woman wishes to delay pregnancy, egg freezing can be discussed. For those already trying to conceive, referral to assisted reproduction is usually made without delay, with protocols adapted to a poor response. Women with no desire for pregnancy receive follow-up focused on bone and cardiovascular health. The plan is individualized.

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