By:- Dr Kalpana Jain, Fertility Specialist, Birla Fertility and IVF, Guwahati
In clinical practice, ovarian reserve concerns are often discovered unexpectedly. A woman may have regular periods, no obvious symptoms and still show a lower-than-expected response during fertility evaluation. This is because the decline in the remaining egg pool usually happens silently and does not follow the same pattern in every woman.
Ovarian reserve does not decline on a fixed schedule
Age remains the most important factor influencing fertility, but women of the same age may have different ovarian reserves. The decline is gradual and individual, rather than a sudden change beginning at one birthday.
Factors that may influence ovarian reserve include:
· Family history of early menopause
· Endometriosis or other ovarian conditions
· Previous surgery involving ovaries
· Chemotherapy or radiation treatment
· Smoking and certain genetic or medical conditions
These factors do not affect every woman in the same way, but they may justify an earlier discussion with a fertility specialist.
What AMH and AFC can reveal
Anti-Müllerian hormone, or AMH, is measured through a blood test and provides an estimate of the remaining follicle pool.
Antral follicle count, or AFC, counts the small follicles visible on an ultrasound, usually at the beginning of the menstrual cycle.
AMH and AFC are currently among the most reliable markers of ovarian reserve. They are particularly useful for estimating how the ovaries may respond to stimulation during IVF or egg freezing.
What these tests cannot predict
AMH and AFC reflect egg quantity, not egg quality. They cannot independently predict whether a woman will conceive naturally or how long she can safely delay pregnancy. Age remains a stronger predictor of reproductive potential than either result alone.
A low AMH result does not mean pregnancy is impossible, just as a normal result does not guarantee easy conception.
Why knowing early can help
Understanding ovarian reserve can support more informed decisions about family-planning timelines, fertility treatment or preservation. However, testing should be interpreted alongside age, menstrual history, medical conditions and reproductive plans rather than treated as a standalone fertility score.
The purpose of evaluation is not to create anxiety or certainty where none exists. It is to provide context while meaningful choices may still be available.
In regional context, Guwahati and across the Northeast, many women seek fertility evaluation only after prolonged difficulty conceiving. Earlier awareness of ovarian reserve could help preserve a wider range of reproductive choices.