What every woman should know about ovarian reserve

For many women, fertility isn't part of the conversation until they're actively trying to conceive. But by the time they have their first fertility evaluation, some are surprised to learn they have diminished ovarian reserve, raising questions about whether earlier fertility testing could have given them more options.

One of the most common things we hear from patients is, "I wish someone had told me sooner that I had low AMH".

At Collab Fertility, we believe that fertility timelines should be part of the conversation long before someone is actively trying to conceive. One tool that can help guide those conversations is the Anti-Müllerian Hormone (AMH) test.

But what exactly is AMH, and why should every woman have it checked?

What is AMH, and what does it measure?

Anti-Müllerian Hormone (AMH) is a hormone produced by the small follicles in your ovaries. A simple blood test can estimate your ovarian reserve, or the number of eggs remaining in your ovaries.

Unlike many reproductive hormones, AMH can typically be measured at any point during your menstrual cycle.

While AMH is a valuable piece of information, it's important to remember that it is only one part of the fertility picture. Your age, medical history, ultrasound findings, ovulation, and other hormone levels all help us better understand your reproductive health.

It's also important to know that certain forms of hormonal birth control can temporarily lower AMH levels. Birth control pills and the contraceptive implant (Nexplanon), for example, may suppress AMH, causing your ovarian reserve to appear lower than it actually is. If you've recently stopped one of these methods, it's often recommended to repeat your AMH test about three months after discontinuation to allow your hormone levels to stabilize. In contrast, both hormonal IUDs and copper IUDs generally do not have a significant impact on AMH levels, so testing while using an IUD is typically considered reliable. 

As always, AMH results should be interpreted alongside your medical history, ultrasound findings, age, and other fertility markers—not in isolation.

Should AMH be part of your annual well-woman exam?

At Collab Fertility, we believe women deserve access to information that allows them to make informed decisions about their reproductive future.

Too often, patients are reassured that they don't need to think about fertility until age 35—only to discover years later that their ovarian reserve is lower than expected.

Knowing your AMH earlier doesn't mean you need fertility treatment. It doesn't mean you need to freeze your eggs. It doesn't even mean you'll have difficulty conceiving.

What it does mean is that you have more information about your fertility, allowing you to have thoughtful conversations with your healthcare provider and make decisions based on your own goals and timeline.

For some women, AMH testing may provide reassurance. For others, it may prompt earlier fertility planning or additional evaluation. The decision to test should always be individualized and discussed with your healthcare provider.

Does AMH predict egg quality?

This is one of the biggest misconceptions surrounding AMH.

The short answer is no. AMH measures egg quantity, not egg quality.

Egg quality is primarily influenced by age and reflects the likelihood that an egg contains the correct number of chromosomes to create a healthy embryo.

This means:

• A woman with a low AMH can still have healthy eggs and conceive naturally.
• A woman with a high AMH may still experience infertility for reasons unrelated to ovarian reserve.

AMH should never be interpreted in isolation. While AMH does not predict egg quality, it does help fertility specialists estimate how your ovaries may respond to ovarian stimulation during IVF. Women with a higher AMH often produce more eggs during an IVF cycle, while women with a lower AMH may produce fewer eggs. This information helps physicians personalize medication protocols and set realistic expectations before treatment begins. 

What can you do to improve egg quality?

While you can’t increase the number of eggs remaining in your ovaries, you can make lifestyle and dietary changes to support egg quality and overall reproductive health. 

Eggs take roughly 3 months to mature before ovulation, so the lifestyle and dietary changes that you make today can positively influence the environment before you try to conceive or go through an egg retrieval. 

Depending on your age, medical history, and fertility goals, your doctor or fertility nutritionist may recommend supplements such as:

• Coenzyme Q10 (CoQ10): An antioxidant that supports mitochondrial function, helping provide the energy needed for healthy egg development. Some studies suggest CoQ10 may improve egg quality, particularly in women with diminished ovarian reserve or advanced maternal age.
• Folic acid (or methylfolate): An essential nutrient that supports DNA synthesis and healthy cell division. It's recommended for anyone trying to conceive to reduce the risk of neural tube defects and support early embryonic development.
• N-acetylcysteine (NAC): A powerful antioxidant that may help reduce oxidative stress and inflammation. NAC has also been studied for its potential benefits in women with PCOS by supporting ovulation and metabolic health.

Eating a nutrient-dense diet, maintaining regular physical activity, prioritizing sleep, managing stress, and avoiding smoking and excessive alcohol consumption can all help create an environment that supports healthy egg development.

While no supplement or diet can reverse age-related changes in egg quality, optimizing your overall health before pregnancy can improve reproductive outcomes and help you feel your best throughout your fertility journey.

How does AMH relate to egg freezing?

One of the biggest advantages of learning your AMH before you're ready to have children is that it gives you more information about your future family-building options.

If your ovarian reserve is lower than expected—or if you know you'd like to delay pregnancy—your physician may discuss fertility preservation through egg freezing. While AMH alone shouldn't determine whether someone freezes their eggs, it can be an important part of the conversation alongside your age, ultrasound findings, and long-term reproductive goals.

If you're interested in learning more about fertility preservation, read our guide to egg freezing to understand who may benefit and what to expect throughout the process.

What other tests help evaluate fertility?

While AMH provides valuable information, it is only one component of a comprehensive fertility evaluation.

Depending on your age, symptoms, and family-building goals, your physician may also recommend:

• Pelvic ultrasound with antral follicle count (AFC)
• Follicle-stimulating hormone (FSH) and Estradiol
• Preconception labs, including thyroid, hemoglobin A1c, and prolactin
• Tubal patency testing (making sure the fallopian tubes are open)
• Semen analysis for male partners
• A review of your medical, surgical, and family history

Looking at the complete picture helps create the most accurate understanding of your reproductive health.

Who should consider AMH testing?

AMH testing may be worth discussing with your healthcare provider if you:

• Have a family history of early menopause
• Have been diagnosed with endometriosis or PCOS/PMOS
• Have had ovarian surgery
• Are preparing for cancer treatment
• Have irregular menstrual cycles
• Want to better understand your reproductive timeline
• A history of radiation or chemotherapy

If you have been diagnosed with PCOS/PMOS, AMH levels are often elevated because there are more small follicles in the ovaries. While AMH can support the overall clinical picture, it should never be used alone to diagnose PCOS/PMOS. 

Every patient's situation is different, but the bottom line is that there is no downside to getting an AMH test; it provides powerful information to inform your family planning. 

What should you do if your AMH is low?

A low AMH result can feel overwhelming, but it's important not to panic.

A low AMH does not mean pregnancy isn't possible. Instead, it means it's time to gather more information.

Meeting with a reproductive endocrinologist can help you understand what your results mean in the context of your age, ultrasound findings, hormone levels, and family-building goals.

Depending on your situation, your physician may recommend continued monitoring, trying to conceive sooner, fertility preservation, or fertility treatment. Every plan is individualized.

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Knowledge creates options

Understanding your fertility isn't about creating fear; it's about understanding your options. 

Whether you're planning to have children right away, considering waiting a few years, or simply want to better understand your reproductive health, having the right information can help you make decisions about family building with confidence.

At Collab Fertility, we believe every patient deserves personalized, evidence-based fertility care that looks at the whole person rather than just a single lab value.

If you're wondering whether AMH testing is right for you, our team is here to help you understand your options and create a plan that aligns with your goals. 

Interested in learning more? Schedule a consultation with Dr. Thalia Segal to take the next step in understanding your fertility.

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