Low AMH/Poor Ovarian Reserve/Low Egg Count
Ovarian reserve refers to the number of eggs present in a woman’s ovaries.
When the egg count is lower than expected for your age, it is known as low egg count or diminished ovarian reserve.
At Sarkar Hospital, Agra, we observe this condition in nearly one in four women seeking fertility treatment.
Unfortunately, there are no tests that can accurately predict how quickly the egg count will decline. In simpler terms, we cannot determine how soon your chances of conceiving may reduce significantly.
That’s why it is important not to delay pregnancy planning. If you are already experiencing difficulty conceiving, our fertility experts at Sarkar Hospital recommend considering timely and effective fertility treatment options to improve your chances of pregnancy.
How egg count is decided/ determined?
In females, the total number of eggs (oocytes) is fixed before birth. These eggs remain in a resting phase until puberty. As a woman ages, the number of eggs gradually decreases, and some women may have a naturally low egg count at birth or experience faster egg depletion over time.
According to the American College of Obstetricians and Gynecologists (ACOG), the average number of eggs by age is:
20 weeks of gestation (in womb): 6–7 million oocytes
At birth: 1–2 million oocytes
At puberty: 3–5 lakh oocytes
Around age 37: ~25,000 oocytes
Around age 51 (menopause): ~1,000 oocytes
Ovarian Reserve Testing
Your ovarian reserve—the number and quality of remaining eggs—is determined using a combination of age, ultrasound (antral follicle count), and hormone tests such as AMH and FSH.
AMH (Anti-Müllerian Hormone):
AMH is produced by small growing follicles in the ovary. It gradually decreases with age and reflects the remaining egg supply.Normal AMH: Above 3 ng/ml (21.98 pmol/l)
Low AMH: Indicates fewer developing eggs and lower fertility potential.
A low AMH mainly reflects quantity, not necessarily egg quality.
FSH (Follicle Stimulating Hormone):
High FSH levels can indicate poor ovarian reserve, but this rise occurs only at an advanced stage of depletion.
What Causes Poor Ovarian Reserve?
While age is the most common cause, younger women can also have low ovarian reserve due to:
Endometriosis or ovarian surgeries
Chronic pelvic infections
Genetic causes (e.g., fragile X premutation)
Ovarian cyst removal or previous ovarian surgery
Unhealthy lifestyle (stress, smoking, obesity, anorexia)
Environmental pollution
Chemotherapy or radiotherapy
Autoimmune disorders
A family history of early menopause may also indicate a faster fertility decline.
Symptoms of poor ovarian reserve / Low egg count
Shorter menstrual cycles (less than 26 days)
Irregular or unpredictable periods
Difficulty conceiving despite regular unprotected intercourse
Changes in premenstrual symptoms or shorter luteal phase
Hot flashes or night sweats
No symptoms — many women feel normal and only discover it during fertility testing
Treatment for poor ovarian reserve / Low egg count
1. Supplements & Medicines
Certain supplements like DHEA, CoQ10, and multivitamins may support egg health, but their benefits are limited.
2. IVF (In Vitro Fertilization)
IVF helps retrieve and fertilize available eggs in a controlled lab environment and is often the most effective treatment for low ovarian reserve.
3. IVF with Donor Eggs
When egg quality or number is critically low, using donor eggs significantly improves success rates.
4. Ovarian Rejuvenation (PRP Therapy)
An advanced option involving Platelet-Rich Plasma (PRP) injections enriched with nutrients to stimulate ovarian activity. This may help improve egg count and quality in selected patients.
5. Dual Stimulation (DuoStim IVF)
A specialized IVF approach where two stimulations are performed in one menstrual cycle—one in the follicular phase and another mid-cycle—to retrieve more eggs in a shorter time. The embryos are frozen and transferred later under optimal conditions.
6. Natural or Modified Natural IVF
For women with very low ovarian reserve, gentler IVF cycles using minimal medication may be more effective and better tolerated.
7. Early Fertility Planning
Starting evaluation and treatment early can make a significant difference in outcomes. Delaying fertility treatment reduces chances of success.
What if I have very low AMH/ovarian reserve?
Having very low AMH (Anti-Müllerian Hormone) or poor ovarian reserve means that the number of eggs in your ovaries is very low. While this can make conception more challenging, pregnancy is still possible with the right treatment approach and timely medical care.
1. Donor Eggs – A Highly Effective Option
For women with very low egg count or poor-quality eggs, using donor eggs is one of the most effective fertility options.
At Sarkar Hospital, Agra, we provide a safe, confidential, and ethically guided donor egg program to help you achieve pregnancy successfully when your own eggs are not viable.
2. Ovarian Rejuvenation Therapy
This innovative treatment aims to stimulate egg growth and improve ovarian function.
It involves injecting Platelet-Rich Plasma (PRP) enriched with nutrients directly into the ovaries, combined with customized medications and supplements.
The goal is to help the ovaries produce more eggs naturally and improve their quality before IVF or natural conception attempts.
3. Dual Stimulation (DuoStim) IVF Protocol
DuoStim is a modified IVF approach designed to maximize egg collection and improve success rates, especially in women with poor ovarian reserve.
In this protocol:
Two IVF stimulations are done within one menstrual cycle — one before ovulation and another after egg retrieval.
The embryos from both cycles are frozen and later transferred when the uterus is in the best condition for implantation.
Studies suggest the second stimulation may yield better-quality eggs and improve pregnancy outcomes.
This approach helps save time and increase the total number of embryos available for transfer.
4. Natural and Modified Natural IVF
For women who do not respond well to high medication doses, Natural IVF or Modified Natural IVF may be a better choice.
These cycles use minimal hormonal stimulation, relying on the few natural eggs available while maintaining a gentle, body-friendly approach.
5. Personalized Fertility Care at Sarkar Hospital
At Sarkar Hospital, Agra, we understand the emotional and medical challenges that come with low ovarian reserve.
We aim to support every woman’s wish to conceive using her own eggs whenever possible — while ensuring realistic guidance and effective options.
Our approach includes:
Detailed evaluation of ovarian health and hormone levels.
Customized treatment plans for each patient’s unique needs.
Advanced ovarian rejuvenation and fertility enhancement therapies.
Sophisticated ovum pickup techniques using double-lumen needles and follicle flushing to retrieve maximum eggs.
Highly skilled embryologists and a state-of-the-art IVF lab for optimal embryo handling.
Zero-error embryo transfer protocols and thorough post-transfer support.
Even with poor or very poor ovarian reserve, we strive to help you achieve the best possible success rates with expert care, compassion, and cutting-edge technology.