Poor Ovarian Reserve & IVF: What Every Woman Needs to Know
Patient: Dr Malpani, my gynaecologist, said I might have poor ovarian reserve. Honestly, I don’t even understand what that means. Could you explain?
Dr Malpani: Of course. Every woman is born with a fixed number of eggs, and this number declines as she gets older. What matters isn’t just your chronological age—the number of birthdays you’ve had—but your biological age, which reflects how many eggs are left in your ovaries. That’s what we call ovarian reserve.
Patient: So how do you actually measure ovarian reserve?
Dr Malpani: There are several ways. Traditionally, we looked at Day 3 FSH levels. If FSH is high, it suggests the ovaries are struggling. Another test is the Clomiphene Citrate Challenge Test (CCCT). More recently, we also check AMH levels and do an antral follicle count (AFC) using a vaginal ultrasound. These tests together give us an idea of your egg quantity—but remember, numbers don’t always tell the whole story.
Patient: But why does FSH go up when egg quality goes down? That feels confusing.
Dr Malpani: Great question. Think of FSH as fuel. In younger women with good eggs, a small amount of fuel is enough to make the engine run. But as egg quality declines, the ovary becomes less responsive. So, the pituitary gland makes more and more FSH to push the ovary harder. High FSH doesn’t mean more eggs—it means the ovary is resisting stimulation.
Patient: I see. But I have regular periods. Doesn’t that mean my eggs should be fine?
Dr Malpani: Not necessarily. Regular periods only mean your ovaries are making enough hormones to keep your cycle going. They don’t guarantee egg quality good enough for pregnancy. That’s why some young women with regular cycles still struggle with poor ovarian reserve—what some experts call “oopause”.
Patient: That’s scary. If my eggs are really few or poor quality, is there any treatment?
Dr Malpani: Sadly, we can’t create new eggs. But there are strategies to try and make the best use of the eggs you still have. Some women try DHEA supplements, wheat germ, yoga, or acupuncture to improve ovarian blood flow and response. Results vary, but it gives many patients peace of mind that they tried everything.
Patient: And what about IVF?
Dr Malpani: IVF is usually the best option because it maximises your chances. For women with poor ovarian response, we may use special protocols like the Letrozole-Antagonist protocolorminimal stimulation IVF. The goal is to retrieve whatever good eggs we can. Sometimes, despite everything, the chances remain low—and in such cases, we may gently discuss donor eggs as a future option.
Patient: That sounds like a lot to process. So, should I be focusing on my test numbers?
Dr Malpani: Numbers are helpful, but they don’t define you. The real proof is in how your ovaries actually respond to stimulation during IVF. One good egg can still make one good embryo—and one baby.
Patient: Thank you, doctor. This makes me feel more hopeful and less confused.
Dr Malpani: I’m glad. Remember, every woman’s journey is unique. My job is to help you make the best decisions for your situation with honesty and compassion.
Want to know what your ovarian reserve results really mean for your IVF chances? Book a video consultation with Dr. Malpani today and get clarity before starting treatment.