Low ovarian reserve
A low AMH result is one of the most frightening things a woman can read on a lab report, and one of the most misunderstood. It says how many eggs are left, not how good they are, and not whether you can conceive. Dr. Shami treats it as a reason to plan carefully, not to give up.
What it means
Ovarian reserve is the number of eggs remaining in the ovaries. It is estimated by the AMH blood test and by counting small follicles on ultrasound (the antral follicle count). Reserve falls with age in everyone, faster in some women than others, and can also be reduced by surgery on the ovaries, endometriosis, chemotherapy, or genetic factors.
What low reserve does not mean: it does not mean your eggs are poor quality, which depends mostly on age. It does not mean you cannot conceive naturally; women with low AMH conceive every month. It does mean that time matters more, that stimulation for IVF will produce fewer eggs, and that the plan should be efficient.
Who should be checked
- Women over 35 who have been trying for six months
- Anyone with a family history of early menopause
- Women who have had ovarian surgery, endometriosis or cancer treatment
- Women with short or changing cycles
- Anyone planning to delay childbearing who wants to decide about egg freezing with real numbers
How Dr. Shami investigates it
AMH, FSH and estradiol at the right point in the cycle, an antral follicle count by transvaginal ultrasound, and a review of anything that might have lowered the reserve. Just as important, an honest conversation about what the numbers mean for you, given your age and how long you have been trying, so that decisions are made on facts rather than fear.
How she plans treatment
- 1
Do not lose time
With low reserve, waiting is the one thing that never helps. The plan is decided quickly, and gentle options are given a defined number of cycles, not an open-ended trial.
- 2
Protocols designed for fewer eggs
In IVF, stimulation is tailored to a low-responding ovary, and the choice between conventional and mild stimulation is discussed openly. Sometimes several small cycles and freezing embryos along the way, sometimes one well-planned cycle.
- 3
Quality over quantity
With fewer embryos, testing them (PGT-A) is discussed when age makes it useful, so that transfers are not spent on embryos that could not have worked.
- 4
The full range of options
If your own eggs are unlikely to succeed, she will say so plainly, and discuss every option available with you.
Dr. Ghina Shami
Questions patients ask
My AMH is low. Can I still get pregnant naturally?
Yes. AMH predicts how many eggs you have, not whether the next one will fertilise and implant. Women with low AMH conceive naturally. The difference is that there is less time to wait if nothing happens, which is why the plan should be made early.
Can ovarian reserve be improved?
The number of eggs cannot be increased. Some supplements and lifestyle measures may support egg quality, and Dr. Shami will tell you honestly which have evidence. The most effective response to low reserve is a good plan made quickly.
Should I freeze my eggs?
If you are not ready to try for a pregnancy and your reserve is falling, egg freezing can preserve options. Dr. Shami will give you realistic expectations based on your age and numbers so that you can decide.
Medically reviewed by Dr. Ghina Shami, Consultant Reproductive Endocrinology & Infertility · September 2026
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