Causes of reduced ovarian reserve

More and more women are hearing the diagnosis of “reduced ovarian reserve” — sometimes even before they've tried to get pregnant. And the natural question is: “Why? How did you get here?”

The answer is not always simple. But in many cases there is an explanation that can help to better understand and react in a timely manner.

What is ovarian reserve?

Ovarian reserve indicates the quantity and quality of eggs that a woman has at the moment.
Most often it is measured by:
- AMH (antimylar hormone);
- number of antral follicles (AFC);
- response of the ovaries to stimulation.

The reserve naturally decreases with age, but in some women the decline is earlier or faster than expected.

What are the possible reasons for a reduced reserve?

1. Age is the most natural factor. We know that after the age of 35 the decrease is more noticeable, and after 38—40 — sharper. But there are also women with low reserve before the age of 30.

2. Genetic factors

- Hereditary predisposition;
- Syndrome of premature ovarian failure (POI);
- Mutations or deletions that affect ovarian function.

3. Autoimmune diseases

- For example, Hashimoto's thyroiditis, lupus, rheumatoid arthritis;
- The immune system can attack ovarian tissue.

4. Interventions on the ovaries

- Operations for cysts, endometriosis, tumors;
- Removal of ovarian tissue leads to the loss of follicles.

5. Chemotherapy and radiotherapy

- Impaired ovarian function — sometimes even after a short treatment;
- Fertility preservation before starting therapy is key.

6. Infections and inflammations

- Severe pelvic infections or viral diseases (e.g. mumps in adulthood);
- May lead to tissue damage.

7. Smoking, toxins, stress

- Cigarettes have been shown to be toxic to the ovaries;
- Chronic stress, pollution, diets and extreme regimes also have an impact.

And sometimes there is no explanation...

There are cases when the reserve is low for no apparent reason. It's not your fault. This does not mean that you are late or have done something wrong. It's just biology. And it is important to know in time - so that you have a choice.

What happens when there is a low reserve?

- Not waiting. Action is key;
- The possibility of freezing eggs is discussed (if there is no partner);
- In case of desire for pregnancy — individual stimulation plan and in vitro;
- In certain cases — discussion of a donor egg.

Conclusion

Ovarian reserve does not determine your value. It is a medical indicator—not destiny. But the sooner you know, the more options you have.
Information is power. The choice is a chance.

‍