Ovarian Reserve

The Stock of Reproductive Potential

What Is Ovarian Reserve?

Female fertility is not determined solely by the presence of menstruation or the regularity of the menstrual cycle. One of the most important indicators of reproductive potential is ovarian reserve that is, the quantity of eggs a woman has in her ovaries at any given time. This is a physiological parameter that directly affects the chances of achieving pregnancy, both naturally and through assisted reproduction.

Ovarian reserve refers to the total number of follicles remaining in a woman’s ovaries at any stage of her life. From birth, every woman has a finite number of eggs, approximately 1 million. Over time, this number gradually declines due to natural cell loss, menstrual cycles, and ovarian aging. By puberty, this number decreases to around 300,000–500,000 eggs, while by the age of 40, most women have fewer than 10,000 eggs remaining, many of which may present chromosomal abnormalities.

The importance of ovarian reserve is not limited to egg quantity but also includes egg quality. Egg quality declines significantly with age, leading to lower fertilization rates and a substantially increased risk of miscarriage. Ovarian reserve testing is often one of the first and most important evaluations performed in assessing a woman’s fertility. It is also particularly relevant in adulthood when there is suspicion of conditions such as polycystic ovary syndrome (PCOS) or premature ovarian insufficiency (POI).

When and Why We Evaluate Ovarian Reserve

Ovarian reserve assessment is particularly important in the following cases:

When a woman is approaching or over 35 and wishes to conceive naturally
When a woman has been trying to conceive for a long time without success
When planning to start an IVF cycle or other infertility treatment
In cases of previous failed IVF attempts
When there are signs of early menopause or ovarian insufficiency
Before medical treatments (e.g., chemotherapy) that may affect the ovaries
During adulthood, particularly when there is suspicion of polycystic ovary syndrome (PCOS) or premature ovarian insufficiency (POI).

Evaluation by a gynecologist and the use of high-resolution ultrasound are necessary steps to exclude pathology and select the appropriate management.

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What Does Ovarian Reserve Assessment Include

The evaluation of ovarian reserve is based on three main pillars:

Anti-Müllerian Hormone (AMH) Test

Anti-Müllerian Hormone (AMH) is the most reliable blood test for assessing ovarian reserve. AMH is a protein produced by the cells of ovarian follicles, and its levels naturally decline with age.

An AMH level of 2–3 ng/ml is generally considered normal, while low AMH levels indicate a reduced egg reserve, and high levels are often associated with polycystic ovaries. However, AMH does not reflect egg quality, and therefore a low AMH value does not necessarily indicate infertility.

Follicle Stimulating Hormone (FSH) Levels

Follicle Stimulating Hormone (FSH) is a glycoprotein hormone that plays a key role in ovarian function. It is measured at the beginning of the menstrual cycle (day 2–4).

Normal FSH levels range between 3–10 IU/L, while elevated values suggest that the ovaries require greater stimulation to function, which is associated with reduced ovarian reserve.

Ultrasound with Antral Follicle Count (AFC)

Through a transvaginal ultrasound, the number of visible follicles is measured at the beginning of the cycle (day 2–4).

The Antral Follicle Count (AFC) is indicative of ovarian function. If fewer than 6–10 follicles are detected, this suggests a low ovarian reserve. AFC is particularly important in IVF cycles, as it helps determine the appropriate stimulation protocol used during fertility treatment.

Beyond the main tests (AMH, FSH, and AFC ultrasound), additional markers may provide further insight, especially when results are borderline or conflicting:

Estradiol (E2)

Measuring estradiol (E2) on days 2–4 of the cycle can reveal underlying dysfunction. Elevated estradiol levels early in the cycle, even when FSH is within normal range, may indicate reduced ovarian reserve.

Inhibin B

Inhibin B is produced by developing ovarian follicles and acts as a regulator of FSH (Follicle Stimulating Hormone). Levels below 45 pg/ml during the early phase of the menstrual cycle are associated with a poor response to ovarian stimulation protocols and lower chances of achieving a successful pregnancy.

Although not required in all cases, Inhibin B testing can be used in combination with primary markers when greater diagnostic accuracy is needed, particularly in cases of suspected premature ovarian insufficiency (POI).

Factors That Affect Ovarian Reserve

Ovarian reserve is primarily affected by age, but also by a variety of other factors, such as:

Genetics and hereditary factors
Autoimmune diseases
Chemotherapy or radiotherapy
Ovarian surgeries
Endometriosis
Smoking and other environmental stressors

It is important for every woman to be aware of her ovarian reserve status, even if she is not currently trying to conceive. Early assessment allows women to plan their future with knowledge and security.

Low Ovarian Reserve – What It Means and What Options Are Available

A low AMH level or elevated FSH does not necessarily mean that a woman cannot get pregnant. On the contrary, many women with low ovarian reserve have conceived either naturally or through IVF (in vitro fertilization).

At FertUlity, the treatment strategy is shaped by multiple factors, including age, the number of previous unsuccessful pregnancy attempts, and other fertility parameters. Every approach is fully personalized to the individual patient. In many cases, PRP fertility treatment may help support ovarian rejuvenation. In other cases, ovarian stimulation using alternative protocols or natural / modified natural cycle IVF can provide additional solutions with high success rates.

Frequently Asked Questions About Ovarian Reserve

Can I get pregnant with low ovarian reserve?

Yes, pregnancy is still possible. However, the chances of conception may decrease depending on the extent of the reduced reserve. The outcome depends not only on the number of eggs but also on egg quality.

Many women with diminished ovarian reserve successfully conceive, either naturally or with assisted reproductive techniques, especially when early diagnosis and proper medical guidance are in place. Treatment approaches may range from mild stimulation protocols to alternative options such as egg donation or egg freezing at a younger age.

Why is early testing important?

Early assessment of ovarian reserve provides valuable information about a woman’s fertility. When we are aware of our fertility status in time, we can make more informed decisions about the future. Testing is particularly useful before attempting pregnancy, when there is an intention to delay motherhood for personal reasons, in cases of infertility, before starting IVF, and prior to chemotherapy. This information may lead to preventive actions such as egg freezing, giving a woman the opportunity to protect her future fertility.

How is ovarian reserve tested?

Ovarian reserve assessment includes a combination of hormonal tests and ultrasound imaging. The main hormonal markers measured through blood tests are AMH (Anti-Müllerian Hormone), which reflects the number of developing follicles, and FSH (Follicle Stimulating Hormone), which, when elevated, indicates reduced ovarian reserve. Additionally, estradiol (E2) and in some cases Inhibin B may also be measured. At the same time, an ultrasound for Antral Follicle Count (AFC) is performed, which shows how many follicles are visible in a given cycle.

Our Doctors

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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Dr. Chrysostomos Papadopoulos - Specialist in Infertility, Endocrinology & Menopause in Athens

Dr. Maria Oikonomou Obstetrician – Gynecologist

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FertulityThrough the Words of our Parents

100% genuine, public Google reviews.
Because every fertility journey begins with honesty and trust.

      EXCELLENT  
   Based on 12 reviews 
    
 
 
 
   
 
 
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   Μαρια 
 26 days ago
 
 
  The word "thank you" to Dr. Makis Papadopoulos is too small to describe the gratitude we feel for this man. I am pregnant after IVF, having succeeded on the first attempt, and we owe this exclusively to our doctor. First Contact & Communication: From the very first contact, he won us over with his kindness, enthusiasm and willingness to dedicate as much time as we needed. Willing to explain everything in every detail, he solved every question we had in depth — not even a professor to students would analyze them with such patience and contagiousness! Scientific Training: He is an excellent scientist, with deep knowledge of the subject, a perfectionist and focused professional who leaves absolutely nothing to chance. He designed the right treatment for us, solving every problem down to the last detail, making us feel that whatever problem arises, it is certain that it will be solved. HUMANITY & SUPPORT: The most important thing, however, is his humanity. Communication with him was Immediate and he always had as much time as you needed on the phone to solve every question. He showed a deep, real interest, embracing us not just as a doctor, but as if he were our brother. We highly recommend him to every couple starting this journey. He deserves blind trust! We thank you from the bottom of our hearts for the greatest miracle of our lives!

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   Alexandra 
 52 days ago
 
 
  I don't often write reviews, but I feel that Mr. Makis truly deserves it. From the very first moment, he made me feel safe and confident. He listened carefully to what was on my mind, answered every question I had, and explained everything in a simple way, always based on scientific data. Many times, he even sent me relevant scientific studies so that I could better understand why he was suggesting a particular approach. But what stood out to me the most was that he didn't stop at the appointment. He followed up, was genuinely interested in my progress, and was available when I needed him. This is something you rarely encounter. Fortunately, he returned to Greece. He is one of the few doctors who, beyond their knowledge, remain above all human beings. He makes you feel like he sees you as a person and not as just another incident.

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   Matina 
 69 days ago
 
 
  A big thank you to Dr. Makis Papadopoulos who supported us from day one, who checked every little detail, who explained to us every move-step, every test, every medication for the reason we were doing it and what we would achieve. With incredible experience, knowledge, a lot of patience (because we had two other failed attempts with another doctor) and trust, within 8 months he adapted the protocols for our case and we achieved the positive result and we hold in our arms a priceless diamond. Above all, a rare person, calm and always available to listen to our concerns and reassure us. I highly recommend him!

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   Eva 
 93 days ago
 
 
  Thanks to Dr Makis Papadopoulos, I am now holding my two beautiful babies in my arms! He is a true expert. Professional with a human centric approach, friendly and empathetic, always available to answer our (many many) questions. I trust Dr Makis blindly and, honestly, I cannot recommend him enough!
  
 
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   Ivy 
 100 days ago
 
 
  My experience with Dr. Makis took me from a clinical stagnation to an incredible breakthrough, highly recommend Dr. Makis! Navigating the exhausting world of IVF, you know how devastating it is to watch your protocol dosages go up while your results go down. After three intense, high-dosage cycles with a previous clinic, I was left feeling incredibly discouraged. Despite escalating medications and growth hormones, my blastocyst yield was dwindling, culminating in a heartbreaking round with zero blastocysts. I knew I needed a doctor who didn't just follow a standard script, but who truly understood the nuances of egg quality and customized protocols. That is when I found Dr. Makis. Dr. Makis completely revolutionized my treatment plan. Instead of just pushing maximum dosages, he took a highly strategic, tailored approach. The result? Quality over pure protocol size. While my previous doctors kept increasing the medication dosages (which yielded fewer or zero blastocysts), Dr. Makis completely changed the strategy. He lowered the heavy stimulation, introduced smart egg-quality support (like melatonin), changed the protocol style entirely, and achieved a 700% increase in blastocysts compared to my best previous rounds. Beyond the incredible results, Dr. Makis brings a level of expertise, precision, and reassuring care that is rare to find. He looks at you as an individual, not a statistic, and knows exactly how to pivot when traditional routes fail. If you are looking for a specialist who can turn a difficult prognosis into an overwhelming success, look no further than Dr. Makis. I am incredibly grateful for his care.
  
 
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   Olga 
 111 days ago
 
 
  Dr. Makis Papadopoulos was excellent, professional, and very reassuring throughout the entire process. Thanks to his expertise and guidance, we were able to identify the issue early and take the appropriate steps from the beginning. He took the time to explain everything clearly, answered all our questions with patience, and made us feel comfortable and confident throughout our journey. We truly appreciated his caring approach, professionalism, and dedication. Highly recommended!
  
 
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   Euaggelia 
 122 days ago
 
 
  Dr. Makis Papadopoulos is an excellent scientist and above all a rare person! He is an approachable and smiling doctor, with excellent medical knowledge, who from the first moment I met him made me feel comfortable and trust him completely, answering every question I had with patience and documenting every answer with scientific studies and articles! The most important thing, however, is that Dr. Makis Papadopoulos is always there on the other end of the line to listen to you and reassure you without a trace of haste, a doctor who truly cares and makes you feel like he is your own person! Makis, thank you very much for everything!!! I am very lucky to have met you!

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   Anastasia 
 129 days ago
 
 
  Dr. Makis Papadopoulos is an excellent scientist with a human-centered interest. Our collaboration was excellent from the very beginning and he made me feel confident and secure by explaining every step of the process in great detail. I highly recommend him!

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   Fay 
 131 days ago
 
 
  Dr Makis Papadopoulos is very professional, caring and attentive. Very thorough in explaining the whole process throughout every step. Thank you! Highly recommended!!
  
 
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   Christina 
 134 days ago
 
 
  I would like to share my experience with Dr. Makis Papadopoulos, an outstanding gynecologist and scientist. We first connected in the summer of 2024, while he was based in Germany, through a mutual acquaintance, following a particularly challenging period for us. Prior to meeting him, we had gone through repeated unsuccessful attempts of stimulation and fertilization with other gynecologists. Unfortunately, those approaches relied largely on standardized protocols, without sufficient personalization to address the specific needs of my case. From the very beginning, Dr. Makis stood out for his human-centered approach and his willingness to dedicate time to truly understand our situation in depth. With strong, up-to-date scientific knowledge, he approaches every case holistically, focusing on individualized treatment and adapting protocols to the patient's unique needs. Throughout our collaboration, which now spans approximately two years (with a few breaks on our side), he has consistently been available, supportive, and clear in his guidance. He inspired confidence and helped us stay positive even during difficult phases of the journey. Beyond his scientific expertise, what truly sets him apart is his genuine care for the person behind each case: his empathy, honesty, and continuous effort to achieve the best possible outcome. My husband and I are deeply grateful for his support and guidance, and we now feel ready and optimistic to move forward to the next final stage. We highly recommend him to anyone seeking a gynecologist with true expertise, professionalism, and compassion. I would like to share my experience with Dr. Makis Papadopoulos, an excellent gynecologist and scientist. We met in the summer of 2024, when he was in Germany, through a mutual acquaintance, after a particularly demanding period for us. Before meeting him, we had gone through repeated failed attempts at stimulation and fertilization with other gynecologists. Unfortunately, the approaches that had been followed were mainly based on standardized protocols, without the necessary individualization to the specifics of my case. From the beginning, Dr. Makis stood out for his human approach and his willingness to spend time to understand our case in depth. With modern knowledge and scientific training, he approaches each issue multidimensionally, emphasizing the individualization of treatment and adapting the protocols to the real needs of the patient. During our collaboration, which now spans about two years (with short breaks on our part), he was always available, supportive and clear in his guidance. He inspired confidence in us and helped us remain optimistic even in difficult phases. In addition to his scientific competence, what sets him apart is his genuine interest in the person behind each case: his empathy, his honesty and his constant effort to achieve the best possible outcome. My husband and I thank him warmly for his support and guidance and we now feel ready and optimistic to move on to the next final stage. We highly recommend him to anyone looking for a gynecologist with real knowledge, professionalism and humanity.

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   Faidra 
 135 days ago
 
 
  Dr. Makis Papadopoulos is an excellent gynecologist and above all an excellent person! I truly thank him for his support and care during the egg freezing process. Although my case was particularly demanding, he stood by me with patience, knowledge, great experience and real interest. Our communication was direct and human, while his availability at the many appointments made me feel safe at every step. The protocols were designed specifically for me, aiming for the best possible result, while also taking into account the cost of the medications. I recommend him with all my heart to every woman who wants to trust someone for something so important and sensitive for her.

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   Iliana 
 137 days ago
 
 
  I highly recommend Dr. Makis, he is an incredible specialist. My journey was far from easy, encountering several challenges that  made the process feel overwhelming at times. What sets him apart is his willingness to go beyond standard procedures. He developed a specialized, custom protocol, tailored to my situation, which ultimately made all the difference. Beyond his technical expertise, his calm and clear communication kept me grounded throughout the process. I am so grateful for his persistence and high level of care!

Why choose FertUlity?

Because every fertility journey deserves the right support. At FertUlity, we provide science-based fertility care with a human approach. We support every path, from fertility assessment and preservation to modern assisted reproduction.

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