A baby girl is born with about one to two million egg follicles; around 300,000–400,000 remain at puberty, and the number keeps falling, faster after 35. From that age the chance of pregnancy falls and the risks of miscarriage and chromosomal abnormalities rise, because fewer eggs remain and their quality declines. Because age and ovarian reserve strongly affect fertility and the response to any treatment, ovarian reserve is assessed before treatment is planned.
AMH (anti-Müllerian hormone)
AMH is produced by the small follicles in the ovary, so its level reflects the remaining egg supply. It is low with advancing age and high in polycystic ovary syndrome (PCOS). It can be measured on any day of the cycle and is now the most widely used blood test of ovarian reserve. Typical interpretation (laboratories and assays vary slightly):
| AMH (ng/mL) | AMH (pmol/L) | Interpretation |
|---|---|---|
| Above 3.5 | Above 25 | High (may suggest PCOS) |
| 1.0 – 3.5 | 7 – 25 | Normal |
| 0.5 – 1.0 | 3.5 – 7 | Low |
| Below 0.5 | Below 3.5 | Very low |
FSH on day 2–5 of the cycle
FSH is measured on day 2–5 of the cycle, together with estradiol. A rising FSH indicates that the pituitary is working harder to stimulate a declining ovary. Very low levels suggest reduced pituitary output instead.
| Day 2–5 FSH (mIU/mL) | Interpretation |
|---|---|
| Below 9 | Normal |
| 9 – 11 | Borderline |
| 11 – 15 | Reduced |
| 15 – 20 | Markedly reduced |
| Above 20 | Severely reduced |
Antral follicle count (AFC)
A transvaginal ultrasound early in the cycle counts the small (2–10 mm) antral follicles visible in both ovaries. A higher count indicates a better reserve; fewer than about 5–7 in total suggests a low reserve.
What these tests can and cannot tell you
AMH and AFC predict how many eggs are likely to respond to IVF stimulation and help choose the right dose. They do not measure egg quality and do not predict natural fertility well; a woman with a low AMH can still conceive naturally, especially when younger. Age remains the strongest predictor of egg quality.
International Guidelines
In line with global standards, Dr. Sabry follows the latest recommendations from the American Society for Reproductive Medicine (ASRM), European Society of Human Reproduction and Embryology (ESHRE), and Royal College of Obstetricians and Gynaecologists (RCOG). Thus, patients receive care that is safe, ethical, and evidence-based.
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Why Choose Dr. Ashraf Sabry?
Dr. Ashraf Sabry, consultant in obstetrics, gynecology, fertility, and aesthetic gynecology, is recognized among the best OBGYN and fertility specialists in Cairo. With over 20 years of experience, he combines science and compassion to provide world-class care. Book your appointment through the contact page, WhatsApp, or call +201022224442.