We are born with all the eggs we will ever have!
When we are born- around 3-4 million eggs
When we hit puberty- around 300-400 thousand eggs
Reproductive years- as we ovulate, we naturally lose a pool of eggs and it is thought from the age of 35 this decline becomes increasingly faster, but remember everyone is different, has different backgrounds/lifestyles/genetics etc.
Each cycle during ovulation, some of these eggs will get recruited into a “pool” in hopes of one of them becoming the dominant egg. Think about it this way:
What happens to the other swimmers in stage 3, they are left out of the team forever (aka The follicles that don't release an egg disintegrate. This process is known as atresia)
The swimmers in stage 1, they get “old” and naturally decline and can’t be recruited to the Olympic team again.
So what does AMH and AFC tell us?
Note: these tests combined with FSH and estrogen give us the full picture, none of these tests should be done in isolation, it will provide an inaccurate conclusion. Some doctors will do ovarian reserve testing whenever you go for your usual check- up so you are always in the know about where you stand with your reserve which i think is great.
AMH is a protein hormone produced by cells inside the ovarian follicles; the level of AMH in the blood can help doctors estimate the number of follicles inside the ovaries (long term reserve and this can be tested at any part of the cycle).
An antral follicle count (AFC), on the other hand, is performed by a doctor during an ultrasound. After visualizing the ovaries, the doctor can count the “activated” follicles, and use that number to estimate a woman’s total ovarian reserve (currently recruited eggs and this should be tested at the beginning of the cycle, around day 3-ish depending on the individual, but usually your doctor will guide you).
Something to remember, these ovarian reserve tests tell us about a woman’s egg count, not the QUALITY. So you can have a high AMH but maybe the quality of the eggs aren’t good, or a low AMH but the quality of the eggs are great. Don’t let low values get you down!
Again, we know that with age there is an inevitable decline in reserve, this is natural and meant to happen. If anyone tries to sell you that you can increase your count, run!
But you can improve the quality of the eggs!
AFC works the same as AMH, you could be 25 with with a low reserve or 35 with a high reserve.
No test is perfect, it just gives you the best overview it can to help you understand your reserve and plan ahead.
Also, don’t let your tests define you, I have seen many women get pregnant naturally on low AMH values. You may not have control over your quantity, but there are things you can do fr the quality!
Your reserve quality (internal) responds to what you eat, environmental toxins, lifestyle (external). By just nourishing the eggs you do have left, you are trying your best to ensure quality!