Testing Essentials: Ovarian Reserve Test
Ovarian reserve testing offers a snapshot of your current fertility potential. By measuring hormone levels (like AMH) and often including an antral follicle count (AFC), it helps you understand how your ovaries are responding — so you can plan ahead or prepare for treatment with more clarity.
Author
Tassia O’Callaghan
Reviewed by
Kayleigh Hartigan
18 min read
Treatment Spotlight:
- There isn’t one simple test for ovarian reserve — it’s usually a combination of blood tests (like AMH) and an ultrasound to check antral follicles. Together, they give insight into the quantity of eggs your ovaries are working with, but they can’t tell you about egg quality.
- It’s most commonly done through a blood test (AMH, FSH) and an internal scan (antral follicle count or AFC).
- AMH and AFC are the most reliable indicators of egg quantity, while FSH gives a general sense of how your ovaries are functioning.
- Your results won’t predict whether or when you’ll get pregnant, but they can help guide treatment decisions or planning.
- AMH testing isn’t routinely available on the NHS (like AFC). However, if you’ve been referred for NHS-funded fertility treatment, your clinic may carry out these tests as part of designing your treatment plan. Otherwise, they’re often available privately or as part of a fertility MOT.
- Your age, health history, and symptoms all matter too — ovarian reserve is just one piece of the fertility picture.
What is ovarian reserve testing?
Ovarian reserve testing helps assess how your ovaries are currently functioning — typically by looking at hormone levels and antral follicle count. It can’t predict if or when you’ll conceive, but it’s a useful tool when planning fertility treatment, especially if you’ve been trying to conceive for a while. [1]
We’re all born with a fixed number of egg-containing follicles in our ovaries — around one to two million. By the time puberty begins, this number drops to about 300,000. From there, your ovarian reserve continues to decline with age. Most of these follicles are lost naturally over time through a process called atresia — not through ovulation. This process continues throughout your life, even when you’re on hormonal contraception or pregnant. [2]
Everyone’s rate of decline is different, and it can be affected by things like age, genetics, medical conditions, and lifestyle (smoking, for instance, can speed up egg loss). As ovarian reserve decreases, it may become harder to conceive naturally — and your response to fertility treatment like IVF may also be affected.
Ovarian reserve testing gives a snapshot of how your ovaries are responding right now. It’s one piece of the puzzle — often used alongside other tests and clinical insight to help plan treatment (like egg freezing, IUI, or IVF) if you’ve been trying to conceive without success. It’s not about making big decisions based on one number, but about understanding your options as part of a fuller picture.
Who is ovarian reserve testing for?
Ovarian reserve testing is for anyone who wants a clearer picture of their current fertility — especially when time, health, or planning ahead are part of the equation.
It can be particularly useful if:
- You’re 35 or older and haven’t conceived after six months of trying. Egg quantity and quality tend to decline more rapidly after this age, and testing may help guide next steps sooner rather than later. [2,3]
- You have a known medical condition that might impact ovarian health — such as endometriosis, ovarian cysts, or autoimmune conditions. Some treatments or surgeries may affect your egg supply, and reserve testing can help assess any potential impact. [2,4]
- You’ve had previous ovarian surgery or pelvic treatment, including surgery for cysts, adhesions, or endometriosis. These can sometimes affect the ovarian tissue, and it’s useful to monitor reserve both before and after. [4]
- You’re considering assisted fertility treatment or egg freezing. Clinics often use ovarian reserve results to help plan medication doses and tailor treatment approaches.
It’s important to note that ovarian reserve testing is not a reliable way to predict your natural fertility or give you a simple “fertile or infertile” answer. Results can guide treatment planning, but they can’t tell you whether — or how quickly — you’ll conceive without medical help.
Find the right clinic for you
Choosing a clinic is one of the biggest decisions you’ll make. We’ll find the best options for you and arrange your pre-treatment tests, empowering you from this point onwards.
What are the tests for ovarian reserve?
There are three main ways to assess ovarian reserve: two blood tests and one internal scan. These tests — AMH, FSH, and antral follicle count (AFC) — each offer different insights, and are most useful when interpreted together, alongside your medical history and a consultation with a fertility specialist.
Anti-Müllerian Hormone (AMH)
Type of test: Blood test
When can it be done: At any point in your menstrual cycle (even during your period or ovulation)
AMH is considered one of the most reliable ways to estimate ovarian reserve. It’s a hormone released by the small follicles in your ovaries, and because each of those follicles contains an egg, your AMH level gives an indication of how many eggs may be left. The test is a simple blood sample, and the results remain fairly stable from month to month. AMH is particularly helpful for predicting how your body might respond to IVF medication. However, it can’t tell you anything about egg quality — only quantity — and it naturally declines as you age. It also can’t be improved through lifestyle changes, though understanding your levels may help guide your fertility choices. [5,6]
Antral Follicle Count (AFC)
Type of test: Ultrasound
When can it be done: At any point in your menstrual cycle (even during your period or ovulation)
Antral Follicle Count is a type of transvaginal ultrasound scan that’s used to count the number of small, developing follicles in your ovaries. These follicles are visible at the start of your cycle and give a real-time indication of how many eggs your ovaries may be preparing that month. AFC is often used alongside AMH to help plan fertility treatment, especially to determine the appropriate medication dose or assess the likelihood of a good response to stimulation. [6]
Follicle Stimulating Hormone (FSH)
Type of test: Blood test
When can it be done: Between day 2 and day 5 of your menstrual cycle
FSH is another hormone involved in egg development. It’s produced by the brain and acts on your ovaries to encourage follicles to grow. When your egg supply starts to decline, your body often compensates by producing more FSH. That’s why higher levels can sometimes signal a lower ovarian reserve. The test is taken via blood sample, sometimes alongside a measurement of oestradiol (a form of oestrogen) to give more context. FSH levels can vary from cycle to cycle, which makes it less consistent than AMH, but it can still offer useful clues about how your ovaries are functioning. [7,8]
How long does ovarian reserve testing take?
Ovarian reserve testing is usually quick and straightforward. The blood tests — such as AMH or FSH — only take a few minutes to carry out, and most results are ready within a few days, though this can vary depending on the clinic. The ultrasound scan (Antral Follicle Count) typically takes around 10–15 minutes and is often done during the early part of your menstrual cycle, usually between days 2 and 5.
If you’re having a full fertility assessment, these tests are usually carried out in clinic. Your team may combine them into a single visit or space them out depending on your cycle and availability. From your first appointment to receiving results, the process typically takes a few days to a couple of weeks.
How accurate is ovarian reserve testing?
Ovarian reserve tests are a useful way to understand how many eggs you may have left — but like all tests, they have limits.
The most reliable indicators are AMH (Anti-Müllerian Hormone) and AFC (Antral Follicle Count). These are good at estimating egg quantity and predicting how your ovaries might respond to fertility treatment like IVF. They’re more accurate and consistent than older tests like FSH or the clomiphene challenge test, which can vary depending on when they’re taken and don’t always spot a low reserve early. [5,9,10]
That said, ovarian reserve tests don’t measure egg quality — and this matters just as much. You could have a low reserve but still have good quality eggs and a chance of conceiving. Or a high reserve with eggs that are less likely to fertilise or lead to pregnancy, especially as you get older. Age still plays a major role here. [2]
It’s also worth knowing that ovarian reserve isn’t a fixed number — it changes over time and results can vary slightly between cycles or clinics. So the results are a snapshot, not a full prediction.
Can you get ovarian reserve testing on the NHS?
You may be able to access some ovarian reserve testing through the NHS, but what’s offered — and how soon — depends on your local Integrated Care Board (ICB), as well as your age and personal circumstances. If you’ve been trying to conceive for over a year (or six months if you’re over 35), your GP can refer you for initial fertility investigations. These typically include hormone blood tests like FSH (follicle-stimulating hormone) and may also involve a transvaginal ultrasound to examine your ovaries and uterus. While not specific to ovarian reserve, these tests can offer an early view of your reproductive health and egg quantity.
However, these are not the same as a full ovarian reserve assessment. AMH testing, antral follicle count (AFC), and consultation with a fertility specialist — the three elements most relevant to understanding ovarian reserve — are usually only offered on the NHS if you qualify for funded IVF. Otherwise, they are not routinely provided as standalone diagnostics through the NHS. [11]
If you don’t want to wait or you’re looking for faster access to more comprehensive testing, you can book privately with a fertility clinic. Many offer quick appointments, and often include AMH testing and ultrasound scans as part of a full fertility assessment. Find the best fertility clinic for you with our Clinic Match tool or browse options near you in the our clinic directory.
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Use our NHS IVF Eligibility Calculator to discover if you can access free IVF and IUI.
How much does ovarian reserve testing cost?
Ovarian reserve testing prices can vary depending on the clinic and what’s bundled together. A “fertility MOT” is often advertised, but this usually means a consultation, pelvic scan, and AMH test. FSH can be offered too, though it’s not usually part of a standard fertility MOT package. Always check exactly what’s included before booking.
Test or package
Cost range
Average cost
What’s usually included
AMH test (in a fertility clinic)
£56 – £180
£125
Often the main hormone checked in a fertility MOT.
FSH test (in a fertility clinic)
£20 – £150
£59
Can be ordered separately, but not usually part of a standard MOT.
Female fertility MOT
£250 – £500
£350
Typically includes a consultation, pelvic scan, and AMH test. FSH is rarely included.
Baseline pelvic scan
£100 – £270
£199.50
An ultrasound scan to check ovaries, uterus, lining, and antral follicle count (AFC).
What to do before ovarian reserve testing
Your clinic will let you know if there’s anything specific you need to do before your tests — and in most cases, there aren’t any strict requirements. That said, a few simple steps can help the process go smoothly and ensure your results are as useful as possible:
- Track your cycle, especially if you’re having tests like a scan or FSH blood test, which are usually done between days 2–5.
- Let your clinic know if you’re using hormonal contraception, as this can affect test timing or interpretation. If you’re on the pill, you’ll usually need to stop for at least three months before doing ovarian reserve testing — especially AMH or follicle tracking — to get accurate results.
- Share a list of any medications or supplements you’re taking, particularly if they include hormones or fertility-related treatments.
- Stay hydrated and well-rested — it can make blood draws more comfortable.
- Bring previous test results if you’ve had them done elsewhere — your clinic may still retest, but it’s helpful context.
- Bring a support person if it’ll make you feel more at ease.
Understanding ovarian reserve testing results
Ovarian reserve test results can feel technical at first glance, but each one offers a piece of the puzzle when it comes to understanding your reproductive timeline. Here’s how to make sense of what your AMH, AFC, and FSH levels might mean.
AMH (Anti-Müllerian Hormone)
- Low AMH (under 9 pmol/L): Suggests a lower number of growing follicles, which may mean reduced ovarian reserve. This doesn’t rule out pregnancy, but might point to a lower response to fertility treatment, or a shorter length of time to conceive with your own eggs. [5]
- Normal or ‘satisfactory’ AMH (9–25 pmol/L): Indicates a typical range for your age group and may suggest a normal response to stimulation. [5]
- High AMH (over 25–40+ pmol/L): Often seen in younger individuals or those with polycystic ovary syndrome (PCOS). A high result suggests a larger number of follicles, but doesn’t necessarily mean better egg quality — and in some cases, may increase the risk of overstimulation during IVF. [5]
Age
5th percentile
10th percentile
Median
90th percentile
95th percentile
25–29
11.9
13.4
28.3
52.1
67.8
25–29
8.4
13.1
23.8
53.8
65.4
30–34
4.8
6.8
19.7
47.8
53.9
35–39
–*
5.5
14.6
37.4
–*
40–44
40–44
–*
0.7
7.6
21.1
45–50
–*
0.3
1.6
14.7
–*
* Due to low numbers of patients in the older age groups, the lowest and highest percentiles were not calculated. [12]
AFC (Antral Follicle Count)
- Low AFC (fewer than 6–8 follicles total): May indicate reduced ovarian reserve and is often used as a marker for predicting how well the ovaries will respond to IVF stimulation. [13]
- Normal AFC (around 8–20 follicles): Suggests a healthy number of antral follicles for your age, with good response likely. [13]
- High AFC (more than 20 follicles, or more than 12 per ovary): May point to PCOS or a risk of over-responding to IVF medications. This result should always be interpreted in the context of your symptoms and other hormone levels. [13]
Age*
3rd percentile
10th percentile
25th percentile
50th percentile
75th percentile
90th percentile
97th percentile
20
8.0
10.3
12.7
16.0
21.0
26.4
34.8
21
7.7
10.0
12.2
15.5
20.5
25.9
34.0
22
7.4
9.6
12.0
15.0
20.0
25.4
33.2
23
7.1
9.3
11.5
15.0
19.5
24.7
32.4
24
6.7
9.0
11.2
14.5
19.0
23.9
31.6
25
6.4
8.5
11.0
14.0
18.5
23.5
30.7
26
6.2
8.3
10.5
13.5
18.0
22.7
30.0
27
5.9
8.0
10.2
13.0
17.5
22.1
29.2
28
5.6
7.6
10.0
13.0
17.0
21.8
28.4
29
5.3
7.3
9.5
12.5
16.5
21.1
27.6
30
5.0
7.0
9.0
12.0
16.2
20.4
26.7
31
4.7
6.7
8.7
11.5
15.7
19.6
26.0
32
4.3
6.3
8.2
11.0
15.2
19.0
25.4
33
4.1
6.0
8.0
11.0
14.7
18.6
24.5
34
3.7
5.7
7.4
10.5
14.2
18.0
23.6
35
3.6
5.3
7.2
10.0
13.7
17.4
22.6
36
3.2
4.9
7.0
9.5
13.2
16.5
22.0
37
3.0
4.6
6.5
9.0
13.0
16.1
21.2
38
2.4
4.2
6.0
9.0
12.5
15.6
20.5
39
2.2
4.0
5.6
8.5
12.0
15.0
19.8
40
2.0
3.5
5.5
8.0
11.5
14.4
19.0
* This data is based on a small study of women. [14]
FSH (Follicle-Stimulating Hormone)
- Low FSH (under 9 IU/L): Generally reassuring and suggests your ovaries are responding normally. [8,15]
- Borderline FSH (9–12 IU/L): May suggest the beginning of a decline in ovarian reserve, but should be considered alongside AMH and AFC. [8,15]
- High FSH (over 12 IU/L): Often a sign of reduced ovarian function. The higher it is, the more likely it is that your ovaries are working harder to produce a mature follicle. Very high levels (e.g., above 16 IU/L) are sometimes used to diagnose perimenopause or early ovarian insufficiency. [8,15]
Age
Mean FSH (IU/L)
6.5 ± 2.3
35-38
7.5 ± 2.4
38-40
7.5 ± 2.4
40+
8.5 ± 2.4
What happens after ovarian reserve testing?
Once your results are in, your clinician will schedule a follow-up appointment to talk them through with you. This is your opportunity to ask questions, explore what the numbers might mean in your individual context, and discuss what comes next.
If your ovarian reserve appears within the expected range for your age, your doctor may suggest continuing to try naturally for a while or explore other lifestyle and timing strategies. If the results suggest a lower or higher than expected reserve, you may be offered further testing, support with fertility planning, or tailored treatment recommendations — such as egg freezing, IVF, or hormone-based options.
Sometimes, your ovarian reserve test results might help explain other symptoms you’ve been experiencing, such as irregular cycles or early signs of menopause. And even if everything looks reassuring, the information can still be useful when thinking ahead — especially if you’re not ready to try for a baby yet.
Whatever the outcome, your clinic will help put it into context. Ovarian reserve is just one part of the bigger fertility picture, and your next steps should always reflect your goals, values, and overall health.
Sources
1. https://www.cambridge-ivf.nhs.uk/services/fertility-assessment-packages/ovarian-reserve-blood-test/
2. https://mft.nhs.uk/saint-marys/services/gynaecology/reproductive-medicine/what-else-do-i-need-to-know/
3. https://www.uclh.nhs.uk/our-services/find-service/womens-health-1/gynaecology/reproductive-medicine-unit/faqs
4. https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/endometriosis-and-ovarian-reserve/
5. https://www.plymouthhospitals.nhs.uk/display-pil/pil-antimllerian-hormone-amh-test-5585/
6. https://mft.nhs.uk/saint-marys/services/gynaecology/reproductive-medicine/how-do-we-start-the-process/
7. https://www.worcsacute.nhs.uk/documents/documents/patient-information-leaflets-a-z/you-and-your-fertility-journey//?layout=file
8. https://www.southtees.nhs.uk/services/pathology/tests/follicle-stimulating-hormone-fsh/
9. https://www.ncbi.nlm.nih.gov/books/NBK279058/
10. https://pubmed.ncbi.nlm.nih.gov/10548630/
11. https://www.uhcw.nhs.uk/ivf/treatments/what-to-expect/
12. [https://www.uhcw.nhs.uk/clientfiles/files/IVF/CRM AMH Patient Information (GEN-PI-000213V11).pdf](https://www.uhcw.nhs.uk/clientfiles/files/IVF/CRM%20AMH%20Patient%20Information%20(GEN-PI-000213V11).pdf)
13. [https://www.fertstert.org/article/S0015-0282(10)02461-1/fulltext](https://www.fertstert.org/article/S0015-0282(10)02461-1/fulltext)
14. https://pmc.ncbi.nlm.nih.gov/articles/PMC10556339/
15. https://www.nbt.nhs.uk/severn-pathology/requesting/test-information/fsh
16. [https://www.fertstert.org/article/S0015-0282(06)04396-2/pdf](https://www.fertstert.org/article/S0015-0282(06)04396-2/pdf)