Is low ovarian reserve normal in your 20s or 30s? Fertility expert answers

For a long time, fertility issues were mainly linked to women in their late 30s or 40s. But now, doctors in India are noticing a change. More women in their 20s and 30s are being diagnosed with Diminished Ovarian Reserve (DOR). This means their fertility window may be shrinking earlier than expected, often without any obvious signs.

Dr. Apurva Satish Amarnath, a fertility specialist at Nova IVF Fertility in Bengaluru, explains that this trend is increasing. “We are seeing many young women with low ovarian reserve, low AMH levels, and irregular menstrual cycles,” she says. “This is far more common today than it was even ten years ago.”

Ovarian reserve refers to the number and quality of eggs a woman has in her ovaries. Unlike other cells, women are born with all the eggs they will ever have. Over time, the number and quality of eggs naturally decline. For most women, this reduction becomes noticeable in the late 30s or early 40s. However, when the decline happens earlier, it is called early ovarian ageing or diminished ovarian reserve. This condition can affect fertility planning and make it more difficult to conceive.

What makes this issue concerning is that it often develops silently. Many women feel healthy, have regular routines, and assume their fertility is normal—until they actively try to get pregnant. Clinicians now report that 30–35% of infertility cases involve women with low ovarian reserve. In severe cases, it can progress to premature ovarian insufficiency, where ovarian function stops entirely.

Why early fertility check-ups are important

Detecting diminished ovarian reserve early can be challenging. Irregular menstrual cycles are often mistaken for PCOS, especially in younger women. While PCOS is common, assuming every cycle irregularity is due to it can delay the correct diagnosis. Dr. Amarnath emphasizes that specific tests, such as measuring AMH (anti-Müllerian hormone) levels or performing an ultrasound-based antral follicle count (AFC), are needed to accurately assess ovarian reserve. Without these tests, diminished reserve can easily be missed.

Even though low ovarian reserve can sound alarming, it does not always mean infertility. Dr. Amarnath shares a case where a 26-year-old woman with severely diminished ovarian reserve was initially advised to use donor eggs. However, careful evaluation revealed a single mature follicle. That one egg was retrieved, fertilized, and successfully implanted, leading to a healthy pregnancy. This shows that fertility is not only about the number of eggs—timely assessment and proper management can lead to successful outcomes.

The rise of early ovarian decline has also led to more cases of secondary infertility, where women struggle to conceive a second child after a previous pregnancy. Because of this, doctors strongly recommend early fertility assessments, particularly for women with irregular cycles, unexplained difficulties in conceiving, or those planning to delay pregnancy.

Early evaluation helps couples understand their fertility status and make informed choices. Options may include timing conception carefully, considering medical support, or even fertility preservation. Dr. Amarnath stresses that proactive and personalized fertility care is most effective. “Early evaluation gives women options, and options are empowering,” she says.

In addition to medical tests, maintaining a healthy lifestyle can also support fertility. Balanced nutrition, regular exercise, managing stress, and avoiding smoking or excessive alcohol intake all help preserve ovarian function. Understanding risk factors, family history, and personal health patterns can guide women in making decisions about when to try for pregnancy and whether to seek fertility support.

In summary, low ovarian reserve is becoming increasingly common among women in their 20s and 30s. While it may be silent at first, early detection through proper testing is critical. Fertility specialists emphasize that even a small number of healthy eggs can lead to successful pregnancies if managed properly. Regular check-ups, awareness, and timely intervention give women more control over their reproductive health and future family planning.