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Endometriosis and Ovarian Reserve: What Patients Should Know

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus, often causing symptoms such as pelvic pain and irregular or painful periods. For many patients, the condition can also affect fertility. 

While the exact mechanisms are still being studied, research suggests that endometriosis may influence ovarian reserve, which refers to the number of eggs remaining in the ovaries. Some researchers believe this may be related to the inflammatory environment created by the condition, which can interfere with egg development and maturation. This effect may be more pronounced when endometriosis forms ovarian cysts known as endometriomas or when surgery is performed to remove them.

One of the first ways providers assess how endometriosis may be affecting fertility is through ovarian reserve testing, which includes a blood test that measures anti-Müllerian hormone (AMH). AMH levels provide insight into the number of eggs remaining in the ovaries and can help guide conversations about possible treatment options. 

Understanding Ovarian Reserve and AMH

To understand what AMH levels reveal, it helps to know a little about how the ovaries function. Women are born with all the eggs they will ever have. These eggs are stored in tiny structures within the ovaries called follicles. Over time, some follicles develop while others naturally break down, gradually reducing the total number of eggs remaining.

AMH is produced by the cells surrounding early-stage follicles. Because these follicles contain immature eggs, the amount of AMH circulating in the bloodstream can give providers an estimate of how many potential eggs remain. In general, higher AMH levels suggest a larger remaining egg supply, while lower levels indicate a smaller ovarian reserve.

Providers often pair this blood test with a transvaginal ultrasound, which allows them to count visible antral follicles in the ovaries. Together, these tools help give a clearer picture of ovarian reserve.

Egg Quantity vs. Egg Quality

While ovarian reserve testing provides valuable information, it is important to understand what these results do and do not tell us. Tests such as AMH measure egg quantity, meaning the number of eggs remaining in the ovaries. They do not directly measure egg quality, which refers to whether or not an egg has the correct number of chromosomes needed to develop into a viable embryo. This means that a low AMH level does not necessarily indicate low fertility, as someone with a low egg count can still become pregnant if the eggs that remain are healthy.  On the other hand, someone with a higher AMH level may have more eggs but can still experience fertility challenges if egg quality is affected. Therefore, AMH results are best understood as just one part of a broader fertility evaluation. 

Because endometriosis can affect ovarian reserve, providers may recommend AMH testing for patients with the condition who are thinking about pregnancy or experiencing fertility challenges. The results can help show where someone currently stands in terms of egg supply and give providers insight into how the ovaries may respond to certain fertility treatments or help determine whether more testing is needed. 

An early fertility evaluation can help clarify how endometriosis may be affecting your ovarian reserve and allow for more informed planning around your fertility goals. 

Taking the Next Step in Your Fertility Care

The effects of endometriosis can vary widely from person to person, meaning there is no one-size-fits-all approach to care. At Pacific Fertility Center, our team works closely with each patient to develop treatment strategies that reflect their unique needs and priorities. If you are navigating endometriosis and thinking about your fertility, schedule a consultation to learn more. 

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