Egg Quality & Ovarian Reserve

What is the difference between egg quantity (AMH/AFC)and egg quality?

AMH (anti-Mullerian hormone) and AFC (antral follicle count on ultrasound) are both measures of quantity: they estimate how many eggs remain in your ovarian reserve at a given point in time. Neither test tells you anything directly about the quality, meaning the chromosomal normality and developmental competence, of those remaining eggs.

This is a common source of confusion, because a good AMH can feel reassuring in a way that doesn't reflect the full picture, and a lower AMH doesn't necessarily mean poor quality either. Quantity and quality decline on related but separate timelines as we age, which is why the two need to be considered as distinct pieces of information rather than one standing in for the other.

Can egg quality actually be improved after age 35 or 40?

This is a nuanced area. Age is the dominant factor in egg quality, and no intervention reverses the underlying chromosomal changes that become more common as eggs age, since those changes are largely set by the time an egg begins its final maturation. So it's important not to overstate what's possible here.

What the evidence does support is that the environment an egg matures in during its final 90-day developmental window can be influenced by factors like oxidative stress, blood flow, inflammation and mitochondrial function. Supporting that environment through nutrition, sleep, targeted supplementation and reducing oxidative load is about giving each cycle's eggs the best conditions available within your own age and reserve, not reversing age itself.
How long does it take to improve egg quality before trying to conceive or starting IVF?

The eggs that mature and are released, or retrieved during an IVF cycle, began their final growth phase roughly 90 days beforehand. This is why most functional preparation protocols work on a minimum three-month timeline, since that's the window during which nutrition, supplementation and lifestyle changes can plausibly influence the eggs currently developing.

Some people choose to extend preparation to four to six months, particularly where there are additional factors to address like insulin resistance, nutrient deficiencies or significant inflammation, since those often need their own time to shift before layering egg-specific support on top.

Can AMH levels change or fluctuate over time?

AMH declines gradually and fairly steadily with age as part of normal ovarian reserve depletion, but it can also fluctuate to a smaller degree between tests due to lab variation, the specific assay used, and factors like vitamin D status or hormonal contraceptive use, which has been shown in some research to temporarily lower measured AMH.

Because of this, a single low reading isn't always the full picture, and retesting after addressing factors like vitamin D deficiency, or testing with a different lab, can sometimes show a different number. That said, AMH doesn't meaningfully increase through lifestyle changes; what can change is the accuracy of the measurement itself, not the underlying reserve.

What role do cellular energy and mitochondrial function play in egg maturation?

Eggs are among the most energy-demanding cells in the body during maturation, and mitochondria (the cell's energy-producing structures) are present in eggs in far greater numbers than in most other cell types, reflecting how much energy the process requires. Healthy mitochondrial function supports accurate chromosomal division during maturation, which is directly linked to whether an egg is chromosomally normal.

Mitochondrial function and number both decline somewhat with age, which is part of why older eggs are more prone to chromosomal errors. This is the rationale behind nutrients like CoQ10, which supports mitochondrial energy production, being commonly used in egg quality protocols, alongside broader support for oxidative stress and cellular energy through diet and lifestyle.