The biological clock of fertility in women has steadily advanced. A female fetus develops a reserve of 5-6 million oocytes, which declines to about 2 million at birth. At puberty, approximately 400,000-500,000 oocytes remain, followed by progressive depletion over time until the reserve is exhausted and menopause occurs, on average, around 50 years of age.

“This message is increasingly communicated in alarming tones by the media, which highlight declining birth rates in our country and urge women to become aware of their reproductive potential before it is too late,” said Edgardo Somigliana, MD, professor of obstetrics and gynecology from the Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy, during the 9th National Congress of SIRU, the Italian Society of Human Reproduction, titled “Reproductive Medicine 4.0: New Frontiers and Strategies for Integrated Health,” held from April 16 to 18, 2026, at the University of Siena in Siena, Italy.

“Many women respond to these ‘awareness campaigns’ by undergoing two tests: measurement of anti-Müllerian hormone (AMH) levels in blood and ultrasound assessment of antral follicle count (AFC) to evaluate their fertility. Some propose extending these tests to all women of reproductive age to support informed reproductive choices.”

Clinical Limits

Commercial pressure has increased in parallel with clinics promoting AMH testing and do-it-yourself kits available online that measure hormone levels from a drop of blood. These direct-to-consumer products are often marketed with misleading claims regarding their ability to find reproductive potential or predict the age of menopause onset.

Measurement of AMH and AFC assesses the ovarian reserve. “These tests are indicated in patients undergoing medical assisted reproduction because they help predict ovarian response to stimulation: how many oocytes can be retrieved and, consequently, the probability of treatment success,” Somigliana said.

However, these parameters are not useful for assessing natural fertility. Female fertility declines with age, but this process is not directly linked to reduced ovarian reserve. Menopause occurs around 50 years of age, when oocytes are depleted, but fertility declines earlier, around 40 years of age because oocytes that have still been dormant for decades have aged, and their quality has deteriorated. Having plenty of oocytes is important for in vitro fertilization because it allows choice of the best ones. During spontaneous ovulation, the dominant oocyte that matures is not selected on the basis of quality. Selection is random, and the mechanism is the same regardless of whether few or many oocytes are available.

Multiple studies support these observations. The likelihood of spontaneous conception did not differ between individuals with high or low AMH levels. Even in older women, ovarian reserve status does not affect the probability of spontaneous conception. AMH concentration does not reliably show reproductive potential, and no significant difference in AMH levels exists between women with unexplained infertility and those being the general population. Among patients undergoing assisted reproduction, low AMH levels were not associated with a higher risk for spontaneous loss of pregnancy.

Screening Debate

“Based on these considerations, it is clear that screening ovarian reserve in the entire population of reproductive age would be ineffective,” Somigliana said. “Mass screening is appropriate for rapidly progressive conditions where intervention can alter outcomes. One example is the Pap test for cervical cancer. The decline in natural fertility is a slow process, predictable based on women’s age, and not related to ovarian reserve.”

They added that even if testing revealed a significant reduction in available oocytes, intervention options would be limited. “At that stage, it would be relatively late to consider oocyte cryopreservation because only a small number of oocytes could be retrieved. Individuals who choose to preserve oocytes should do so at a younger age, when oocyte quality is higher and the likelihood of achieving pregnancy later is greater.”

This story was translated from Univadis Italy, part of the Medscape Professional Network.