There are many misconceptions about women’s reproductive health: here’s what you need to know about egg reserve, fertility and ovarian ageing

Women across the world continue to face enormous social expectations around fertility, often alongside widespread misinformation about how the female reproductive system actually works. According to the World Health Organization (WHO), infertility affects around one in six people globally during their lifetime. Conditions that influence reproductive health are also common: polyendocrine metabolic ovarian syndrome (previously known as PCOS) affects an estimated 6-13% of women of reproductive age, endometriosis affects about one in 10 women and girls of reproductive age, while premature ovarian insufficiency affects around 1% of women under 40 years.Yet many women continue to encounter misconceptions that oversimplify fertility, place disproportionate responsibility on them and create anxiety around ageing and motherhood. Doctors say these myths do more than spread misinformation: they often delay medical evaluations, increase emotional distress, reinforce gender stereotypes around infertility and lead women to either seek unnecessary interventions or postpone appropriate care.Understanding egg reserveOne of the most common areas of confusion is about the ovarian, or egg, reserve. Experts explain that women are born with their lifetime supply of eggs. During foetal life, the ovaries contain around one to two million immature eggs. This number declines substantially before birth and continues to decrease throughout life. By puberty, roughly three lakh to five lakh eggs remain, but only about 400 will eventually be released through ovulation before menopause. The remaining eggs undergo a natural process of degeneration.A widespread misconception is that women lose a significant number of eggs after pregnancy or childbirth. Ramya Praveen Chander, consultant, reproductive medicine and IVF specialist, Kauvery Hospital, Chennai, said pregnancy temporarily pauses ovulation but does not accelerate depletion of the ovarian reserve. “The gradual decline in egg reserve is driven primarily by age and the natural loss of follicles over time, irrespective of whether a woman has had children.”Age remains the strongest determinant of ovarian reserve. Doctors say it generally begins declining around the age of 30, with a steeper fall after 35 and substantially lower reserves by 40. However, chronological age alone does not tell the full story. Niveditha Bharathy K., senior consultant, obstetrics and gynaecology, Apollo Speciality Hospitals, Vanagaram, Chennai, said two women of the same age can have markedly different ovarian reserves because genetics and individual ovarian biology also influence reproductive ageing.While there are tests to assess ovarian reserves, specialists caution against overinterpreting these tests. Dhivya C., senior consultant, reproductive medicine, Rela Hospital, Chennai, said AMH and AFC tests estimate ovarian reserve and help predict response to fertility treatment, they cannot reliably assess egg quality or accurately predict a woman’s chances of conceiving naturally.Dispelling fertility mythsMany misconceptions about fertility continue to delay evaluation and influence reproductive decisions.One of the most common myths is that regular menstrual cycles automatically indicate normal fertility. “Many women assume that if they have regular periods, they are definitely ovulating and therefore have every chance of conceiving. But regular menstruation does not necessarily mean normal ovulation,” Dr. Gopinath said. Ovulation may be absent, poor or normal despite regular cycles, making menstrual regularity an unreliable indicator of fertility.Fertility depends on several factors beyond ovulation, including egg quality, ovarian reserve, the health of the uterus and fallopian tubes, sperm quality and underlying medical conditions. Specialists also caution against the belief that fertility remains unchanged until menopause or suddenly drops after the age of 35. Fertility declines gradually with age, with a steeper decline during the mid- to late-thirties rather than at a fixed cut-off. Dr. Niveditha said, “the notion that fertility “falls off a cliff” at 35 is misleading. Although many women conceive naturally after 35 and even after 40, the chances of conception decrease while the risks of miscarriage and chromosomal abnormalities increase.”The belief that IVF “uses up” all of a woman’s eggs or causes early menopause also persists. Dr. Ramya explained that ovarian stimulation recruits only the eggs naturally selected to grow during that menstrual cycle. “Egg retrieval does not deplete future egg reserves or trigger menopause,”she said. Ovarian stimulation does not consume eggs that would otherwise have been available in future cycles.Experts also challenge the belief that infertility is solely a woman’s problem. Dr. Ramya said male factor infertility contributes to nearly as many infertility cases as female factors. Some couples have combined male and female factors, while others have unexplained infertility. Specialists therefore stress the importance of evaluating both partners.What influences reproductive ageing?Although biological ageing cannot be prevented, several factors influence ovarian health alongside age.Genetics plays an important role. Women with a family history of premature menopause may experience an earlier decline in ovarian reserve. Experts said family history can provide important clues, genetics influences both a woman’s starting ovarian reserve and the pace at which it declines.Medical conditions such as endometriosis, premature ovarian insufficiency, autoimmune disorders, previous ovarian surgery, chemotherapy and radiation therapy can affect ovarian function or accelerate egg loss. Lifestyle and environmental factors can also influence reproductive health. Doctors say smoking is among the strongest modifiable risk factors affecting fertility. Research has also linked obesity, being underweight, excessive alcohol consumption, air pollution and exposure to certain chemicals with changes in ovarian function, although the extent of these effects continues to be studied.Eating a balanced diet and staying physically active support overall reproductive health. However, these measures cannot prevent the natural age-related decline in egg quantity and qualityFuture fertility careResearchers are increasingly focusing on improving prediction, preservation and treatment rather than reversing ovarian ageing itself.Researchers are also investigating advanced biomarkers, including proteomic and metabolomic profiling, that could identify declining ovarian health earlier and more accurately than existing tests. Experimental approaches aimed at reactivating dormant follicles, including growth factor-based therapies and in vitro activation techniques, are also being explored for women with very low ovarian reserve. Researchers are also working to improve fertility preservation by refining egg and ovarian tissue freezing techniques.For women planning to delay pregnancy for education, career or personal reasons, specialists say assessing ovarian reserve may help inform reproductive planning. Women with diminished ovarian reserve may consider fertility preservation through egg or embryo freezing after appropriate medical evaluation. However, doctors emphasise that such decisions should be individualised and based on informed counselling rather than misconceptions or age alone.