A Hidden Culprit Behind Low Egg Reserve: What Most Tests Miss

If you’ve recently been told that your egg reserve is low, especially if you’re relatively young and otherwise healthy, you may be left with more questions than answers. Many people facing fertility challenges feel blindsided by this diagnosis. It can be an overwhelming and emotional experience, made worse when no one can clearly explain why this is happening.

One of the most overlooked yet impactful causes of diminished egg reserve is a condition that remains underdiagnosed in reproductive healthcare: endometriosis.

Endometriosis: Often Missed, But Not Rare

Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus: commonly affecting the ovaries, fallopian tubes, and pelvic structures. While it’s often associated with painful periods and pelvic discomfort, the reality is that over 50% of cases may go undiagnosed, this is especially critical in people undergoing fertility assessments.

Why? Because endometriosis doesn’t always present with classic symptoms. In fact, a growing number of individuals with low egg reserve and no clear reason behind it are later found to have symptoms suggestive of endometriosis, but only after a more in-depth evaluation.

Some of the signs that may be overlooked early on include:

• Pain during intercourse (dyspareunia)

• Painful periods (dysmenorrhea)

• Cyclical bloating, fatigue, or digestive symptoms

• Significant lower back pain or pelvic discomfort that worsens during menstruation

These symptoms may be normalized or dismissed, and when fertility testing focuses only on surface-level hormone levels or imaging, the deeper picture is often missed.

Understanding Egg Reserve...And Why It May Be Low

Ovarian or egg reserve refers to the quantity and potential quality of eggs remaining in the ovaries. A low reserve doesn’t mean pregnancy is impossible, but it often signals a narrower window for conception and lower response to fertility treatment.

While aging is a well-known factor in declining egg reserve, it’s not the only one. Some of the other possible contributors include:

• Genetics and family history

• Smoking and toxin exposure

• Autoimmune conditions

• Surgical damage to the ovaries

• And importantly, undiagnosed endometriosis

Endometriosis can reduce egg reserve through a number of mechanisms:

• Inflammatory damage to the ovaries

• Formation of endometriomas (ovarian cysts) that damage surrounding tissue

• Hormonal disruption and oxidative stress

• Immune dysregulation that may interfere with reproductive function

• Alterations in the reproductive microbiome

In severe or advanced cases, people are diagnosed with diminished ovarian reserve and given little to no explanation, ust a recommendation to consider IVF as quickly as possible. This creates significant stress, and often a sense of helplessness.

What Standard Testing May Miss

For many individuals, routine fertility workups don’t include a proper assessment for endometriosis, especially when ultrasounds and lab work appear normal. Unfortunately, a normal scan doesn’t rule out the presence of deep or subtle endometriotic lesions.

Many are told their fertility is “unexplained” or simply “bad luck.” But when low egg reserve is present and symptoms suggestive of endometriosis emerge upon deeper questioning, it’s a sign that further assessment needs to be considered.

Taking a Root-Cause Approach to Care

At our clinic, we approach fertility with the understanding that there is always a reason — even if it hasn’t been found yet.

If your egg reserve is low and there hasn’t been a clear explanation, here’s what a more comprehensive, personalized evaluation can include:

• A detailed review of symptoms, medical history, and lifestyle

• Comprehenisve testing for additional risk factors that may contribute to the specific symptoms and case of infertility

• Assessment of immune and inflammatory markers

• Evaluation of hormonal patterns and egg quality

• A holistic treatment plan to support egg quality, hormonal balance, and reduce inflammation

• Considering detailed assessment and treatment for Partner to support sperm health

You're Not Alone, And You're Not Out of Options

Being told your egg reserve is low can feel like a door is closing. But for many people, uncovering an underlying cause like endometriosis helps shift the focus from fear to action and opens a path forward that actually addresses the root of the issue.

Whether you’re just beginning your fertility journey or have already done several rounds of testing, we’re here to listen, assess thoroughly, and help you move forward with clarity and confidence.

Book a consultation to explore your symptoms and history in more depth. Together, we can create a targeted, compassionate, and proactive strategy to support your reproductive health.

Disclaimer: This blog is for informational purposes only and should not be taken as medical advice. Always consult with your Naturopathic Doctor before starting any new supplement, especially during fertility treatments like IVF.