Can You Test Egg Quality? What a Fertility Doctor Wants You to Know

“Can you test egg quality?” is probably the single most common question I hear in my practice, and one of the most frequent questions that lands in my Instagram DMs. I understand why. When you are navigating fertility, whether you are trying to conceive, considering egg freezing, or going through IVF, you want answers. You want a number, a test result, something concrete you can point to and say this is where I stand.

I wish I could give you that. But the honest answer is more complicated than most people expect, and I think it is far more important that you understand the truth than that I give you a comforting oversimplification.

I’m Dr. Lucky Sekhon, a double board-certified Reproductive Endocrinologist and Infertility (REI) specialist practicing in New York City, and author of The Lucky Egg: Understanding Your Fertility and How to Get Pregnant Now. Through this blog, my Instagram @lucky.sekhon, and my monthly newsletter The Lucky Egg Drop, my mission is to cut through the confusion and empower you with science-backed, practical fertility knowledge. And few topics need that clarity more than egg quality, because there is an enormous amount of misinformation out there, from supplement companies promising to “restore” your eggs to well-meaning providers who conflate egg quantity with egg quality, sometimes with devastating consequences for the patients sitting in front of them.

So here is the bottom line up front: there is no direct test for egg quality. Not AMH, not AFC, not PGT, not a blood test, not an ultrasound, not a hormone panel! But that does not mean we are flying blind. There are meaningful ways to gain insight into your egg quality, and understanding what those are (and what they are not) is one of the most empowering things you can do for your fertility. In this post, I am going to walk you through what egg quality actually means, why the tests you may have already had do not measure it, what actually gives us real insight, and what you can and cannot do about it.

What “Egg Quality” Actually Means

When fertility specialists talk about egg quality, we are not talking about how an egg looks under a microscope (though embryologists do assess that too, and I go into detail about how embryos are visually graded in a separate post). What we are really talking about is the chromosomal health of an egg, specifically, whether an egg has the potential to yield an embryo with the correct number of chromosomes. A healthy human embryo needs exactly 46 chromosomes, 23 from the egg and 23 from the sperm. When that balance is right, the embryo is called euploid, and it has the highest chance of implanting, sustaining a pregnancy, and resulting in a healthy baby. When the balance is off, which we call aneuploidy, the outcomes are much less favorable. The most common result is that the embryo simply does not implant. You do not get pregnant that month, and you may never know that a chromosomally abnormal embryo was the reason. The second most common outcome is an early miscarriage, where the embryo begins to implant but then stops developing. In rarer cases, aneuploidy can result in conditions like Down syndrome (trisomy 21) or Turner syndrome.

This is why I tell my patients, practically on a daily basis, that human reproduction is fundamentally inefficient. Even in your mid-to-late 20s, when your fertility is at its peak, roughly 20 to 27 percent of embryos would be chromosomally abnormal. That means even in the best-case scenario, not every ovulation is going to result in a viable pregnancy. It is just biology. (This data comes from a landmark analysis of 15,169 trophectoderm biopsies published in Fertility and Sterility by Franasiak and colleagues, which found an aneuploidy prevalence of 20–27% in women aged 26–30.)

And here is the part that is hardest for many of my patients to hear: egg quality declines with age, and that decline is not something we can reverse. Unlike many other cells in the body, eggs lack robust repair mechanisms. We are born with all the eggs we are ever going to have, somewhere between one and two million of them, and we cannot make new ones. Over time, as those eggs sit in the ovary, they accumulate damage to the structures that sort chromosomes during cell division. The result is a gradual increase in the proportion of eggs that yield aneuploid embryos. I discuss the science behind this timeline in depth in my post on the female biological clock and fertility.

The data on this is extensive and consistent. In the same study by Franasiak et al. that I referenced previously, what they found was a clear, reproducible pattern: the prevalence of aneuploidy was lowest between the ages of 26 and 30, at roughly 20 to 27 percent. Aneuploidy then rose steadily with age. By 40 and older, aneuploidy rates had climbed to approximately 58 percent. By age 43, that figure reached approximately 85 percent. The study also found that the risk of having no chromosomally normal embryos within an entire cohort was low and stable between ages 26 and 37 (just 2 to 6 percent), but that risk jumped to 33 percent by age 42 and 53 percent by age 44. A more recent analysis of over 23,000 embryos from 57 fertility clinics reported broadly consistent findings: aneuploidy rates of 46 percent in women under 35, 54 percent at ages 35 to 37, 63 percent at ages 38 to 40, and 66 percent at ages 41 to 42 (Morris et al., Fertility and Sterility 2021).

I want to be clear: these numbers do not mean you cannot get pregnant at 38 or 40 or even 42. People do, every single day. What it means is that the proportion of any given month’s ovulated egg being chromosomally healthy is lower, so it statistically takes longer and the risk of miscarriage is higher. It is a probability game, not a certainty of failure. In fact, the Morris et al. analysis found that even at ages 41 to 42, 56 percent of IVF cycles still yielded at least one chromosomally normal embryo, and for women under 35, that number was 86 percent (based on an analysis of 23,561 embryos from 4,833 IVF cycles across 57 clinics).

The AMH Confusion: Egg Quantity Is Not Egg Quality

If you have had any kind of fertility evaluation, chances are someone checked your AMH level. AMH, or anti-Müllerian hormone, is a blood test that tells us about your egg quantity, meaning how many eggs are available for recruitment to the surface of the ovary in a given cycle. It correlates with how you would respond to ovarian stimulation during IVF or egg freezing, and it gives us a rough sense of where you are in your overall egg supply. A higher AMH generally means more eggs available; a lower AMH means fewer. If you want to understand more about what your follicle count means alongside AMH, I have a detailed breakdown in my post on antral follicle count and what your AFC means for IVF, egg freezing, and fertility.

Here is what AMH does not tell you: the quality of those eggs. AMH cannot tell you whether the eggs in your ovaries are chromosomally healthy. It cannot predict your odds of getting pregnant on your own. It is a quantitative marker, not a qualitative one. And this is not a subtle distinction. It is the difference between knowing how many lottery tickets you have and knowing whether any of them are winners.

I cannot tell you how many patients I see who have been told by another provider that because their AMH is low, it will be “impossible” or “very unlikely” for them to get pregnant. Just recently I saw a patient in her late 30s with a low AMH who was told almost exactly that by a previous fertility specialist, which is just NOT accurate at all! If you are still ovulating regularly, you are still releasing one egg each month. Whether your ovaries are recruiting 5 eggs or 25 behind the scenes does not change the basic biology of how natural conception works. You ovulate one egg, and if it happens to be chromosomally normal, a healthy pregnancy is absolutely possible. Remember my catch phrase, that one day I hope to trademark: as long as you are ovulating, you are in the game!

The same goes for FSH (follicle-stimulating hormone) and AFC (antral follicle count) on ultrasound. These are all quantity markers. None of them tell us about the genetic health of individual eggs. And yet I see them being used as de facto “fertility tests” all the time, both by providers and by direct-to-consumer testing companies that market AMH as a way to “check your fertility.” If I was ever to create merch, my first order of business would be a T-shirt, maybe a mug, that says: Your AMH is not a fertility test!

Now, I want to be fair and nuanced here. The science on AMH and natural fertility is evolving. In 2017, a landmark prospective cohort study by Steiner and colleagues, published in JAMA, followed 750 women aged 30 to 44 without a history of infertility. They found that women with low AMH levels (below 0.7 ng/mL) had no statistically significant reduction in their probability of conceiving over 6 or 12 cycles compared to women with normal AMH levels. In fact, the cumulative probability of conception after 12 cycles was 84 percent in the low AMH group versus 75 percent in the normal AMH group. A more recent 2024 cohort study of over 3,000 women published in Fertility and Sterility did find a modest association between low AMH (below 1.0 ng/mL) and reduced conception probability (adjusted hazard ratio of 0.77), though the absolute per-cycle difference was small, about 11 percent versus 14 percent. But even this newer data does not change the fundamental message: AMH is primarily a marker of how many eggs you have available for stimulation, and it should never be used to tell someone they cannot get pregnant. If you want a deeper dive into the IUI-versus-IVF decision when AMH is low, I walk through that in my post on how to choose between IVF and IUI when you have a low AMH level.

I do not think it makes sense to keep checking your AMH every six months as a "fertility check-in," which is something a lot of my patients do. How is the information actionable? If the level drops significantly (which we know it will with enough time), all it does is make you anxious. If you are worried enough about your fertility to be serially tracking your AMH, it may be time to have a real conversation about fertility preservation, rather than watching a number decline and hoping for the best.

If you want to understand where your AMH falls relative to age-matched norms, I built a free AMH Level Checker tool on this blog that can help you contextualize your results.

So What Actually Gives Us Insight Into Egg Quality?

If there is no blood test and no ultrasound for egg quality, how do we learn anything about it at all? In my clinical practice, I rely on two things: age and IVF with preimplantation genetic testing (PGT-A). That is it. Everything else is either indirect, unproven, or marketing.

Age is the single strongest predictor of egg quality. The data I shared earlier on aneuploidy rates by age comes from decades of PGT-A testing across hundreds of thousands of embryos, and the pattern is remarkably consistent. When a patient asks me about her egg quality, the first and most informative piece of information I have is her age. However, it is not a perfect predictor on an individual leveI, I have seen 28-year-olds with surprisingly high rates of chromosomally abnormal embryos, and 40-year-olds who produce a beautiful cohort of euploid blastocysts, but it is the best population-level estimate we have.

IVF with PGT-A is the only way to get direct, individualized insight into the chromosomal health of specific embryos made from your eggs. This is something I feel strongly about and talk about often: IVF is not only therapeutic, it is diagnostic. When we take eggs out of the body, fertilize them with sperm, grow them into embryos, and then biopsy and test those embryos, we are gaining information that is simply not available any other way. We see how your eggs interact with sperm. We see how many fertilized eggs actually develop into blastocysts (day 5 to 7 embryos). And we see, through PGT-A, which of those embryos have the correct number of chromosomes. For a broader look at what PGT-A can and cannot tell you, including its limitations, see my posts on why a PGT-normal embryo is not a guarantee and whether you should consider PGT-P polygenic screening.

The attrition that happens at each stage of this process is itself informative. In general, I tell patients to expect roughly 50 to 60 percent of fertilized eggs to make it to the blastocyst stage. If you are seeing something much steeper than that, say only one out of seven fertilized eggs making it to blastocyst, that is a signal worth investigating. It could point to egg quality issues, but it could also be related to sperm quality beyond what a standard semen analysis reveals, PCOS with underlying insulin resistance, lab conditions, or even parental chromosomal rearrangements that a karyotype test could uncover.

This is one reason I advocate for PGT-A even in patients under 35 who have unexplained infertility, which I know goes against what some providers recommend. The traditional thinking has been that younger patients do not need PGT-A because their aneuploidy rates are lower. But here is my concern with that logic: if you have unexplained infertility, meaning all your standard tests came back normal but you have not been able to get pregnant, we do not know what we are treating. It could be an egg quality issue, but we have no direct way to test that without going through IVF and actually looking at the embryos. I think it is a missed opportunity to skip the very thing that could give us the most insight into what is going on.

Even in your 20s, 20 to 25 percent of embryos are chromosomally abnormal. Anyone can make an abnormal embryo. If you have been struggling for a year on your own and have failed medicated IUI cycles, once you reach the point of doing IVF, it just makes sense to take advantage of the diagnostic window it provides. If you want to estimate your chances ahead of time, my Euploid Embryo Predictor tool can give you a personalized projection based on your age and other variables.

Signs That Egg Quality May Be a Factor

One of the most frustrating things about egg quality issues is that there are no symptoms you can feel. You cannot sense it. There is no pain, no bleeding pattern, no physical sign that would tip you off. But there are clinical patterns and situations that may suggest egg quality is playing a role:

You have been diagnosed with unexplained infertility. Up to one in three couples with infertility receive this diagnosis, and I have written before about how the term "unexplained infertility" needs a rebrand. It sounds like a lazy excuse, like your doctor is saying "sorry, I have got nothing." But what it really means is that the standard tests we have, the semen analysis, the HSG, the pelvic ultrasound, the hormone panels, have not identified the barrier. And one of the most common barriers that these tests simply cannot detect is egg quality. We cannot directly test whether you tend to ovulate chromosomally abnormal eggs, and conditions like silent endometriosis, which can alter the reproductive environment, are often undiagnosed because the gold standard for diagnosis is an invasive surgery. So "all tests normal" does not mean nothing is wrong. It may just mean we cannot test for what is actually going on.

You have experienced recurrent miscarriage. Chromosomal abnormalities are the most commonly identified cause of early pregnancy loss. The American College of Obstetricians and Gynecologists notes that approximately 50 percent of early pregnancy losses are associated with a chromosomal abnormality, and some analyses using comprehensive molecular testing methods have reported rates as high as 70 percent or more. If you have had multiple miscarriages, especially early ones, it is reasonable to consider that egg quality is contributing, particularly if those pregnancies were not tested for chromosomal abnormalities. I discuss the complex relationship between genetic testing and pregnancy loss in my post on why miscarriages still happen after transferring a PGT-normal embryo, and I also explore the role of the hormone progesterone in early pregnancy in my post on whether low progesterone is a cause or symptom of miscarriage.

Your IVF cycle showed steeper-than-expected drop-off. If you went through IVF and the number of embryos that made it to the blastocyst stage was well below the expected 50 to 60 percent conversion rate, that is worth a closer look. This is especially true if you are under 35, where steep drop-off is less expected. In my practice, when I see this pattern in a younger patient, I immediately think about three things: could this patient have PCOS with unaddressed insulin resistance? Could there be a sperm quality issue that a standard semen analysis did not catch? And should we check both partners' karyotypes to rule out chromosomal rearrangements?

You have had repeated failed embryo transfers without PGT-A. If you have transferred multiple embryos that were not genetically tested and none resulted in a pregnancy, it is possible that those embryos were aneuploid. Without testing, there is simply no way to know, and each failed transfer may be telling you more about embryo quality than about your uterus. If you find yourself in this situation, I outline the key questions to ask your doctor in my post on what to do after a failed frozen embryo transfer.

You are over 35, and especially over 38. This is not a "sign" in the traditional sense, but age is the single most significant risk factor for declining egg quality. If you are in this age range and struggling to conceive, egg quality should be part of the conversation with your doctor.

I also want to be clear about what is NOT a sign of poor egg quality: a low AMH level on its own is not evidence of poor egg quality. Neither is an irregular period in isolation, a single failed IUI, or anything a supplement company's marketing department has told you are "symptoms of aging eggs."

What You Can (and Cannot) Do About Egg Quality

I am going to be direct with you here, because I think you deserve honesty more than you deserve hope that is not grounded in science.

There is no proven treatment, supplement, or lifestyle change that has been shown to reverse egg quality decline. The ovaries and the eggs they contain lack the repair mechanisms that other cells in the body have. Once chromosomal damage has occurred in an egg, we do not have a way to undo it. I see a lot of people, and many well-meaning influencers, attribute a successful pregnancy after a period of struggle to a new supplement or a major diet change. The reality is that we do not have proof of that. More likely, they happened to ovulate one of the good eggs that were still in there. And that is the important thing to understand: even at ages where aneuploidy rates are high, there are still normal eggs. The odds are lower, but they are not zero. I explore this kind of magical thinking in detail in my brutally honest review of It Starts With the Egg.

Do a quick Google search for "improve egg quality" and you will find thousands of products and claims promising to reverse these changes. None of it is backed by rigorous evidence, and some of it preys on people who are desperate and vulnerable. Hucksters and charlatans crowd the fertility related search rankings, unfortunately. That is something that, as both a fertility doctor and someone who went through IVF myself, makes me genuinely angry. The same pattern of overpromising applies to treatments like growth hormone (Omnitrope) in IVF and PRP for ovarian rejuvenation, both of which I have written about at length.

Here is what the evidence actually supports:

Freeze your eggs or embryos. This is the single most effective thing you can do to preserve egg quality at a given point in time. When we freeze eggs or embryos, we halt the aging process for those cells. You can come back and use them years later, and their quality will reflect the age you were when they were frozen, not the age you are when you use them. Your uterus does not age in the same way, which is why this works. I underwent embryo freezing with my husband when I was 34, and I talk about this openly because I want patients to understand that fertility preservation is a proactive tool, not a sign of failure. If you are thinking about this path, my egg freezing calculator can help you estimate how many eggs you may need to freeze to meet your family-building goals.

Pursue IVF with PGT-A if you want to identify and select chromosomally normal embryos. This does not improve the quality of your eggs, but it does allow us to find the normal embryos in the group and prioritize those for transfer. It can significantly reduce miscarriage risk and shorten the time to a successful pregnancy, especially for women over 35. It is also worth knowing that mosaic embryos, those that come back with a mix of normal and abnormal cells, can sometimes still lead to healthy pregnancies, which is an important nuance I discuss in a separate post.

CoQ10 supplementation. Coenzyme Q10, studied at doses of 600 milligrams per day, has shown some promising results in older women with diminished ovarian reserve as a way to potentially boost response to ovarian stimulation and possibly the yield of eggs from a given cycle. I want to be precise about what this means: it is not proven to change the chromosomal health of individual eggs. But it may help you get more eggs to work with during IVF, which improves your overall odds. It is also known to be good for heart health and is generally safe, so my view is that if there is no potential harm and there could be a potential benefit, it is reasonable to consider.

Stop smoking. This is one area where the data is definitive. Smoking is directly linked to accelerated loss of eggs and reduced egg quality. If you smoke and are trying to conceive or planning to in the future, quitting is one of the most impactful things you can do. Actually, let me rephrase that, even if you are NOT trying to conceive or planning to in the future, you should still quit smoking!!

General health optimization. Regular exercise, a Mediterranean-style diet rich in leafy greens, fruits, nuts, seeds, and healthy fats, and reducing your exposure to endocrine-disrupting chemicals in household products and cosmetics are all sensible steps. Concerns about microplastics and fertility are also understandable, though I have written about why the current evidence does not warrant panic. These measures are unlikely to reverse existing damage, but they support your overall reproductive health and may help slow the rate of decline. I go into this in much more detail in my book, The Lucky Egg.

I want to end this section on a note of hope. The Morris et al. analysis of over 4,800 IVF cycles with PGT-A across 57 fertility clinics found that the vast majority of women, even in older age groups, had at least one chromosomally normal embryo available per cycle: 86 percent for women under 35, 81 percent at ages 35 to 37, 70 percent at ages 38 to 40, and 56 percent at ages 41 to 42. These are encouraging numbers (Morris et al., Fertility and Sterility 2021). They tell us that even when the odds are not in your favor on a per-egg basis, IVF gives us the ability to work with a larger cohort of eggs at once and find the good ones.

The Bottom Line

If there is one thing I hope you take away from this post, it is this: the absence of a direct egg quality test is not a reason to feel powerless. It is a reason to be informed. When you understand what your fertility tests actually measure, when you stop conflating egg count with egg quality, and when you recognize that age and IVF with PGT-A are the most honest tools we have for gaining insight into chromosomal health, you are in a far stronger position to make decisions that are right for you. I know the uncertainty is hard. I have sat on both sides of that conversation, as the doctor delivering the information and as the patient receiving it. But I have also seen, over and over again in my clinic, that knowledge does not take away hope. It sharpens it. It helps you direct your energy, your time, and your resources toward the strategies that are most likely to work for your specific situation, rather than chasing false promises or spiraling over a lab result that was never designed to answer the question you are really asking. You deserve better than that, and I hope this post has given you a clearer picture of where things actually stand.

If you found this post helpful, I encourage you to follow me on Instagram @lucky.sekhon for regular fertility updates, subscribe to my monthly newsletter The Lucky Egg Drop, and check out my book The Lucky Egg: Understanding Your Fertility and How to Get Pregnant Now, which covers egg quality, IVF decision-making, and much more in depth.