The difference between ovarian reserve and egg quality

Most young patients who have a good antral follicle count and a normal AMH automatically assume that they will have good quality eggs , and therefore good quality embryos. However, the reality is that, while this is true for most young patients, this is not always true . Thus, every once in a while we will see young patients who have a good ovarian response, but whose egg quality is poor. They ultrasound scans show their follicular response is good, and their E2 levels rise properly, but when the embryologist checks the eggs in the IVF lab before doing ICSI, he finds to his dismay that they are of poor quality. There is a high proportion of immature eggs ( GV and M1) ; or they look abnormal ( they have an abnormal zona or their cytoplasm is granular and dark).

Unfortunately, poor egg quality is not something we can predict in advance . Eggs are microscopic , and we can only check their quality eggs after doing the egg collection and seeing how the eggs
look ; and whether they fertilize in the lab or not.  Ultrasounds scans only allow us to look at follicles, and while most mature follicles will contain good quality eggs, this is not always true. Thus, we will have patients with poor ovarian reserve who are poor ovarian responders, who end up producing beautiful blastocysts which become gorgeous babies; and we will also see patients who have lots of follicles, but whose eggs never become blastocysts. 

This is invaluable information , which teaches us more about the functional competence of the egg, but short of actually doing IVF, there is no way we can get this information. While the AMH test and the antral follicle count are useful tests, they are indirect markers for ovarian reserve , and do not allow to predict egg quality for the individual patient. Thus, poor egg quality is often one of the reasons for what was called "unexplained infertility" before we had a chance to look at the eggs.
This only serves to emphasise the fact that IVF can provide  important diagnostic information for infertile couples.


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