Indoor image of an Indian female assistant doctor preparing injection in a clinic where a senior Asian female doctor is checking x-ray of patient sitting in the background his wife. Four people, waist up, horizontal composition with selective focus and copy space.
| Photo Credit: GAWRAV
It’s a striking claim that’s been repeated in clinics and headlines: ovaries in some Indian women appear to show signs of “ageing” earlier than in many Western peers. Put simply, markers that clinicians use to estimate ovarian reserve — most commonly serum anti-Müllerian hormone (AMH) and antral follicle count (AFC) — tend to decline earlier in many Indian cohorts. Recent studies from 2024 and 2025 do not claim that there is a single simple cause; rather, they point to a complex mix of genetics, environment, metabolic health, and social change that together may explain why a sizable subset of Indian women show lower ovarian reserves at younger ages.
Where did the “six-year” figure that is being touted about come from? Older comparative work and clinic-based observations popularised the idea that the ovarian age in Indian women can appear roughly several years “older” than age-matched Caucasian women. More recent Indian population studies don’t aim to pin a single universal number on that gap; instead, they show consistent patterns of earlier AMH decline in multiple regional cohorts, supporting clinical observations, while calling for population-specific age nomograms and careful interpretation of AMH across ethnicities.
Possible reasons
What could be behind this phenomenon? To start with, genetics and developmental factors are probably major contributors. Variability in the number of follicles one is born with as well as genes that regulate DNA repair in oocytes can determine the amount of ovarian reserve left at birth – these biological origins can be different for different populations. Next, a lot of evidence is gradually coming in that points to lifestyle and environmental stresses as major factors – increased exposure to endocrine-disrupting pollutants, heavy metals, and oxidative stressors can not only expedite follicular depletion, but can also cause damage. Several recent articles on premature ovarian insufficiency and ovarian ageing focus on the main cause of the environmental insults, together with genetics.
Metabolic health and reproductive disorders also matter. Rising rates of metabolic syndrome, obesity, and insulin resistance — paradoxically coexisting with undernutrition in parts of India — influence ovarian function. Polycystic ovary syndrome (PCOS), which alters follicular dynamics and AMH measures, is highly prevalent and complicates the interpretation of “reserve” versus “function.” Insulin resistance and chronic inflammation may blunt ovarian responsiveness and accelerate clinically apparent decline. Recent Indian studies link reproductive and metabolic markers to AMH trends.
The third component is societal change. Women in India are progressively postponing childbirth for education and careers; as a result, there has been an increase in women who come to fertility clinics at older ages or after years of subfertility; thereby, clinics are becoming more aware of cases of diminished reserves. Besides that, the differential limitations in access to nutrition, healthcare, and early detection lead to the manifestation of ovarian ageing being mostly at the stage when fertility is already compromised. International commentary in 2024 on AMH testing in India emphasises that there is a necessity for population-specific reference ranges and that the public should be more aware, so that over-diagnosis as well as under-diagnosis can be avoided.
Limits of tools
Nevertheless, a warning should be placed at the forefront: AMH is a worthwhile clinical tool – in particular, for the purpose of assisted reproduction – however, it is not a miraculous predictor of a woman’s capability of conceiving naturally or the time of menopause. Women need to stay wary of the heavy interpretation of AMH as a consumer “fertility test” without counselling; the hormone refers to the number of small follicles, not necessarily the quality of eggs or other aspects of fertility.
Healthcare providers recommend that the AMH level be accompanied with other criteria such as: age, ultrasound, menstrual history, and metabolic screening together, in order to provide a comprehensive picture of fertility.
What can be done?
At a public-health level, researchers recommend establishing robust, region-specific AMH/AFC nomograms so that clinicians and women have realistic, population-appropriate expectations; tackling environmental exposures, reducing air and water pollution, and monitoring heavy metals should be made a priority; addressing metabolic health early through lifestyle and primary care is crucial; and improving access to fertility counselling and timely testing for women who plan pregnancy will also help. On an individual level, awareness matters: earlier fertility planning, metabolic health optimisation, and early discussion with a reproductive specialist can preserve options.
In short, the observation that ovarian reserve declines earlier in many Indian women is supported by studies and expert consensus, but it is not reducible to one cause or a single number. It is a multifactorial reality at the intersection of biology, environment, and social change, and it demands both better population-specific research and practical public health responses so women can make informed reproductive choices.
(Dr. Latha V., clinical director and fertility specialist, Nova IVF Fertility, Coimbatore. Email: v.latha@novaivffertility.com)
Published – December 24, 2025 07:00 am IST
