Egg Quality vs. Egg Count and What the Biological Clock Really Means

Many women are told they are “running out of eggs.” According to Dr. Lucky Sekhon, that framing misses what actually determines fertility outcomes.

On The Tamsen Show podcast, Dr. Sekhon explains that fertility has two components, egg quantity and egg quality, and they do not matter equally in most situations.

Egg quantity refers to how many eggs remain in the ovaries. This can be estimated through ultrasound and blood tests such as AMH (anti-Müllerian hormone). These tools help fertility specialists plan treatments like IVF or egg freezing by estimating how many eggs may be retrieved. They do not measure whether those eggs are genetically healthy.

Egg quality refers to whether an egg can successfully fertilize, develop into an embryo, and result in a healthy pregnancy. There is no direct clinical test for egg quality in 2025. This is one of the largest blind spots in reproductive medicine.

Dr. Sekhon explains that egg quality declines as part of normal aging due to changes in the proteins that organize chromosomes during cell division. As these proteins degrade over time, eggs become more prone to chromosomal errors. This increases the likelihood that embryos will not implant or will miscarry early in pregnancy.

This distinction explains why someone with a “high egg count” can still struggle to conceive, and why someone with a lower egg count can still get pregnant. Each cycle produces only one ovulated egg. Quantity does not override quality.

The term biological clock often gets reduced to fear-based messaging. Dr. Sekhon reframes it as a statistical shift, not a deadline. In the 20s, approximately 20 to 25 percent of embryos may have chromosomal abnormalities. By the late 30s, that percentage rises. By the early 40s, a majority of embryos may be affected. Healthy eggs still exist, but they are less frequent.

This is why age impacts fertility even when cycles are regular and hormone levels appear “normal.”

Understanding this reality helps women make informed decisions without self-blame. Fertility outcomes are not a reflection of effort, discipline, or worth. They reflect probability and biology.

If you want to learn more, listen to this episode of The Tamsen Show podcast.