The ovarian reserve is the number of primary ovarian follicles that are able to transform into an egg. Women are born with a predetermined number of these follicles, which decreases over time and therefore the likelihood of pregnancy decreases. Therefore, the earlier we decide to have a child, the better the chances of conception are. How to test your ovarian reserve and what to do when it turns out to be low?
Ovarian reserveis the reproductive potential of the ovaries - the number of follicles that are able to grow and transform into a mature egg.
A girl is born with a certain specific ovarian reserve, which is about 1-2 million. primary cells, i.e. oocytes, from which egg cells will be formed in due course. From now on, the number of oocytes is only dropping.
At the time of puberty, it is already 300-500 thousand. Then most of these oocytes are degraded and ultimately only 400-500 remain, which mature successively under the influence of hormones.
One of them ovulates in each menstrual cycle. Therefore, the older we are, the less chance of conception is.
As late as 30-40 years ago, most women had babies in their twenties. Today things are completely different. After graduation, we go to work, then we focus on our career.
Having children becomes a secondary matter: "I still have time for that", "Not now, later", we say. We start a family in our thirties, and only in a few years does the thought of a child appear. For many couples, it may already be too late. Well, the biological clock is ticking …
What does the ovarian reserve depend on
Ovarian reserve is primarily related to the age of a woman. The older she is, the fewer eggs she has, so her chances of fertilization decrease.
Other reasons:
- ovarian diseases, cysts, gynecological operations. If a cyst is detected, a very thorough diagnosis should be carried out, because most of these changes do not require surgical intervention, but only appropriately selected pharmacological therapy. However, the procedure is associated with the risk of damage to the ovary or fallopian tube, which has a negative impact on the ovarian reserve
- nicotine
- lack of physical activity
- genetic background orautoimmune (hypothyroidism caused by Hashimoto's disease, Addison's disease, i.e. primary autoimmune adrenal insufficiency, visceral lupus erythematosus, rheumatoid arthritis, diabetes)
- viral infections, e.g. epidemic salivary gland inflammation combined with adnexitis
- chemotherapy
- radiation therapy
When does the ovarian reserve fall?
This has been happening since the age of 20, and a particularly marked decrease in the number of eggs has been observed from the age of 30, although it is an individual matter.
The thesis that a woman's reproductive capacity drops sharply after the age of 30 has recently been challenged by the American psychologist Jean Twenge.
She claims that this data comes from outdated statistics, based on studies of a completely different population.
Today, women are physically active longer, smoke less, use much more modern medical knowledge and technology. Anyway - they even look younger!
Twenge gave birth to three children, all after the age of 35, and proves that there is really little difference between the fertility of a woman in her twenties and a more mature woman.
This is supported by a 2004 study conducted under the supervision of David Dunson. The chances of 770 European women getting pregnant were analyzed.
Among participants aged 27-34, 86% became pregnant within a year, and 82% in the 35-39 age group. According to Jean Twenge, this is proof that fertility does not decline so dramatically in your 30s, and that endometriosis and blocked fallopian tubes are a much bigger problem when it comes to getting pregnant.
How to test the ovarian reserve?
Ladies trying to conceive can do some tests to help estimate the chances of conception. They are:
FSH (Follicular Stimulating Hormone)- testing the level of follicle stimulating hormone (also called follicle stimulating hormone) produced by the pituitary gland.
It is thanks to FSH that the egg follicles mature and estrogens are released. Interestingly, this hormone is present not only in the body of women, but also men, and its testing in both sexes is used to diagnose infertility.
The FSH test consists in drawing blood on the 3rd day of the cycle. They can be performed free of charge, if we have a referral from a doctor working under the National He alth Fund. Privately, it costs PLN 15-50, depending on the laboratory.
How to interpret FSH level results?
- below 3 mIU / ml - pituitary insufficiency
- 3-9 mIU / ml - a satisfactory ovarian reserve
- 9-12 mIU / ml - low ovarian reserve
- 12-18 mIU / ml - significantlydecreased (exhausting) ovarian reserve
- over 18 mIU / ml - ovarian reserve depleted
In women, in addition to diagnosing infertility, FSH can also help diagnose ovarian diseases such as polycystic ovary syndrome and other hormonal disorders, as well as determine whether a woman has entered menopause.
AMH- test of anti-Mullerian hormone concentration in blood serum. This hormone is produced by the follicles that surround the eggs, and the fewer eggs there are, the lower the concentration is. The test is performed in any phase of the cycle.
How to interpret AMH results?
- over 3.0 ng / ml - high level of the hormone that may indicate polycystic ovary syndrome
- over 1.0 ng / ml - normal level
- below 1.0 ng / ml - low level, which may indicate low ovarian reserve, including menopause.
AFC (Antral Follicle Count)- ultrasound examination determining the number of antral follicles that are ready to grow (during their growth the eggs mature in them) under the influence of natural gonadotropins produced by the pituitary gland or the same hormones administered externally during treatment.
If there are less than 4 of these follicles, your chances of getting pregnant are low.
Estradiol- when the estradiol concentration test on the 3rd day of the cycle is E2<75 pg/ml, oznacza to niską rezerwę jajnikową lub obecność torbieli.
Progesterone- when the progesterone test in the second phase of the cycle is ≤3 ng / ml, it means an ovulation.
Inhibin B- a hormone produced by granulosa cells located in the ovarian follicle.
A result of less than 45 pg / m (ng / L) on day 3 of the menstrual cycle indicates a low ovarian reserve or menopause. Postmenopausal women have the result<10 pg / ml (ng / L).
Low ovarian reserve and the chance of pregnancy
A low result in the ovarian reserve does not eliminate the chances of motherhood. It only indicates that there is less and less time to get pregnant, so we should "mobilize" if we want to have a baby.
However, in the case of women who are already trying to conceive, have started treatment, these results may suggest that the discontinuation of low-efficiency methods such as cycle observations, ovulation stimulation with attempts to conceive naturally, insemination intrauterine.
A low ovarian reserve result may also indicate a poor ovarian response to drug stimulation. Perhaps it is worth considering in vitro fertilization or egg freezing.
Does low ovarian reserve mean amenorrhea or scantymenstruation? Not necessarily.
Women with extremely low AMH may have regular periods, and women with high FSH may not have any abnormalities in this regard, and may even have single ovulatory cycles.
Low ovarian reserve - therapy
Unfortunately, the ovarian reserve cannot be improved. The number of eggs is decreasing all the time and we cannot change that.
However, we can activate those cells that are left. This is mainly done with the help of hormone replacement therapy.
They can also increase the fertility of women:
- Immunomodulating therapy, which consists of administering high doses of corticosteroids or intravenous immunoglobulins to induce ovulation
- melatonin supplementation
- DHEA adrenal androgen supplementation - estrogens are produced from the metabolism of this hormone.
If a woman who wishes to become a mother is diagnosed with a decreased ovarian reserve, it is necessary to develop a therapy, always individually, depending on the cause of the problem.
If it is blocked (e.g. due to adhesions from inflammation) or a twisted fallopian tube, surgery may suffice.
About the author
Marta Uler A journalist specializing in he alth, beauty and psychology. She is also a diet therapist by education. Her interests are medicine, herbal medicine, yoga, vegetarian cuisine and cats. I am a mother of two boys - a 10-year-old and a 6-month-old.
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