Ovarian Reserve means the egg quantity and egg quality determining a woman's ability to conceive. It is no surprise that a woman's ability to get pregnant typically decreases with age. Even though the exact age when a woman can no longer conceive varies, females who are 35 or older find it challenging to get pregnant as they have fewer eggs, their egg quality goes down, and eggs have more abnormalities in their chromosomes. All these factors cause lower pregnancy rates and higher miscarriage rates. In this article, Dr. Shaweez Faizi, Fertility Consultant at Nova IVF Fertility, Mangalore tells how to find out your ovarian reserve to increase chances of conception.
What is Ovarian Reserve Testing?
Ovarian reserve tests reflect the potential of women to conceive at any given point of time. Many people are unaware that a few ovarian reserve tests can offer information on a woman's egg supply and determine ovarian reserve. They can also tell when a woman is getting close to menopause or if she is nearing a decline in this reserve much earlier than expected- premature ovarian failure. Some of these tests include:
The anti-Müllerian hormone (AMH) is one of the hormones produced by the cells in the follicle, a fluid-filled sac present in each egg in a woman's ovaries. The level of AMH in a woman's blood determines the number of follicles in her ovaries. An AMH level within the normal range suggests a woman has an adequate number of eggs for her age and consequently a better chance of pregnancy. However, having too high or too low AMH is not ideal as it indicates polycystic ovarian syndrome (PCOS) or a premature ageing process respectively.
FSH stands for follicle-stimulating hormone, which released by the pituitary gland in the brain. It drives the growth of ovarian follicles, which produce hormones like AMH, oestrogen, and progesterone. If the FSH levels are above or below what is ideal for the woman's age, it could indicate infertility issues. The FSH levels vary throughout the monthly menstrual cycle unlike AMH which remains fairly constant. AMH is the more preferred blood test when compared to FSH.
Counting Eggs on Ultrasound
A woman's fertility is determined by the quality and quantity of her eggs. They are born with the maximum number of eggs they will ever have, which begins to decline as they age. A newborn girl is born with 2 million eggs, and 11,000 die every month until she hits puberty, leaving just a couple hundred thousand eggs.
After 37, there is an accelerated decline in the quantity of eggs, with roughly a thousand left by menopause. At the beginning of every month, a few eggs in each ovary appear and one out of these is destined to grow and ovulate.
A transvaginal ultrasound performed on the second day of the menstrual cycle will give a fair idea of how many eggs are visible for that particular month.
What is a Diminished Ovarian Reserve?
Diminished Ovarian Reserve (DOR) refers to the decline in reproductive potential due to the low egg quality and egg quantity, further causing infertility. Some of the signs of DOR include:
- High day 2 or 3 FSH level
- Low AMH level
- Low antral follicle count (AFC)
- History of an insufficient response during stimulation in an IVF cycle.
What causes diminished ovarian reserve?
Ageing is the leading cause of diminished ovarian reserve. Other factors that affect DOR include:
- Tobacco use
- History of pelvic infection, endometriosis(chocolate cyst of ovary )
- Ovarian surgery
- Genetic abnormalities
One must remember that DOR does not necessarily suggest the inability to conceive.
What can I do to improve my egg quality and egg quantity?
Making simple lifestyle changes can help boost fertility by ensuring that your eggs are at their best. Some of the changes that you can make in your life are :
Quit smoking- The chemicals in cigarettes speed up egg loss in the ovaries, making them unsuitable for conception.
Manage Stress- Stress produces hormones like cortisol and prolactin that interfere with ovulation and egg production. Activities such as yoga, meditation, and exercise help manage stress.
Maintain a Normal BMI (body mass index)- Obesity is often a factor in causing infertility and decreased egg quality. Eating healthy and exercising can help you achieve and maintain a normal BMI, further boosting fertility.
It is important to note that a Diminished Ovarian Reserve does not necessarily mean that you cannot conceive. Women facing problems in conceiving due to issues with their ovarian reserve can always use the support of Assisted Reproductive Technologies (ART). An early evaluation and consultation will help in detecting any such issues which can be recognized and treated accordingly to get the desired results. You can consult a fertility specialist and get the required guidance to fulfill your dream of parenthood.
Image credits- freepik