Ovarian Reserve is one of the more frequently discussed topic in my infertility practice, especially as many working women plan to defer child bearing while they remain worried about their fertility potential in future. Besides this, I see a lot of women who are not able to conceive and have poor ovarian reserve. Here are seven most frequently asked questions related to “Ovarian Reserve” and my answers to these.
What is ovarian reserve?
Ovarian reserve of a woman is defined as an estimated number of oocytes/ eggs a woman has in her ovaries at a given time. A female fetus has a maximum of 6 to 7 million eggs at 16 to 20 weeks of gestational age. Thereafter, this number keeps on declining and reaches an approximate count of 1 to 2 million eggs at the time of birth, and further falls to approximately 250,000 to 500,000 eggs at puberty. This count further declines to approximately 25,000 at around 37 years of age and to less than 1000 at menopause.
How is ovarian reserve estimated?
There are various tests to assess ovarian reserve. The main tests include –
Serum FSH/LH- done on the 2nd /3rd day of a woman’s menstrual cycle gives an indication of the woman’s egg reserves.
Serum Anti mullerian hormone (AMH) – very sensitive test of testing a woman’s ovarian reserve. It can be done on any day of the menstrual cycle.
Antral Follicle count- Antral follicle are small follicles present in the ovary that are best seen during the early phases of the menstrual cycle. Transvaginal ultrasound (TVS) of the pelvis is used to count the number of antral follicles, which gives good estimate of the woman’s ovarian reserve.
3. Why is testing for ovarian reserve important?
A woman’s ovarian reserve is an indicator of her fertility potential. Women facing difficulty in conception or planning to delay child bearing should be assessed for their ovarian reserve for timely and appropriate fertility intervention.
What is poor ovarian reserve?
If a woman has a premature decline in her egg quantity due to any reason which reduces her chances of having a mature egg, she is suspected to have “poor ovarian reserve”. It is natural for the number of eggs present in a lady to decline as she ages – both due to ovulation and a natural cell death process called “Apoptosis” – and normally the woman would exhaust her egg reserve by the time she reaches menopause. But, if the decline in egg count happens faster than that and the woman is depleted of her egg reserve before expected menopause, she should be suspected to have “poor ovarian reserve”.
What causes poor ovarian reserve?
Poor ovarian reserve can be caused by a number of reasons-
Genetic defects including chromosomal anomalies such as Turner’s syndrome and gene defects like Fragile X syndrome.
Damage to the ovaries due to any injury, torsion, infection, surgery or due to radiation or chemotherapy.
However in most cases the exact cause of poor ovarian reserve remains unknown.
Does poor ovarian reserve lead to reduced chances of pregnancy?
Poor ovarian reserve is associated with reduced chances of pregnancy both naturally and following fertility treatment. This is because the number of eggs is reduced which corresponds to reduced chances of pregnancy. The goal of ovarian reserve testing is to identify those individuals who are at risk of diminished ovarian reserve so that they can be encouraged to pursue more aggressive treatment to achieve pregnancy.
Is there any treatment to improve the ovarian reserve?
There are no concrete remedies to improve Ovarian reserve however lately some medications have been developed to improve the egg quality and number. The benefits of these medicines are not yet conclusively proven.
You can read more about management of Poor Ovarian Reserve at http://www.slideshare.net/DrParulKatiyar/management-of-poor-ovarian-reserve-dr-parul-katiyar
Dr Parul Katiyar
For more information on poor ovarian reserve and ways to address poor fertility resulting from this, please write to me at ivfgurgaon@gmail.com.