Friday, October 02, 2015

How reduced ovarian reserve reduces your fertility



Today, a larger number of women are delaying childbirth and are focusing on building their careers instead of building their families. All would be well, if they could pause their biological clocks. The sad part is that while these women are pursuing their career dreams, their ovarian reserves keep steadily depleting and when they actually do decide  to have a baby, it may sometimes be too late to get pregnant the natural way.  Since the decline in ovarian reserve is silent, their inability to have a baby when they want to have one comes as a rude shock , and can be very frustrating. Since these are successful women who are used to having their own way, they are very upset when their body doesn’t live up to their expectations – especially because they pride themselves on their health and fitness. The problem is that they get misled by the fact that their menstrual cycles are regular, because they assume that regular cycles in a healthy woman equates with normal fertility, no matter what her calendar age is. This brush with their own biological frailties can cause a lot of heartache, and they resent and regret the fact that no one bothered to educate them about the harm which the inexorable passage of time has on their ovarian reserve.

Let’s take a look at how ovarian reserve testing is done and what impact it has on treating infertility.

Number of Eggs

Every woman is born with all the eggs she will ever have, which is around 1 to 2 million. By the time she has her first menstrual period, this egg count will have diminished to 300,000- 400,000. In each cycle, more than forty follicles will start to grow , but typically, only one of these eggs is released during ovulation; the rest of them will be reabsorbed silently, and aren’t functional.

The Age Factor

In a woman, peak fertility occurs before 20 years of age , and her fertility rate ( called her fecundity) is approximately 20-25%. By age 32, this monthly rate begins to decline but by the time the woman reaches her late 30’s, there will be an even more rapid decline in this rate. By the time she reaches age 40, she will definitely  face difficulties getting pregnant and almost one in 3 women experience infertility by this age; the primary cause being poor egg quality .

As a woman ages, this decrease in her egg quality results in impaired fertilization and reduced implantation . She also has a greater chance of having a miscarriage; and there is also an increased potential of the fetus having chromosomal abnormalities.

Monitoring Ovarian Function- The Tests

When we have to measure ovarian function in our patients, there are a number of different tests that can be used including:

Day 3 blood test for FSH (follicle stimulating hormone) & estradiol levels
Transvaginal ultrasound for checking antral follicle count
The newest test is a blood test to check your AMH Level

The oldest test was checking the Day 3 FSH and estradiol level. As the woman’s egg reserves decrease, there is a rise in the blood levels of FSH. We measure both levels , as higher estradiol levels can bring down the Day-3 FSH level and this can provide false reassurance that all is well.

Checking the AMH level has the advantage that it can be done on any day of the cycle. However, like any other test, this has limitations as well, and it needs to be interpreted intelligently by an experienced infertility expert.

Adding a transvaginal ultrasound AFC has significantly added to our ability to diagnose decreased ovarian reserves.

The Egg Freezing Option

And so, even as women focus on their careers, it’s important that they focus on their fertility too. After all, when they are young, while some women feel that they may never want to have children, many do have a change of heart later in life. Today, it’s possible for women to opt for egg freezing when they are young and then use these eggs at a later stage in life, if necessary.

Need help in getting pregnant ? Please  send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!


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