Sunday, October 28, 2007

Two numbers every women should know !

Many women are now choosing to postpone childbearing because they want to pursue their career. However, sometimes it's hard to have your cake and eat it too, and some older women regret their decision when they find out that their eggs are too old for them to be able to have a baby .

So it is safe for you to do so ? At what age should you start worrying about your eggs ? 30 ? 35 ? What about all the celebs having kids at the age of 40 ? And can't IVF fix all problems ?

Unfortunately, there is no alarm on your biological clock, and every woman has a limited number of eggs which will run out as she grows older. So how do you know how old your eggs are and how much time you have left ? How can you assess what doctors call your "ovarian reserve" ?

There are 2 simple numbers which will help you to do so - your FSH level; and your antral follicle count. These are two basic numbers every woman who is more than 25 needs to know, so she can make well-informed decisions as to how long she can safely postpone childbearing.

Let's review some basic biology. Women are born with all of the eggs (oocytes) that they will ever have. A female fetus will have the greatest number of eggs around 16-20 weeks of pregnancy (5 million); at birth this number decreases to about 1 million; and by puberty it's down to about 300,000. This constant and dynamic process of decline continues until menopause and is not interrupted by birth control pills, pregnancy, or ovulation. From this reservoir of eggs, fewer than 500 eggs will ovulate during a woman’s reproductive life. Once a women runs out of eggs, she reaches her menopause. About 10 years prior to the menopause is a phase called the oopause, when the egg quality is good enough to produce hormones to generate a regular menstrual cycle ( and this sometimes lulls women into a false sense of security); but not enough to make a baby.

There is a continuous process occurring in the ovaries where eggs are constantly being prepared for the maturation process. It takes 3-6 months for eggs to develop and mature. As the eggs are developing, they transition from a primordial ( immature follicle) to a mature follicle, called an antral follicle. Antral follicles are visible by vaginal ultrasound. Antral follicles therefore represent the reserve of eggs in the ovaries ; and these are the follicles which can be stimulated by fertility stimulation medications (gonadotropins).

An antral follicle count ( AFC) is done during the 2nd-4th days of menstrual flow and is performed by doing a vaginal ultrasound scan. Studies show that the AFC is predictive of the expected ovarian response to gonadotropins. An AFC less than 6 total (between both ovaries), predicts a poor stimulation response. This means a low AFC can correlate with diminished ovarian reserve.

The other simple test for checking how young your ovaries are (the ovarian reserve) is by doing a blood test to measure the level of FSH ( follicle stimulating hormone) in the blood on Day 3 of your cycle . This is called the basal ( day 3) FSH level. Young women with lots of follicles produce a hormone called inhibin, which inhibits the production of FSH, which means they have low Day 3 FSH levels. A normal level is about 3-4 mIU/ml. A high level ( more than 8 mIU/ml) suggests poor ovarian reserve; and a very high level ( more than 20 mIU/ml) is diagnostic of ovarian failure.

These 2 basic tests should be a part of the annual checkup for all women. Unfortunately, most family physicians and gynecologists are clueless about the importance of this test. When a 28 year old asks them whether it's safe for her to postpone childbearing, most of them give her a reassuring pat on the head, and tell her not to worry !

While this advise may be fine for some women, it's a major disservice for others. I feel women need to take matters in their own hands, and ask their doctor to measure their FSH levels, so there is a sound scientific basis for their reassurance. If the FSH level is borderline high, which suggests poor ovarian reserve, further testing to check ovarian reserve is called for, including an ultrasound scan for antral follicle counts.

As Robert Ringer explains, remember that there is a price you pay for every decision you take in your life. There is a price you pay for pursuing a career; and there’s a price you pay for having a baby. No matter what you do in life, do it with your eyes wide open to the tradeoffs involved. And then deal with those tradeoffs with a mature confidence ... and don’t complain. If you find that you are not willing to live with the price of a decision you’ve made, cut your losses short and try to reverse the error as quickly as possible.

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