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OVARIAN RESERVE

What is an Ovarian Reserve?

At any given time, a woman carries a number of oocytes or eggs in her ovaries. This estimated count is known as Ovarian Reserve. When a female is born, she possesses approximately one to two million eggs which decline as her age progresses

and at puberty the count is almost 250,000 to 500,000 eggs. At around the age of 37, it further reduces to roughly 25000 and at menopause it becomes less than 1000.

How is Ovarian Reserve estimated?

There are various tests to assess ovarian reserve. The main tests include –

1. Serum FSH/LH- done on the 2nd /3rd day of a woman’s menstrual cycle gives an indication of the woman’s egg reserves.

2. Serum Anti mullerian hormone (AMH) – A very sensitive test of testing a woman’s ovarian reserve. This test can be conducted any time during the menstrual cycle.

3. Antral Follicle count- Antral follicle are small follicles present in the ovary that are best seen during the early phases of the menstrual cycle. They also give a good estimate of the ovarian reserve and can be counted through Trans-vaginal ultrasound (TVS) of the pelvis.

Why is Testing for Ovarian Reserve Important?

A woman’s fertility potential is indicated by her ovarian reserve. If a woman is facing difficulty conceiving or has plans to delay child bearing, it is advisable to have an assessment of their ovarian reserve so that an appropriate and timely fertility intervention can be undertaken.

What is Poor Ovarian reserve?

If a premature decline in the quantity of eggs occurs due to some reason that results in reduction of the chances of producing a mature egg, a poor ovarian reserve can be suspected. The decline in number of eggs is natural with advancing age, mainly due to two reasons. First is ‘Apoptosis’ which is the process of natural cell death and second is ovulation.

The egg reserve is completely exhausted at the advent of menopause in normal circumstances. But when the depletion occurs faster than usual and before menopausal age, ‘poor ovarian reserve can be suspected.

• What causes Poor Ovarian Reserve?

A number of factors can cause poor ovarian reserve:

1. Advanced maternal age.

2. Genetic defects including chromosomal anomalies such as Turner’s syndrome and gene defects like Fragile X syndrome.

3. Damage to the ovaries due to any injury, torsion, infection, surgery or due to radiation or chemotherapy leading to premature ovarian failure.

However, the exact cause still remains unknown in most cases.

Can poor ovarian reserve result in reduced chances of getting pregnant?

The chances of getting pregnant are greatly reduced if there’s a reduction in the number of eggs. It is for this reason that poor ovarian reserve is connected to reduced probability of pregnancy whether it is naturally or following fertility treatment. Ovarian reserve is tested to identify the women who might be at a risk declining number of eggs so that they may be guided to pursue more aggressive mode of treatment to get pregnant.

• Treatment options:

Even if your doctor has diagnosed a diminished ovarian reserve, there is no need to despair. Only one egg is required for a successful pregnancy so you may still be able to get pregnant.

• Borderline or low ovarian reserve:

In vitro fertilization (IVF) can provide an excellent solution in the case of low or borderline ovarian reserve. We offer protocols to help the maximum number of follicles reach maturity in your cycle. Many patients have conceived with this method over the years.

• Very low ovarian reserve:

The best treatment option in this case is the mini-IVF protocol. A gentler approach is used in this case wherein cost-effective medications like Femara or clomiphene are used to assist the release of natural follicle stimulating hormones. These are released from the pituitary gland and contribute in the growth of follicles.

• What you can do to improve your odds:

Like with everything else in life, quality has an upper hand over quantity. Even though you may lack adequate eggs in your reserve, certain lifestyle choices can influence the chances of getting pregnant positively. Here’s what you can do:

• Stop smoking and avoid breathing in secondhand smoke.
• Maintain a healthy weight with a body mass index less than 35.
• Keep your stress in check. Stree can negatively affect mini IVF treatments by decreasing the production of natural follicle stimulating hormones
• Eat foods with natural antioxidants, like blueberries, green tea, vegetables. I has been observed that Antioxidants increase the fertilization rates in patients who are undergoing IVF treatments.
• Take a coenzyme Q10 supplement to encourage cell division after fertilization.
• Consider taking DHEA to increase the number of eggs available each month.

Are there any treatments available to improve one’s ovarian reserve?

Even though there are no sure shot remedies to enhance ovarian reserve, in the recent past, medications have been developed that target the egg quality and number and improve it. There are conclusively proven benefits of these medicines yet. If a couple struggles with infertility, it is advised to consult an infertility expert and undergo tests for ovarian reserve as well. If the reserves are insufficient, appropriate management may very well lead successfully to the dream of parenthood.

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