Most women only start to deal with their ovarian reserve when they try to get pregnant and do not succeed, often after the age of 30. Although it is common knowledge that age has a negative effect on male but especially on female fertility, most women are not aware of how valuable these tiny cells are and how quickly they disappear over the years.
In today’s article, we have compiled all the relevant information about the ovarian reserve, looked at basic concepts such as egg quality and antral follicle count, and tried to answer all the basic questions.
Relationship between infertility and ovarian reserve
To understand what happens to the ovarian reserve and why it is associated with fertility problems, we need to go back to the origins: a female fetus in the womb has an ovarian reserve of almost 6 million eggs.
After birth, this number is reduced by 80%, so that the newborn has an ovarian reserve of about 2-3 million eggs. In the course of life, a sexually mature woman loses eggs in each menstrual cycle, and this process is particularly rapid from the age of 35 onwards.
What many people do not know is that age affects not only the number of available eggs, but also the egg quality. As we get older, it not only becomes more difficult to conceive a child, but also reduces the likelihood that the child will be born healthy.
The meaning of the AMH value
The AMH value, the Anti-Müllerian hormone, is a key indicator of the ovarian reserve. This hormone is produced in the follicles – a vesicle-like structure inside the ovaries, where ideally an egg cell matures. The AMH level can be determined by blood analysis and provides information about the status of a woman’s ovarian reserve, but says nothing about the quality of eggs. Assessing a patient’s ovarian reserve and the functionality of her ovaries allows us to design the treatment in order to maximise her pregnancy chances. If the AMH level is low, the chances of pregnancy are very low, especially in a natural way.
AMH and antral follicles: how reliable are these indicators?
Many patients often ask us whether they can still become pregnant with their own eggs. To answer this question, it is necessary to determine the AMH level and count the number of antral follicles.
The antral follicle count is performed during an ultrasound examination (transvaginal ultrasound). In this way, the doctor counts the follicles present in both ovaries. These two tests provide reliable information about a woman’s ovarian reserve and a proper treatment type. However, sometimes there are discrepancies between these two tests, and an apparently normal AMH value may contrast with a low antral follicle count, or vice versa.
Most of the patients who come to us come with less encouraging results. Low AMH levels and a low antral follicle count indicate that it will be difficult to become pregnant with your own eggs, and that egg donation may be required.
It is important to understand that a woman’s reproductive ability is not reduced to a single value, such as AMH, and that the diagnosis should be supplemented by further tests. These additional tests include an ultrasound scan, which is performed at a specific time of the cycle to determine the perfect time to start stimulation. Ovarian stimulation depends, among other things, on the active follicles present in the ovaries.
On the other hand, we go beyond the traditional follicular phases and have specialised in developing ovarian stimulation techniques for the prior preparation of the follicles (previous to the stimulation), as well as other means of improving the quality of the follicles. The above techniques are complemented by other therapeutic strategies that contribute to achieving pregnancy, such as: the genetic viability of the embryo, the receptivity of the endometrium or other immunological factors.
As experts in the field of reproductive medicine, we emphasize that AMH alone cannot be relied upon to determine a woman’s fertility and determine a suitable treatment method.
Can the quality of eggs be improved?
When we talk about the quality of eggs, we mainly refer to whether the egg is genetically normal (euploid) or abnormal (aneuploid). An egg of a good quality should contain 23 chromosomes. With age, the possibility of producing eggs with the wrong number of chromosomes increases, which means that the possibility of miscarriage, failure of IVF treatment or conception of a child with genetic problems such as Down syndrome also increases. Many of the abnormal eggs cannot be fertilised or have developmental problems.
What each of us can do is make some small changes in our lifestyle that will improve our health and in some ways our fertility. A balanced diet, regular exercise and maintaining a healthy weight that allows us to maintain an appropriate body mass index (BMI 18-24) are small changes that will help us.
It is strongly recommended to stop smoking, to limit the consumption of sugar and white bread, because processed foods and saturated fats can also help to improve our health. And, of course, to reduce our stress levels, which is quite difficult when you are trying to get pregnant and it is not happening. However, it has been shown that stress triggers the production of hormones such as cortisol and prolactin, which can disrupt ovulation. In addition, it is beneficial for the quality of our eggs to remain hydrated, as it supports the transport of oxygen to our cells.
The best solution would be to have children in their twenties, but it is not possibe nowadays. However, there are other options such as Social Egg Freezing. The general medical advice is that if you do not become pregnant after six months at the age of 36, you should consult an expert.