Most women don’t think about the amount and quality of their egg cells until they wish to have a baby and it doesn’t work out, this happens normally after the age of 30. In these cases it is really important to learn everything about their ovarian reserve.
Even if there are aware of the fact that they are born with a limited number of egg cells it is not until fertility problems appear, that they realise how valuable these little cells really are and how fast they disappear over the years.
We have collected the most important information to answer all the questions about ovarian reserve and to help to understand terms such as oocyte quality and antral follicle count.
Infertility and ovarian reserve
In order to understand what happens with the ovarian reserve and why it gets associated with fertility problems, we need to go back to the start. In the womb of her mother, a woman has an ovarian reserve of nearly 6 million of egg cells.
Once she is born, this number sinks to 80%, reducing her ovarian reserve to 2-3 millions of egg cells. Afterwards a woman keeps losing until 1000 egg cells every month during her menstrual cycle until she reaches menopause.
At the age of 35 the loss of egg cells increases and with each day that goes by, not only the amount of cells but also their quality decreases, as they get older. The cells age like humans do, and that is how the possibilities to conceive a baby start to decrease with each passing day.
One of the indicators to measure the ovarian reserve is the AMH level, also known as the anti-mullerian hormone. This hormone is produced in the follicles where the egg cells are stored.
The AMH levels are measured thanks to a blood test and the results will show us the state of the ovarian reserve, but without giving us any information about the quality of the eggs.
The evaluation of the ovarian reserve of a patient and function of her ovaries, gives us the chance to elaborate a treatment that will increase her chances of reaching a successful pregnancy.
Low AMH levels can be a sign for the aging of the ovaries, as the hormonal levels also decrease over the years.
Antral Follicle Count
The antral follicle count is done through an ultrasound exam (transvaginal ultrasound), where the specialist will be able to see the amount of follicles developing in both ovaries. Thanks to that analyses, the specialists will be able to make an estimation of the total follicle count in each ovary.
Are the AMH Levels and Follicle Count reliable indicators?
Often Patients ask themselves if they can reach a pregnancy with their own eggs. That is the reason why they get their AMH levels tested and complete the results with an ultrasound assessment, in order to determine her ovarian reserve.
The only reliable indicator to define the ovarian reserve and to find the best treatment, is the combination of both tests. There are some cases where the AMH levels may appear normal, but the ultrasound exam shows no active follicles. And on the other hand, low AMH levels can contrast with ultrasound results, where a good amount of follicles is seen, that could lead to a successful stimulation.
Many patients come to our clinic with bad looking AMH results, which would suggest they will have to look for an egg donation treatment in order to get pregnant. In these cases it is really important to understand, that the reproductive capacity of a woman can not only be measured by one factor like her AMH levels.
For patients with low AMH levels, we complete their diagnosis performing other tests like ultrasounds in specific moments of their menstrual cycle, in order to find the best moment to start the ovarian stimulation. It is important to start this stimulation when there is a good amount of active follicles.
Apart from the traditional follicular phases, we have developed our own ovarian stimulation techniques in order to prepare the follicles before stimulation and to improve their quality.
On the other hand, we complete these therapeutic strategies with additional techniques, which help us to find other factors which can help to reach the desired pregnancy, like the genetic viability of an embryo, the receptivity of the endometrium or other immunologic factors.
As experts in Reproductive Medicine we have to point out that we cannot only rely on the AMH levels to choose the correct treatments and to define the possibilities to reach a successful pregnancy.
It is possible to improve the oocyte quality?
When we talk about oocyte quality we are referring mainly to whether the oocyte is genetically normal (euploid) or abnormal (aneuploid). A good quality egg 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 conceiving a baby with genetic problems such as Down’s syndrome also increases. Many of the abnormal eggs fail to fertilize or do so with developmental problems.
Unfortunately, there is no diagnostic technology that helps us to define the oocyte quality. We know that the best reproductive age of a woman is when she produces the best quality eggs, normally around the age of 20. This often creates frustration, as it is not the best moment to create a family. Nowadays a 20-year-old woman is starting to prepare herself for the future or planning many activities like traveling, where motherhood is no priority.
What we can do is introduce some small changes in our lifestyle that will improve our health and in some way, our fertility. Following a balanced diet, exercising regularly and maintaining a weight that allows us to have an adequate body mass index (BMI 18-24) are small changes that will help us.
It is highly recommended to stop smoking, limit excessive consumption of sugars, avoid the white plan, processed foods and saturated fats can also help improve our health. And of course, reducing our stress levels, something that is quite complicated when you are in the middle of your quest for pregnancy and it doesn’t happen. However, stress has been shown to trigger the production of hormones such as cortisol and prolactin that can disrupt ovulation. Furthermore, staying hydrated is beneficial for the quality of our eggs, as it helps transport oxygen to our cells.
It is clear that the best recipe is to prevent and not delay so much the time to have the first child. We also know that the perfect scenario is not so much for today’s woman, so at IVF-Spain we recommend that you ask for medical advice if, after 36 years of age, the pregnancy does not arrive after six months of searching.