Most women don’t think about the amount and quality of their oocytes until they wish to have a baby and cannot get pregnant. This usually happens after the age of 30. In these cases, it is really important to learn everything about one’s ovarian reserve.
Even though most women 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.
In this Blog, we have collected the most important information to answer all questions you might have about your ovarian reserve. And will also elaborate on connecting terms such as oocyte quality and antral follicle count.
Article reviewed by the IVF-Life clinic medical team.
Infertility and ovarian reserve
In order to understand what happens with the ovarian reserve and why it is associated with fertility problems, we need to go back to the basics. Before being born, every woman has an ovarian reserve of nearly 6 million egg cells.
Once a woman is born, this number sinks to 80%, reducing her ovarian reserve to 2-3 million egg cells. From then on, women lose up to 1000 oocytes every month during their menstrual cycle until reaching menopause.
From the age of 35, not only the number of cells but also the quality of the eggs decreases rapidly. The possibility to conceive a baby start to decrease with each passing day, as the cells age the same way we humans do.
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 in which the egg cells are stored.
The AMH levels are measured with blood tests giving us the possibility to assess the state of the ovarian reserve. However, it does not give us any information about the quality of the eggs.
By evaluating the ovarian reserve of a patient and the function of her ovaries we are able to elaborate a treatment that will increase her chances of getting pregnant.
Low AMH levels can be a sign of ageing ovaries, as the hormonal levels also decrease over the years.
Antral Follicle Count
The antral follicle count is assessed through an ultrasound exam (transvaginal ultrasound). Thanks to this exam the specialist will be able to assess the number of follicles developing in both ovaries. This way an estimation of the total follicle count in each ovary can be made.
Are the AMH Levels and Follicle Count reliable indicators?
After some failed tries, many patients ask themselves if they will be able to get pregnant with their own eggs. Because of this doubt, we test their AMH levels and complete the results with an ultrasound assessment, in order to determine their 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, which could lead to a successful stimulation.
Many patients come to our clinic with not very promising AMH results. This would suggest that they might have to look into 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 at IVF-Life offer to complete their diagnosis by performing other tests like ultrasounds. These other tests are performed in specific moments of their menstrual cycle, in order to find the best time to start the ovarian stimulation. It is very important to start this stimulation when a good amount of follicles are active.
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.
Furthermore, we complete these therapeutic strategies with additional techniques, which help us to find other factors that can help us reach the desired pregnancy. Some of these factors include 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 guarantee its success.
It is possible to improve the oocyte quality?
When we talk about oocyte quality we mainly refer to whether the eggs are 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. Furthermore, 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, when she produces the best quality eggs, normally is around the age of 20. This often creates frustration, as for many women nowadays this is not the best moment to create a family. In today’s day and age, a 20-year-old woman is starting to prepare herself for the future by studying, working or planning activities like travelling, where motherhood is no priority.
But 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 sugar, avoid white bread, processed foods and saturated fats to 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 is something that can also benefit us since 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 easiest way is to just have a child as early as possible, but we also know that this is not the perfect scenario for most women today, which is why we at IVF-Life recommend taking your time and asking for medical advice if you, after the age of 35 do not get pregnant within six months of trying.