The phrase "Ovarian Reserve" describes a woman's ability to bear children in relation to the quantity and quality of eggs in her ovaries.
The idea behind the concept of reproductive ageing is that eggs reach their highest amount during foetal life, go through degeneration, and do not regenerate. Surprisingly, a woman will have the most eggs when she is a 6-7 million egg, 20-week-old foetus. At birth, there are 1-2 million eggs; by puberty, there are about 300,000–500,000 eggs left. Women are thought to ovulate between 400 and 500 eggs overall from puberty till menopause.
Although female fertility decreases with age, the rate at which reproduction declines generally is difficult to anticipate. In her mid-20s to early-30s, a woman's eggs are at their best quality, which corresponds to her most productive years. The reproductive potential starts to decrease from the early 30s as both the amount and quality of eggs start to deteriorate, with the mid-30s and early-40s seeing the biggest drops.
A extended gestation period could be a sign of both egg quantity and quality reduction. As a result, fecundability, or the likelihood of becoming pregnant within one menstrual cycle, starts to fall dramatically in the early 30s and increases after the age of 37.
There are a few ovarian reserve screening tests available, but none of them are particularly accurate at foretelling if a pregnancy will occur. Therefore, it is ideal for a fertility specialist to evaluate the findings of these tests, which also need to take into consideration the woman's age.
On days 2 or 3 of the menstrual cycle, blood levels of FSH, oestrogen, AMH, and the number of antral follicles are measured as part of routine ovarian reserve screening procedures (AFC).
Age: As was previously mentioned, age is a predictor of the outcome in and of itself. After the age of 40, there are very few prospects of obtaining acceptable quantities and quality of eggs. Even if they do occur, spontaneous pregnancies cannot be used as a standard for how to manage women in older age groups.
IVF treatment is seen to be the best in cases of female infertility at the age of 40, which is fairly prevalent. This is because IVF has a 40% success rate on the first try.
Antral Follicle Count: Just before the start of each menstrual cycle, women recruit 15 to 20 eggs, as already stated. One or more of them will eventually reach adult size, depending on the stimulation provided. On Days 2 or 3 of the period, transvaginal ultrasound can be used to count this baseline pool of eggs. The foliculometry test is widely used and crucial for determining the situation.
The best clinician and infertility specialist must oversee the follicular investigation using folliculometry ultrasound.
The woman has a decent possibility of stimulating egg production if there are more than five.
Baseline FSH and Estradiol (E2) levels: FSH levels should be less than 10 and E2 levels should be between 20 and 80 pg/ml as normal values (performed on Days 2 or 3 of periods). Long before the eggs actually complete, one of the first parameters to increase is FSH levels. To give you an idea, think of FSH as the whip that urges the ovary to release eggs.
Normal conditions call for less whipping, which results in low FSH levels. High FSH levels occur when the ovary is failing because more whipping is needed. The FSH levels can
swing between abnormally high and low levels. Though the levels may decrease later, it is important to keep in mind that even one FSH level above 10 indicates that the eggs may not be of very high quality.
Clomiphene Challenge Test: The baseline FSH is examined in this test on Day 3. From Day 5 to Day 9 of the period, 100mg Clomiphene Citrate tablets are then administered orally. On Day 10 of periods, Fsh levels are once again assessed. Both the Day 3 and Day 10 FSH readings should be under 10, which is considered a normal number.
Inhibin levels: While FSH levels in ageing women tend to rise, inhibin levels tend to decrease. Inhibin levels may even be more sensitive and detect minor changes than baseline FSH levels, according to some research. The test isn't utilised in routine practise, though, because it's still experimental, not readily accessible, and rather pricey.
AMH Levels: Anti-Mullerian Hormone, or AMH, is the new kid on the block with a lot of potential. As a measure of the tiniest follicles, or antral follicles, it approximates the USG's count of antral follicles numerically and eliminates human error. Age and a decline in ovarian reserve both tend to cause AMH levels to decline. The test appears to be more accurate than FSH level or Clomiphene Challenge tests, and it does not need to be performed just on Days 2 or 3. It is also not affected by Depot injections of GnRH analogues. Additionally, it is an excellent indicator of the particular profile of patients who might develop ovarian hyperstimulation.
These are the typical criteria we employ in daily practise, but nothing, as they say, "prepares you for life," and similarly, nothing can foretell how the ovary will finally respond once we begin to stimulate it. It's possible that, as doctors, we don't yet fully understand the situation or, as we sometimes remark, "Perhaps there is someone else above us all who oversees everything."
However, it is always advised to get advice from the top infertility specialist to determine the true cause of your infertility as well as for patient counselling.