All you will ever need to know about ovarian reserve
The most eggs you ever had was when you were a 20-week old baby fetus sitting in your mom’s belly. Hard to imagine, right?
There were 6–7 million of them. Understandably, your mom’s nutrition and lifestyle had an impact on your eggs and her future grandchildren, so maybe you want to talk to your mom and find out more about how her lifestyle was at that time.
As you were born, your ovaries contained about 1–2 million eggs. That was the point in time when your “ovarian reserve” was at its highest.
By the time you entered puberty, there were not more than 300,000–400.000 eggs left. This number still seems like a lot, but eggs degrade at a rate of up to a thousand or more every month; with each new period, about one thousand disappear forever.
In addition, our bodies accumulate mutations and toxins and degrade in many ways as we age, meaning that the egg’s neighborhood (ovaries, tubes, uterus) may, at some point, not be able to provide enough support for a healthy pregnancy. Eggs are essential and central, but pregnancy can’t happen without those other factors working well, too.
Hopefully you now realize how important is testing of ovarian reserve and finding out how many eggs you have left on the first place.
Unfortunately, most of these results are limited to mice, to highly controlled laboratory settings, and to the tissue analysis of women who, for some reason, underwent ovarian surgery.
For you, the best and most realistic possibility is to try to find out how to improve the quality of the eggs you still have.
Testing ovarian reserve: How many eggs do you have left?
Ovarian reserve is a medical term to describe a woman’s total egg pool. Everything that is left after decades of contraception pills, wrong partner choices, and monthly bleedings, so to say.
It is essential for every woman to know as much as possible about her ovarian reserve, to be able to plan accordingly.
Thanks to new research, we know that it is possible to improve egg quality to an extent, but it will most likely never be possible to grow any new ones. Or the chance of it happening in the next decade or so is so slim, that it is best to live without relying on it.
Egg leads to an embryo.
Embryo leads to a pregnancy.
Pregnancy leads to a baby.
Eggs are at the beginning of everything, and nothing in terms of becoming a mother happens without them.
When it comes to having healthy eggs, these three factors matter most:
- Your genes: some women enter menopause very early, already in their mid-20s and there is a strong genetic component to this. Meaning, if your mom went into menopause early, there is a chance that your own ovaries may become empty at a faster rate. But be careful not to over-interpret any information and remember that you are not a statistic, but an individual. There is, anyway, not much you can do about your genes apart from knowing early enough and planning accordingly.
- How old you are. What do you thing is better for your eggs, to produce a baby five years or twenty years after your body started ovulating? Right. That’s why it’s important to have a first baby at least before the age of 30.
- Your family history of fertility, on both sides. Like you just learned, your ovarian reserve was created during the time that your mom was pregnant. So how was her nutrition at the time? Her overall health? Hopefully she was not exposed to radiation or similar extreme circumstances at that time? And how is your own health and nutrition?
Obviously, the last point is the only one that we can have some control over. Which is okay. Because with some knowledge and discipline, most women can at least partially improve their egg quality and extract the best out of their individual pool of eggs.
This is not only possible, but has proven both scientifically and practically to bring positive results.
For example, in addition to eating fresh, organic, and nutritionally rich food, a supplementation strategy needs to be tailored that is specifically focused on egg maturation and growth. Certain supplements are generally beneficial, such as vitamin D and Omega-3.
Some others (like CoQ10 and DHEA) need to be individually adjusted and aligned with other parameters to achieve the best results.
Knowing how to do that is enormously important as it will save you time when you come to a phase in life that you most need it. If you need help or a second opinion anywhere in this process, or if you’d like me to adjust the list of supplemens you’re taking, this is how you can find me.
Importantly, results will not occur over night; a time frame of at least 3 months should be allowed.
Testing ovarian reserve: two hormones you need to know about
FSH (Follicle Stimulating Hormone)
When it comes to testing ovarian reserve, this is likely the first parameter your fertility doctor will look at.
This method is inexpensive and easy: FSH is measured in the blood at the beginning of the menstrual cycle (usually on day 3).
As we age and our eggs decrease in number and quality and our brains must produce more FSH to stimulate eggs to ovulate. That’s why it is best for women over 35 who are trying to get pregnant to have FSH values less than 10.
When FSH goes beyond 10, this is telling us that our biological clock is ticking more loudly and that women who are serious about becoming biological mothers should take action. The menopause will not occur overnight, but you are probably entering a phase of decreased fertility and there could be some waiting involved in getting pregnant.
Typically, a rise in FSH does not happen overnight and often there are several years during which FSH oscillates before settling at a higher value. At some point, FSH will become greater than 20, which is, in combination with other predictors, one of the best biomarkers that the egg pool is exhausted. However, even then, ovarian reserve is still not completely empty. We all know of small miracles and healthy pregnancies that happen to women already in menopause.
It is important to understand that elevated FSH levels are related to reproductive age rather than chronologic age, and high FSH can also occur in women much earlier than the age of 40, which is largely genetically determined.
There is one more factor which is (in combination with FSH) really good in determining how many eggs a woman has left. It is called Anti-Mullerian Hormone (AMH).
Anti-Mullerian hormone (AMH)
In the process of testing ovarian reserve, AMH is the next parameter which will be checked and makes a fair predictor of the remaining egg reserve.
In a very simplified form, AMH is a substance produced by the cells that support egg cells. When AMH goes down to 1 ng/ml or less, it is another sign that the biological clock is ticking its last reproductive hours.
But, when AMH falls under 0.7, we are speaking of minutes.
Under 0,4 AMH many clinics won’t bother to perform IVF, to not ruin their success rates. AMH of 0,2 and under is already at the detection level in many labs and suggests that the egg pool is so exhaused that hardly anyone can tell whether this woman can still get pregnant with her own eggs.
Inhibin B and other tests to determine fertility
Inhibin B is similar to AMH in terms of its predictive value. Most labs rather go for AMH, which finally doesn’t matter because they are very similar in terms of telling about the status of ovarian reserve.
There are few more lab tests for assesting remaining fertility: Clomiphene citrate challenge test (CCCT), Exogenous FSH ovarian reserve test, ovarian vascularity test (measured by using Doppler), ovarian biopsy. They all can be employed to complement FSH, AMH and other hormonal values, but they are patient- and clinic-specific so please talk to your doctor about it.
Treatment of diminishing ovarian reserve
At some point, there are no eggs left in the ovaries. This process is called “diminishing ovarian reserve” (when doctors describe anything, it starts sounding like a diagnosis).
Treating a diminished ovarian reserve is often mentioned in context of treating infertility and it is one of those phrases where you don’t know whether to laugh or cry.
Treatment for something which is not there any more?
Treatment for not being able to become a biological parent?
Treatment of not being young any more?
So let’s see which medical options are offered.
The first line of treatment for the dimishing ovarian reserve is IVF, either with own remaining or with donor eggs. Unfortunatelly, women with reduced ovarian reserve usually have fewer than four follicles after stimulation with hormones, which results in a high IVF cycle cancellation rate.
This can mean wasting time, which is very bad because this group of women anyway has not much time left in the reproductive sense. Therefore, if you happen to have a low ovarian reserve, you definitely should try to improve the quality of eggs which are still left.
Supplements to support ovarian reserve and egg health
Luckily, there are supplements which are proven to increase egg quality, especially in women over 35 and women with infertility issues. If you belong to these groups (of if you feel you don’t have much time to waste and would like to get pregnant fast), you may want to consider taking:
Here is where you can find me if you would like me to individualize the supplements you’re taking or discuss anything else related your fertility journey.
Done right, improving egg quality will increase your chances to get pregnant in the advanced age, either naturally, or via IVF and ICSI.
There is of course no guarantee that efforts to improve egg quality will work for all women, but what is left to lose?
For any healthy woman, improving egg quality means also improving her general health, in addition to giving a best start possible to her baby.
If you are 40 or above IVF patient and don’t undertake any effort in this direction, we are speaking of about 3-5% pregnancy chances in the next few years or less. Is that a chance you want to live with?
But if you try hard and give enough time, you may succeed to not only improve the quality of your eggs and hardware around it (ovaries, lining of the uterus), but also maximize your overall health, making a pregnancy not only more likely to occur, but also to end up in a healthy baby.
Hope this was some help. Good luck to you,