Written by Dr Israel Carmona
Many times, we have heard terms like “a good ovarian reserve”, “your egg count”, “number of follicles” and even phrases like “your ovaries look like they are from a 25-year-old woman”; but what exactly is the ovarian reserve and how will this affect your fertility?
A woman is born with a fixed number of eggs and she will release one egg per month (in ovulatory cycles) from her puberty until her menopause. An egg develops inside ovarian follicles, we can see these follicles through an internal scan and, in theory, there is one egg per follicle. Every month, a certain number of follicles start developing but only one of them will mature and be released. The rest of them will be lost. The term “ovarian reserve” applies to how many follicles a woman has and is an indicator of her fertility.
There are two main markers for ovarian reserve, the total antral follicle count (count the number of follicles through an internal scan) and an AMH blood test (AntiMullerian Hormone).
What is the AMH test?
The AntiMullerian hormone is produced by the cells that surround the egg inside the follicles. The more follicles a woman has, the higher the AMH and vice versa. The AMH test can be done anytime during the cycle and is associated with success rates after treatment.
Is the ovarian reserve the same as egg quality?
No. Ovarian reserve does not indicate the actual egg quality. As we mentioned above, the ovarian reserve helps to determine how many follicles/eggs a woman has per month and this is important in terms of chances of success and pregnancy rates. However, the egg quality is highly related to age, other pathologies and the lifestyle of the woman.
I’m 40 years old and I was told that my ovaries “look like they are from a 25 year old girl”
This phrase is incorrect because egg quality diminishes with age. Having a good ovarian reserve doesn’t mean that those ovaries produce eggs of the same quality as a young woman. The eggs also become older and the chances of abnormalities increase. The egg quality starts declining at 35 years old. An example is that we have a higher prevalence of Down Syndrome or miscarriage in such women. Other conditions that can affect the egg quality are pathologies like endometriosis or bad habits like smoking and alcohol consumption.
When do I need to assess my ovarian reserve?
The ovarian reserve can be assessed whenever a woman wants to know about it and especially is recommended when she is planning to postpone her fertility until older ages. Nowadays it is very common that a woman does not plan pregnancy until she is over 35 years old, either because of her own career / job or simply the desire to wait. It is in these cases where we strongly suggest fertility advice and consider options like fertility preservation.
If I have a low ovarian reserve, can I still have children?
A full fertility assessment is highly recommended but in a good number of cases, assisted reproductive techniques can help. A number of options are available and some examples are In Vitro Fertilization and / or the use of donor eggs. It is important to know and understand each and every fertility treatment available at Beacon CARE Fertility and its own chances of success. The decision must be taken by all parts involved taking into consideration success rates, IVF costs and most importantly, your emotional wellbeing.