How is the Ovarian Reserve Decreasing?
In recent years, women's education period has been extended, their active participation in business life and their career desires have postponed the age of having children, and birth control methods have become widely used after the 1960s. It has caused their size to decrease and the rate of age-related female infertility to increase. After the age of 30, women's monthly chances of getting pregnant decrease as a result of aging reproductive potential.
With increasing maternal age, the risk of chromosomally faulty egg production and miscarriage increases, and problems such as diabetes and hypertension during pregnancy also increase. Postponing the age of birth also increases the risk of newborn babies as a result of an increase in the rate of premature birth and low birth weight babies.
Ovarian reserve is a term that reflects the quality and number of egg cells in the ovary and is used to describe their functional potential. With ovarian aging, there is depletion in the number of egg cells and a decrease in egg quality. In women, the reserve of egg cells decreases with advancing age. Age-related decrease in the number of egg cells in the ovaries and deterioration in egg quality cause the natural loss of the chance of getting pregnant, leading the woman towards menopause. Postponing the age of birth increases the rate of couples using assisted reproductive techniques for pregnancy.
Biology of Reproductive Aging
In the fourth month of the mother's womb, there are 6-7 million egg cells in the baby's ovaries. With the natural physiological destruction of egg cells, only 1-2 million egg cells remain at birth. After birth, this rapid loss of egg cells slows down; when the first menstrual period comes, there are 300 000-400 000 egg cells. During the reproductive period, approximately 400 eggs are laid once a month. The decrease in the number of egg cells is constant throughout the reproductive period, an average of 1000 egg cells are lost per month, but the rate of loss increases after the age of 37.
When the number of egg cells drops below 25 000, the decrease is approximately 1000 egg cells. It accelerates until the threshold is reached and menopausal symptoms begin to appear. As a result of the higher number of egg cells destroyed despite ovulation, the number of eggs decreases dramatically with rapid loss near menopause. During menopause, the number of egg cells drops below 1000. It is estimated that 13 years before menopause, while menstruation continues regularly, the ovaries show signs of rapid decline in fertility.
The number of menstrual cycles throughout life varies between individuals due to the different rate of destruction. The regularity of menstrual periods changes with hormonal changes that occur towards the end of the reproductive age period. During the pre-menopausal transition period, FSH hormone increases significantly, inhibin level decreases, and LH hormone level does not change. During the perimenopausal period, estradiol level remains normal due to the ovarian response to the increasing FSH hormone, or it rises slightly on average 1 to 2 years before egg development stops. Estradiol level, which begins to decrease 1-2 years before menopause, continues to decrease for 1 year after the last menstrual period.
The earliest sign of fertility aging is a 2-3 day shortening in menstrual period length. Despite the decrease in the number and quality of eggs, the menstrual cycle does not deteriorate initially, but the monthly chance of getting pregnant decreases dramatically despite regular menstruation. Studies show that the chance of getting pregnant naturally ends at the average age of 43.
The average time between the onset of menstrual irregularity and the emergence of menopause is 5-10 years. While the infertility rate is 10-20% when a woman is over 35, this rate is only 4% in her 20s.
Can ovarian reserve tests predict fertility chances?
The fertility potentials of women in the same age group may differ from each other. Ovarian reserve tests can predict ovarian response and pregnancy chances in people with different fertility potentials.
Women who are shown to have no chance of becoming pregnant by ovarian reserve tests and clinical evaluation are protected from both the negative effects of the treatment and the costs of the treatment. Information about alternative ways to have a child can be provided to them at the appropriate time.
The chance of becoming pregnant in IVF treatments depends not only on the ovarian reserve but also on many factors. Generally, patients undergo ovarian reserve tests during the initial evaluation, but it is not always possible to find out exactly the woman's capacity to conceive. Our current knowledge shows that the patient's response to the ovulation treatment protocol is closely related to the egg pool that can respond to the FSH hormone administered with medications.
Can women with low ovarian reserve become pregnant?
Clinical experience ovarian reserve tests It shows that abnormal women can become pregnant both spontaneously and with in vitro fertilization treatment. Although it has been shown that high serum FSH levels in women are associated with low pregnancy rates, it would not be correct to make a decision based solely on this.
Genetic factors regulate the size of the egg cell pool. The rate of aging of the ovaries varies greatly from woman to woman.
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