According to classical knowledge, women are born with eggs that they will use for a lifetime and no new eggs are produced. Although some study results contrary to this classical information have been published recently, let us seek an answer to the above question in the light of classical information until the results are reflected in the clinic.
It is a normal and physiological process that the number of eggs in the ovary decreases with increasing age. Even for women who have had children before, getting pregnant becomes difficult after the age of 39-40 and almost impossible after the age of 44. Of course, miracles can happen, but there is no significant chance after the age of 44.
Usually, in vitro fertilization programs do not want to accept couples for treatment if the woman is over 44. The decrease in ovarian capacity and therefore the loss of reproductive function should not be perceived as equivalent to menopause. A separation begins in women's reproductive and hormone secretion functions starting from the age of 37. While reproductive function declines rapidly from this age, hormone secretion function continues until the age of menopause, when the last menstrual period occurs. So, the answer to the question of why I am menstruating and why I cannot have children lies in this physiological change.
Ovarian capacity is exhausted earlier in women whose family members have early menopause. These women may experience reproductive difficulties approximately 10 years before the genetically programmed age of menopause. For example, a woman who will enter menopause at the age of 40 begins to have difficulty having children after the age of 30.
There are other reasons that cause a decrease in ovarian capacity other than age and genetic factors:
1. Previous ovarian surgeries. Since removing the ovary completely or removing a cyst will reduce the number of eggs, the capacity will decrease. Removing endometriosis cysts, especially known as chocolate cysts, may reduce the ovarian capacity on that side. It is essential that such surgeries be performed by competent surgeons and with maximum respect for normal tissues.
2. Previous radiotherapy and chemotherapy. Especially since teenage cancers have become treatable, reproductive problems are occurring more frequently in those who survive. It caused knitting.
3. Heavy smoking. When smoking more than 10 cigarettes a day, the ovarian reserve decreases.
The decrease in the reproductive function of the ovary is accompanied by the following symptoms in women.
1. Menstrual bleeding gets closer together. In women who previously menstruated every 28-30 days, bleeding begins to occur every 21-27 days. Sometimes menstrual bleeding may occur at intervals of 15 days. The amount of bleeding usually does not change. The claim that my bleeding has decreased or I am entering menopause is generally not true. In some cases, menstrual bleeding may be delayed as a result of absence or delay in ovulation.
2. The chance of spontaneous or treated pregnancies ending in miscarriage increases. This is usually caused by the remaining eggs being genetically abnormal as a result of decreasing ovarian capacity with increasing age or for another reason. Since the embryo formed as a result of fertilization of an abnormal egg will also be abnormal, it will either not attach to the uterus at all or will end in early miscarriage. In ongoing pregnancies, the number of babies with chromosomal abnormalities (for example, Down syndrome) increases.
3. As a result of stimulation of the ovaries in in vitro fertilization and similar treatments, the number of developing eggs decreases. Despite high doses of medication or changed treatment protocols, the ovaries are resistant to treatment and few eggs develop. Having a low number of eggs significantly reduces the possibility of pregnancies that can be achieved with these treatments. Weak ovarian response is recurrent and there is no known treatment today.
How can poor ovarian response be predicted in advance?
Women with a family history of early menopause and women with previous ovarian surgery should be careful. should be evaluated in some way. Information about ovarian capacity can be obtained through hormone tests (FSH, LH, Estradiol) performed on the 2nd or 3rd day of menstruation. FSH hormone is an indicator of ovarian capacity. If it is high (more than 10), it indicates that the capacity has decreased. Even if it is low in subsequent measurements, the ovary acts according to the higher value. Although FSH is low, estradiol level is high (more than 65) also indicates low ovarian capacity.
Measures of hormones such as inhibin B and AMH. All of them provide information about ovarian capacity. However, routine measurements are not recommended because the tests are more expensive and do not contribute to the information obtained with other tests. The most reliable information about ovarian capacity is obtained by vaginal ultrasound. With vaginal ultrasound, structures within the ovary that will develop potential eggs (antral follicles) can be seen and counted. If there are less than 6 immature egg structures in two ovaries, it can be said that the ovarian capacity is low.
What can be done?
Transition to in vitro fertilization treatment should be planned more quickly. . In in vitro fertilization applications, in the presence of decreased ovarian reserve, the birth rate decreases depending on the degree of decrease.
Can new egg production be achieved in the ovary?
Studies in the last year demonstrated the presence of stem cells within female ovaries. Studies on producing new eggs using stem cells and achieving pregnancy using these eggs have begun on animals. With the results of these studies, new doors of hope will be opened for women with low ovarian capacity, who are a very difficult patient group.
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