Fertility begins to decline with advancing age. The concept of fertility, which can be evaluated especially with the structures called ovarian reserve and called follicles in the ovaries, has become frequently discussed as a result of the increase in the age of motherhood in recent years. The egg reserve in a woman does not vary much until the age of 30, starts to decrease after the age of 32, and begins to run out especially after the age of 45-47, causing the period called menopause to enter. Nowadays, as a natural result of postponing motherhood and increasing the average age of becoming a mother, the need for assisted reproductive techniques, especially in vitro fertilization, has increased. Disadvantages of the desire to become a mother at older ages (> 40) include problems getting pregnant due to low egg reserve, not being able to form a good quality embryo due to possible problems in the chromosome structure of the egg released even if the reserve is good, or the failure of the formed embryo to adhere to the uterus. Even if pregnancy occurs and continues, one should be very careful due to some burdens that advanced age will bring to pregnancy, especially diabetes and hypertension.
Nowadays, as a result of people's awareness and promotion of a healthy lifestyle. Average life expectancy has increased. However, with developing technology, egg reserve is at risk as a result of exposure to some environmental factors. In addition, due to the postponement of motherhood and the addition of some risk factors that have a negative impact on the person's ovarian reserve, if any, the decrease in fertility and the need for assisted reproductive techniques, especially in vitro fertilization, have increased in the process until today.
Reducing the ovarian reserve. Concepts that contribute negatively to fertility are listed below:
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Smoking
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Previous unilateral or bilateral ovarian surgery
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History of previous cancer and therefore chemotherapy and radiotherapy
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Genetic Disorders
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Genetic predisposition to early menopause
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Some disorders in the immune system
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The total number of visible follicles within the ovaries, called the antral follicle count, which is checked on the 2nd day of menstruation (measured by ultrasound)
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Anti-Mullerian Hormone (AMH) test, which is a blood test regardless of the menstrual period (it is more sensitive after the age of 25)
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menstrual period 2 FSH and Estradiol tests taken on the day
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People in the family who have a mother or sibling who went through early menopause and who do not plan to become pregnant in the near future
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People who are under the age of 40 and have prolonged menstrual intervals along with hot flashes
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Regardless of age, having a desire for pregnancy and this condition can cause chocolate cyst and /or accompanied by a disease called endometriosis
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regardless of age, especially people who have had bilateral ovarian surgery
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childhood or adulthood People who received chemotherapy or radiotherapy during the p>
The most fertile age for women is 20-35. Prof. Dr. Recai Pabuçcu underlined that the chance of fertility will decrease especially after the age of 35, and that the age of 38 should be taken as a limit for fertility. For a 30-year-old woman who is healthy and not in menopause, if her tubes are open, her ovarian capacity is good, and her husband's sperm values are also good, the chance of pregnancy that month is approximately 20%, assuming there is no problem with the normal ovulation pattern. The important point here is that even if everything is normal, the probability of pregnancy occurring is less than thought. This rate is evaluated as approximately 80% in a one-year period. When a woman reaches the age of 40, the chance of pregnancy drops to 5%. The message to be taken from here is; If a pregnancy plan is being made, the woman's age should be kept in mind and especially those over the age of 36-38 should not waste any more time.
Which Tests Are Used for Ovarian Reservation in Women?
Today, the most common and most sensitive methods are:
In the follicle count of these tests, if the total number in both ovaries is below 5, if the value in the AMH test is below 1 ng/mL. If the value in the FSH test is above 20 IU/L, it is considered that the person's ovarian reserve is quite low.
Early Menopause
The concept of 'early menopause', which has been frequently examined recently and does not yet have a cure, is observed in approximately 1 in 100 women. Early menopause is the aging and depletion of the ovaries earlier than expected. The average age of menopause in Turkey is considered to be 47. The most important factor determining the age of menopause is the previously mentioned total follicle pool in the ovaries. Due to the decreasing pool over the years, the menopause situation It's like. The number of this follicle pool, the most important concept that determines the ovarian reserve, is also related to genetics. In other words, a woman's age at menopause will often be similar to her mother's menopause age.
If a woman younger than 40 years of age has menstrual irregularities or no menstrual periods lasting more than three months and one month If menopause values are found in the intermediate tests, the diagnosis is made as EARLY MENOPAUSE. Cases diagnosed with early menopause should be handled very carefully and informed in a healthy way. In addition to the negative outcome in fertility, it is very important that people be informed and treated about the risk of bone fractures due to cardiovascular diseases and osteoporosis.
Prof.Dr.Recai Pabuçcu, especially smoking, brings the age of menopause forward by approximately two years. It warns expectant mothers about: It is very important for cases with a family history of early menopause, whose mother or sister entered menopause at the age of 35-40, to consult a gynecologist without further delay and to receive counseling about fertility potential.
In summary, to list who should have their egg reserves measured:
As a result;
The concept of ovarian reserve is genetically determined from birth, irreversible in number over time. It is a decreasing concept. Unfortunately in today's conditions This decrease cannot be prevented by any medication or technique. Therefore, it would be a correct approach to identify women at risk and take precautions as soon as possible. By using the tests we have, we can at least be informed about the situation and request professional support. In this way, we can have an idea about which cases it may be beneficial to wait and for which assisted reproductive methods, including in vitro fertilization treatment, may be beneficial. It should not be forgotten that as a result of negligence and indifference, it may be too late for everything.
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