Fertility & Perinatal Support @InnerSpring WellBeing in Stow, MA 978-461-2001
Fertility & Perinatal Support

Maternal Age and Ovarian Reserve

Measuring Ovarian Reserve

As women get older, their fertility declines due to normal age-related changes in their ovaries. Unlike men, who produce new sperm every day, women start out with a lifetime’s worth of eggs stored in their reproductive system. “Ovarian reserve,” a common measure of female fertility, refers to the ovary’s capacity to provide egg cells that can be fertilized to produce a healthy baby.

It remains a bit of an evolutionary mystery why women have the most eggs they will ever have while still a fetus, at around 16-20 weeks in utero. The total count varies, but by the time a girl is born, that number has decreased to about 2 million, and by puberty to approximately 300,000. From there the number steadily declines until menopause, whose timing is generally controlled by genetics, but also by lifestyle choices.

Only about .001% of the eggs a woman has at puberty will ovulate over the course of her reproductive years; that total is usually about 400-500. The rest of the >99.9% of eggs will undergo “ovarian follicle atresia,” in which the egg basically is resorbed back into the body.

Age related fertility: from How old are your eggs? D.Nikolaou, Current Opinion in Obstetrics and Gynecology 2008, 20:1–5
Age related fertility: from How old are your eggs? D.Nikolaou, Current Opinion in Obstetrics and Gynecology
2008, 20:1–5

As age increases and ovaries are less inclined to ovulate, the pituitary gland will excrete more follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to stimulate the ovaries to kick into monthly action. FSH helps the follicle grow, while an LH surge stimulates ovulation. One measure of the ovarian reserve tests blood levels of FSH and estradiol (E2) on day three of the menstrual cycle. FSH levels greater than 10 mIU/m are considered elevated (the pituitary gland is working too hard to stimulate unresponsive ovaries) and may indicate a poor reserve. The same with an E2 level above 70 pg/ml; it is considered elevated no matter the FSH levels and can also indicate a poor reserve.

In general, women whose day-three levels of FSH and/or estradiol are high are less likely to have a baby after either ovulation induction or in vitro fertilization (IVF) compared with other women of the same age.  However, those numbers do not include women treated with Chinese medicine and other modalities to support their fertility health. We can do much to address issues of ovarian reserve that Western medicine cannot.

Another measure of ovarian reserve is anti-müllerian hormone (AMH), produced by granulosa cells in small (less than 8mm) ovarian follicles. Its level can help us estimate the number of remaining eggs.  Therefore women with many small follicles, such as those with polycystic ovaries, will have elevated AMH values, and women nearing menopause will have low anti-müllerian hormone levels. AMH does not tell us anything about egg quality, which can often be the missing metric that Chinese medicine is able to improve. AMH levels can be tested at any time during the menstrual cycle; optimal levels are between 1.0 and 4.0 ng/ml.

Often a reproductive endocrinologist will run a test of inhibin B along with tests of AMH, FSH, and E2 levels. The amount of inhibin B measured in serum during the start of a new menstrual cycle is directly related to the number and health of small growing follicles. Inhibin B levels are low in women whose ovarian function has diminished.

A transvaginal ultrasound called an antral follicle count (AFC) done in the early part of the menstrual cycle can check the number of small (2mm-10mm) follicles, called antral follicles, in the ovary. This is where eggs develop. Reproductive endocrinologists (REs) often measure the number of antral follicles after using gonadotropins (FSH) to stimulate follicle growth.

Improving Chances and Egg Quality

It’s not all gloom and doom should you have some parameters out of range. Elevated FSH or E2 does not mean you can’t get pregnant, as there are many natural treatments available to improve egg quality, which is not set in stone. Even if the quantity of your eggs is not what it used to be, you can greatly improve their quality, along with your overall health, through lifestyle changes and treatments such as those we offer. Chinese medicine, Functional Nutrition, and abdominal work will all improve your chances of a successful live birth.

Chinese medicine can also improve the chances of success for older women by helping produce a healthier uterine environment. We can also improve sperm quality, which translates to better embryo quality and greater chances of successful implantation. If you have been told you have diminished ovarian reserve or poor egg or sperm quality, give us a call.

 

Age related fertility: from How old are your eggs? D.Nikolaou, Current Opinion in Obstetrics and Gynecology 2008, 20:1–5

Age related fertility: from How old are your eggs? D.Nikolaou, Current Opinion in Obstetrics and Gynecology
2008, 20:1–5

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