Ovarian reserve or the number and quality of eggs in the ovaries plays a crucial role in ovulation and pregnancy. The production of eggs naturally reduces with age, from millions during birth to a few hundred until there are no eggs produced and a woman attains menopause. This reserve is a key determining factor for fertility.
Age and ovarian reserve
Besides the number of eggs in the ovarian reserve, their quality determines fertility in women. However, both diminish with age, and women over the age of 35 can be at risk of diminished or low ovarian reserve, which affects their fertility, says Dr Chitwan Dubey, gynecologist, Dr LH Hirandandani Hospital, Mumbai.
Women over the age of 40 have only 3% of the ovarian reserve left, shares Dr Sandhya Rani, senior consultant, obstetrics and gynecology, Aster Women and Children Hospital, Whitefield, Bangalore. Understanding the reserve levels helps to understand fertility chances and opt for the most suitable fertility treatment.
Does low ovarian reserve mean no pregnancy?
Low ovarian reserve is one of the factors that hinders pregnancy. However, when the woman is less than 35 years old, the low reserve count may not hinder natural conception.
A 40-year-old woman with anti-mullerian hormone (AMH – a hormone that produces eggs or follicles for menstruation and pregnancy) levels between 0.8-1 has a lesser chance of conceiving naturally compared to a 32-year-old woman with the same AMH levels, explains Dr Dubey. She adds, “Unlike women under the age of 35 with a low ovarian reserve, older women with the same condition may require a donor egg to conceive or need to opt for methods like in vitro fertilization (IVF).”
How can you check the ovarian reserve?
While an AMH test is primarily used to check the ovarian reserve, it is not the only means to do so, shares Dr Dubey. A vaginal ultrasound is crucial to understand the antral follicle count (AFC — a marker of ovarian count), follicular study (time when the follicle ruptures to release an egg), and thickness of the endometrial lining, she explains.
Dr Rani adds that blood tests for follicle-stimulating hormone (FSH) and estradiol are also essential. “These hormones play a key role in egg production and menstrual cycle regulation, so they help in understanding this reserve better,” she explains.
Can ovarian reserve be increased?
When 31-year-old Shilpa Sundar (name changed), who was having trouble conceiving, visited the gynecologist, she was diagnosed with PCOD (polycystic ovarian disorder). She also recalls that she was overweight. The doctors recommended that Sundar test her ovarian reserve before seeking fertility treatment. These revealed that her AMH levels and AFC were borderline. Her obesity, however, was still a concern. She was recommended exercises, diet and medications. In one year, she conceived and delivered a healthy baby boy.
While ovarian reserve cannot be increased, it can be preserved and the decline can be slowed down. Women under the age of 35 can start by making lifestyle changes. One can start by reducing 10-15% of their body weight in case of obesity, restoring hormonal balance and eating a healthy diet. Other factors, such as high stress levels, smoking, drinking alcohol, working night shifts, an unhealthy diet, obesity and autoimmune conditions including diabetes and pre-diabetes can result in quick depletion of the ovarian reserve. At the same time, lifestyle modifications can help one maintain a healthy reserve of eggs, stresses Dr Rani.
But in women over 40 years of age, the chances of pregnancy despite these changes are bleak, shares Dr Dubey. To avoid such complications, women can opt to freeze their eggs before they turn 35, she adds.
How to preserve the ovarian reserve?
While the depletion of ovarian reserve due to genetics and aging cannot be controlled, the dwindling caused by lifestyle and habits can be slowed down, says Dr Rani. “Regular exercise helps maintain a healthy BMI and slow down the decline. Women should start this as early as in their 20s,” suggests Dr Dubey. Also, a diet rich in antioxidants, green leafy vegetables and fruits can help. Moreover, one should consume carbs and sugar in moderation. Too many carbs and sugar can hamper the reproduction cycles by causing insulin resistance, she cautions.
Reduced consumption of caffeine, sugar and alcohol, and timely health checks for thyroid, diabetes and vitamins before pregnancy can help in maintaining a healthy reserve of eggs, explains Dr Rani. One must also avoid smoking and maintain good sleep hygiene, she adds.
Takeaways
- Ovarian reserve is a key factor in fertility.
- Along with AMH levels, FSH hormones, estradiol, AFC, and endometrial lining also indicate the ovarian reserve and chances of fertility.
- Age is the leading cause of diminishing ovarian reserve. Lifestyle factors such as a healthy diet, regular exercise, and reducing smoking and alcohol consumption can help slow down the decline in ovarian reserve.
