Ovarian Reserve 

Natural menopause around age 51 to 52 is usually associated with almost complete loss of eggs. Ovarian reserve testing can provide an accurate evaluation of your current egg quantity. Normal female fetus at twenty weeks of intrauterine gestation has about 7 million eggs in both ovaries.  At birth she will have about 1 million and at puberty around 250,000 to 400,000 eggs in both ovaries.  The continuous and gradual loss of oocytes will become more significant after age 30, and remarkable after age 38 to 42.  As a result, the fertility potential of a woman usually begins to decline appreciably at the age of 35 years with dramatic decline beyond age 40. The reason for decreased fertility potential with increasing age is related to decreased number of remaining oocytes, chromosomal abnormalities in the egg (both egg quality and egg quantity).  As a woman ages, an increasing ratio of her eggs will contain an abnormal number of chromosomes.  Chromosomal abnormalities in the oocytes in woman at age 35 or older result in higher chance of having a baby with Down’s Syndrome, higher risk of miscarriage, and other chromosomal anomalies resulting in severe abnormalities in the embryo such that the embryo may not implant or survive.  These chromosomal anomalies can explain decreased fertility potential as a woman ages, increased risk of spontaneous abortions, and increasing risk of having a baby with chromosomal anomalies including babies with down’s Syndrome or Turner Syndrome.  The average woman’s ovaries will stop functioning around the age of 50 to 51 resulting in natural menopause.  One percent of women, however, can lose almost all of their eggs and become menopausal before the age 40.  Several factors could influence ovarian reserve and the time of menopause including genetic factors, environmental factors, smoking, chemotherapy, radiation therapy, different diseases affecting the ovaries including endometriosis, ovarian surgeries to remove ovarian cysts or Endometriomas, autoimmune factors, and medical diseases such as Galactosemia or Thalassemia.  The decline in ovarian reserve generally begins about 15 years prior to establishment of menopause.  This is associated with an increase in follicle stimulating hormone (FSH) and/or serum estradiol levels during the menstruation.  Ovarian reserve as a result can be evaluated by a cycle day two or three (second or third day of menstruation) serum FSH and estradiol.  In addition to serum FSH and estradiol, another hormone Anti-Mullerian Hormone (AMH) can also be evaluated.  Unlike serum FSH and estradiol which should be done during early days of cycle, AMH can be performed on any day of the menstrual cycle.  It is most preferable way to evaluate a woman’s ovarian reserve by using serum FSH and estradiol and/or AMH along with vaginal sonogram to count the visible small follicles (antral follicular count) to obtain the best and most reliable results. 

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