Among the three most important factors influencing human fertility (egg quality, sperm quality, and the function of Fallopian tubes), egg quality holds the greatest significance for the probability of pregnancy. Female fertility potential is determined by the quality of eggs within the ovaries rather than the receptivity of the uterus.
The term ‘egg quality factor’ refers to the frequency of genetically and biologically ‘perfect’ eggs present within the ovaries. This frequency begins to decrease at the age of approximately 32, and by the age of 40, a vast majority of high-quality eggs have already disappeared from the ovaries. This results in diminished ovarian reserve. For some women, diminished ovarian reserve can begin at a much younger age.
Diminished ovarian reserve occurs when there is only a small proportion of high-quality eggs left within the ovaries.
A combination of transvaginal ultrasound examination of the ovaries and an assessment of reproductive hormone levels known as Ovarian Reserve Assay (ORA) can be utilized to estimate the ‘biological age’ of your ovaries. The results of these tests will determine the most appropriate treatment for you.
The ultrasound of your ovaries will establish the number of antral follicles (seen as small dark circles) within the ovaries. The number of antral follicles is related to the quality of the eggs. Ideally, there should be 8 to 12 antral follicles per ovary.
ORA consists of the measurement of Follicle Stimulating Hormone (FSH), estradiol (estrogen, E2), and Anti-Mullerian Hormone (AMH) blood levels. It can assess the likelihood of producing normal-quality eggs.
FSH stimulates the ovaries to produce eggs. If the ovaries cannot produce normal-quality eggs, the FSH level is increased. Estradiol production by the ovaries influences FSH secretion and is also related to egg quality. The AMH level reflects the quality of eggs, and its result is used to optimize ovarian stimulation.
Most patients with a diminished ovarian reserve will require In Vitro Fertilization, Donor Egg IVF, or Frozen Donor Egg IVF to conceive successfully.
