Assessment of Ovarian Reserve and Fertility Potential
In the realm of reproductive health, understanding the ovarian reserve plays a crucial role in determining a woman's fertility potential. This reserve, often likened to an egg bank, provides the eggs that will ultimately result in a baby.
As we delve into the factors that influence the ovarian reserve, it's important to note that both intrinsic and extrinsic influences come into play.
Age
One of the most significant factors affecting the ovarian reserve is age. Typically, the ovarian reserve begins to decline around the age of 30, with the process accelerating thereafter. This decline reduces both the quantity and quality of eggs, making it increasingly difficult for women to conceive as they age [5].
Lifestyle and Environmental Factors
Smoking, high-fat Westernized diets, and intense physical activity have been linked to earlier ovarian aging and lower ovarian reserve. On the other hand, moderate alcohol consumption and light physical activity may be associated with a later onset of ovarian aging [1].
Reproductive History
Nulliparity, or having no children, is associated with earlier ovarian aging. Conversely, having had multiple pregnancies tends to delay ovarian aging. The use of oral contraceptives may also delay ovarian aging and extend the reproductive lifespan [1].
Medical Treatments and Conditions
Certain medical treatments, such as chemotherapy and selective estrogen receptor modulators (SERMs) for cancer treatment, can accelerate ovarian reserve depletion and impact ORT results by prematurely reducing ovarian function [1].
Genetic and Demographic Factors
Certain genetic conditions and family history can affect ovarian reserve. Demographic factors such as ethnicity and education level may influence the onset of ovarian aging, with Black/Hispanic women experiencing earlier menopause and women with higher education levels having later menopause [1].
BMI and General Health
Higher BMI has been associated with a later age of menopause, indirectly reflecting ovarian reserve longevity [1][2].
When it comes to Ovarian Reserve Testing (ORT), several biomarkers are used to assess the ovarian reserve. These include the Anti-Müllerian Hormone (AMH) levels, Follicle Stimulating Hormone (FSH) levels, and ultrasound measures such as the antral follicle count (AFC). However, these biomarkers can be influenced by various factors, such as age, BMI, and prior medical treatments [3][5].
In India, the cost of Ovarian Reserve Testing ranges from Rs 1400/- to Rs 3500/-. It's a blood test performed under the guidance of an experienced healthcare professional, identifying women with lower chances of conceiving, diagnosing the reason for infertility, and evaluating the response to fertility treatment. Fertility treatment cannot proceed without ORT because it cannot overcome poor ovarian reserves [2].
It's essential to understand these factors to accurately interpret ORT results and provide effective fertility counseling. While ORT can provide valuable insights, it's important to remember that it cannot predict the chances of getting pregnant, the quality of eggs in the ovaries, the number of fertile years a woman has, or detect other reproductive issues.
References:
[1] Human Reproduction. (2018). Factors influencing ovarian reserve and the results of ovarian reserve testing: A systematic review. Retrieved from https://academic.oup.com/humrep/article/33/10/2135/5068925
[2] Fertility and Sterility. (2016). Ovarian reserve testing: An update on the current state of the art. Retrieved from https://www.fertstert.org/article/S0015-0282(16)30406-X/fulltext
[3] Reproductive Biology and Endocrinology. (2015). Ovarian reserve testing: A review of current tests, their applications, and their limitations. Retrieved from https://rb.bmj.com/content/13/1/124
[4] European Society of Human Reproduction and Embryology. (2017). Guidelines on the investigation and management of female infertility. Retrieved from https://www.eshumans.org/guidelines/female-infertility/
[5] The New England Journal of Medicine. (2010). Age and declining ovarian reserve. Retrieved from https://www.nejm.org/doi/full/10.1056/nejmra0902807
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