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Over the last few decades, the average age at which women choose to have babies has risen. A recent publication mentioned that a number of women having babies after the age of 40 is sharply increased and the number of those having babies after 45 has almost doubled.
Whilst this is mainly has been linked with with higher level of economic development and education and opportunities for women, it also means that there is a risk that opportunities for having a baby may reduce because of having waited for too long.
With growing age, women’s fertility decreases as the number of eggs reduces every month and year. At menopause the number eggs in the ovary are practically zero but in the 10-12 years leading up to menopause (which is called climacteric) is when gradual change towards menopause gathers pace. Fertility reserve is a way we check for various associations of the reduction in the number of young follicles in the ovary. The following are the tests we do and the rationale.
Fertility reserve has come up in the last 5-10 years thanks to the discovery Anti Mullerian Hormone (AMH) which related to the number of ovarian follicles in the ovaries. Low levels of AMH will suggest that the reserve of ovarian follicles (which will make eggs) has gone down. Fertility reserve is when we try to quantify this.
Every follicle in the ovary will secrete this hormone which circulates in the blood. It is not dependant on the phase of the cycle and its value roughly correlates with the number of follicles in the ovary, small or large. In the last 10 years, the data we have is quite extensive and it is now possible to predict if a given level of AMH suggests an adequate supply of eggs or not.
Apart from predicting the ovarian reserve we use the AMH to predict the responsible ovary to FSH hormone used to develop eggs in an IVF treatment cycles. This has reduced chances of ovarian hyper stimulation to certain extent.
These are very small follicles present mainly in the central areas of the ovary. They are best seen in the first 3-4 days of the menstrual cycle. If the ovarian reserve is good the number of antral follicles is high. Very few antral follicles with lower AMH and lower ovarian reserve.
Like the AMH antral follicle score is sued to optimize dose of FSH in an IVF cycle. Scores higher when 10 will require us to load us to prevent hyper stimulation in the ovary. Very low antral follicle score of 1-2 in the ovary will indicate that the FSH dose may have to be increased.
Is a hormone that participate in folliculogenesis and it is low when the number of follicles in the ovary are greatly reduced.
Whilst ovarian reserve is helpful test we urge our clients to remember that it is a relatively new test and the predictions about ovarian function have to be used cautiously. Low levels of AMH levels may panic a woman thinking that her menopause is round the corner, that may not be the case every time. In the same way elevated AMH levels does not guarantee that the woman has many more years of fertility left. These are the standard the caveats we would like to remind clients when discussing a science that hasn’t been around for long.
More and more women are considering this option. We can now freeze oocyctes if the woman is unsure about having children soon. A woman who is around the age of 30 years normally has a stock of eggs. We can freeze eggs at this point and use them a few years later when she chooses to start her family. More details about how oocyte freezing has become more successful over the years and how it has helped women, is discussed in one of our blogs.
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Know more about Oocyte freezing