What is the ovarian reserve?
The ovarian reserve is the ovary capacity to produce eggs after stimulation. The ovarian reserve is depending on the woman’s age, being stable until 35 years and diminishing progressively afterwards. The ovarian reserve depends individually on each case, which is why it needs to be analysed in all women with sterility problems.
On what depends the ovarian reserve?
The ovarian reserve is genetically determined. During the embryonic development of each female all follicles she will ever have during her reproductive life are already generated. With the initial phase of each menstrual cycle several follicles are elected but finally only one will produce the ovulation. The rest of the elected follicles will get lost and like this the ovarian reserve diminishes bit by bit until the menopause starts.
There are circumstances that might decrease the ovarian reserve. Special attention should be paid to any kind of ovarian surgery and the use of certain medication, like chemotherapeutic drugs. This is the reason why a conservative approach to ovarian surgery is recommended and it should be avoided, if possible, at all times. In cases of chemotherapy it is recommended to freeze eggs always beforehand if possible, since in many cases these treatments lead to total destruction of the ovarian reserve and therefore cancel all possibilities to achieve a pregnancy with own eggs.
How does the age affect the ovarian reserve?
Age is the most crucial factor in relation with the ovarian reserve, which remains stable until 35 years and diminishes progressively from that moment on.
How can the ovarian reserve be evaluated?
We dispose of several tests to evaluate the ovarian reserve but the most simple and exact ones are the following:
- Anti-Müllerian-Hormone (AMH): produced in the ovary it reflects the quantity of the available follicles. It allows us to evaluate a low ovarian reserve as well as the risk of hyper stimulation during treatment. It has the advantage to be determinable at any moment of the cycle
- Count of antral follicles via ultrasound: is done at the beginning of the cycle and shows all the follicles ready to respond to a hormonal stimulation within this cycle. Has the advantage to be easily done via ultrasound during a consultation
- Basal FSH and estradiol: is always measured at the beginning of the cycle and both hormones need to be determined to evaluate the ovarian reserve. It has the disadvantage that it needs to be carried out at a certain moment of the cycle. The obtained values might vary between cycles, the result will be determined by the highest FSH level obtained
It needs to be considered that the results of these tests for the ovarian reserve are an orientation and need to be analysed considering the clinical history of the patient as well. Despite these markers for the ovarian reserve, the most viable way of measuring is the hormonal stimulation of the ovaries.
What can I do if I have a low ovarian reserve?
The treatment of a low ovarian reserve depends on the clinical history of the couple, the results of the other diagnostic tests and especially on the age of the woman. In cases of low ovarian reserve where it is not possible to obtain own eggs the indicated treatment would be egg donation.