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Know everything about your Egg count

- 10 min read
written by Shield Connect

Are you having difficulty conceiving? Do you feel that you biological age is racing ahead and it is causing a hindrance to your plans of getting pregnant? Maybe you are not wrong. Your biological age does play a role in your chances of getting pregnant. Your egg reserves might be getting diminished. Read on to … Continue reading “Know everything about your Egg count”

Are you having difficulty conceiving? Do you feel that you biological age is racing ahead and it is causing a hindrance to your plans of getting pregnant?

Maybe you are not wrong. Your biological age does play a role in your chances of getting pregnant. Your egg reserves might be getting diminished. Read on to understand more about your egg count.

Ovarian reserve of a woman is nothing but an estimated number of eggs, or oocytes, a woman has in her ovaries at a given time. When a female child is born, she has approximately 1 to 2 million eggs in reserve, which declines to approximately 250,000 to 500,000 eggs at puberty (around teenage). This count further declines to approximately 25,000 at around 37 years of age and to less than 1000 at menopause.1

Poor Ovarian Reserve
The number of eggs present in a woman naturally declines as she ages – both due to ovulation and a natural cell death process called “Apoptosis” – and normally the woman would exhaust her egg reserve by the time she reaches menopause. However, if the decline in egg count happens faster and the woman is depleted of her egg reserve before expected menopause, she should be suspected to have “poor ovarian reserve”.1

Poor ovarian reserve is generally noted in women in their mid to late thirties, but it may affect younger women as well. It is believed that approximately 10% of the women who are undergoing IVF will show poor ovarian reserve. However, the incidence may be much higher in the infertile population as many may never undergo a complete evaluation or even consider IVF.2

Ovarian reserve defines the quantity and quality of the ovarian follicular pool. Poor ovarian reserve (POR) indicates a reduction in the quantity of ovarian follicular pool in women of reproductive age group and is an important cause of infertility in many couples 2

A woman in today’s age, who chooses to marry late and settle for a family even later, has limited time for conception with one’s own eggs. However, recent evidences have stated that poor ovarian reserve may be noticed in young women with low pregnancy rates. poor ovarian reserve may be associated with low pregnancy rates irrespective of age and a high pregnancy loss.2 These women show poor response when ovaries are stimulated with drugs to produce multiple eggs in assisted reproductive technique (ART)

Reasons -for Poor Ovarian Reserve
Poor ovarian reserve can be caused by a number of reasons1:

1. Advanced maternal age
2. Genetic defects such as Turner’s syndrome or Fragile X syndrome.
3. Damage to the ovaries due to any injury, infection, and surgery
4. due to radiation or chemotherapy leading to premature ovarian failure
5. Cigarette smoking

However, in most cases, the exact cause of poor ovarian reserve remains unknown.

Possible Symptoms of Poor Ovarian Reserve
There aren’t many noticeable symptoms of diminished ovarian reserve. However, apart from difficulty getting pregnant, some may experience3:

    • Late or absent menstrual periods
    • Shorter menstrual cycles than average, with the average being 28 days
    • Heavy menstrual flow
    • Miscarriage

These symptoms aren’t always present. Hence it’s important to talk to your doctor.3

Diagnosing Ovarian Reserve
It’s important to get the testing done early if you’re trying to conceive without success or if you have a history of irregular or painful periods, repeated miscarriages, prior cancer treatment, or endometriosis. Early diagnosis means that you have a better chance of successful treatment.3

If you’re under the age of 35 years, you should see a doctor if you’ve been trying to get to conceive for a year. If you’re over 35 years, see a doctor after six months of trying to conceive. However if you’re over 40 and you’re trying to conceive, it’s best to talk to your doctor right away.3

There are various tests to assess ovarian reserve. The main tests include1:

    1. Serum FSH done on the 2nd /3rd day of a woman’s menstrual cycle gives an indication of the woman’s egg reserves.
    2. Serum Anti mullerian hormone (AMH) – very sensitive test to check the woman’s ovarian reserve. It can be done on any day of the menstrual cycle.
    3. Antral Follicle count- Antral follicles are small follicles present in the ovary that are best seen during the early phases of the menstrual cycle.
    4. Trans-vaginal ultrasound (TVS) of the pelvis is used to count the number of Antral follicles, which gives good estimate of the woman’s ovarian reserve.

Importance of Getting Ovarian Reserve Tested
A woman’s ovarian reserve is an indicator of her fertility potential. Women facing difficulty in conceiving naturally or due to some reason is planning to delay in getting pregnant should be assessed for their ovarian reserve for timely and appropriate fertility intervention.1

Poor Ovarian Reserve and Pregnancy
If a woman is diagnosed with poor ovarian reserve then it reduces her chances of getting pregnant both naturally and with fertility treatment.1 However, there is no reason to get disheartened, as it is still possible to get pregnant. There is a 33% chance that after receiving the apt treatment women with poor ovarian reserve can get pregnant with their own eggs. However, for this to happen an early diagnosis is important, as it gives you a better chance of conceiving.3

Treatment to Improve the Ovarian Reserve
A woman can take immediate step and try fertility preservation, in which the woman’s egg is retrieved from her ovaries and is frozen for later use. The best time for women to freeze eggs is when they are young and their ovarian reserve is better.4

Androgen supplementation in the form of oral dehydroepiandrosterone or transdermal testosterone in poor responders has been explored. it shows a modest improvement in number of oocytes, embryo quality, and live birth rates.2

Growth hormone (GH) supplementation is another therapy may be beneficial in poor responders. 2

Oral Leucine an important essential amino acid and a nutrient has a role in follicular activation and to induce Folliculogenesis. This clearly helps in women with poor ovarian reserve

Women diagnosed with poor ovarian reserve have best chances to get conceived with IVF. It IVF includes extensive treatments with injectable hormones to induce the woman to ovulate multiple eggs. The eggs are then  used for fertilization.

If nothing works then donor eggs along with IVF are the best option for women with a low ovarian reserve, especially if their remaining eggs are of low quality.4

Being told you have a diminished ovarian reserve can be discouraging, but it’s completely possible to get pregnant with your own eggs or donor eggs with IVF.. If you suspect you have a diminished ovarian reserve, or if you’re having difficulty with conceiving, speak to your doctor.

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