29/1/2020
PUNE: A woman
is born with 2,000,000 eggs, which subsequently undergo reduction as she ages.
The ability of a woman's ovaries to produce high-quality eggs (and ultimately
good-quality embryos) is known as ovarian reserve (OR). The ovarian reserve
decides the fertility period or fertility health in females and declines
naturally as women age, but some women may experience a decline of ovarian reserve
sooner than others.
Discussing the causes and treatment for low ovarian reserve at
a press meet held today, Dr Karishma Dafle, Fertility Consultant, NOVA IVF Fertility,
Pune, commented, “In the year 2019, Nova IVF Fertility Pune recorded an average
of 26% women as Low Ovarian Reserve cases, with an average of 34% women under
the age of 30 suffering from low ovarian reserve. During a reproductive cycle,
a woman loses around 30-50 eggs every month. This results in a drop in her
ovarian reserve, which eventually leads to total depletion at the age of 45-50
years when menopause occurs. A low ovarian reserve can hamper the ability to conceive
naturally. However, in cases where women plan to delay pregnancy, a simple
blood test called AMH test can help them understand how much longer they can
postpone child-bearing and accordingly plan their pregnancy.”
Menopause or the complete depletion of the ovarian reserve
before the age of 35 is commonly defined as “premature ovarian failure (POF) or
premature ovarian insufficiency. Premature ovarian failure (POF) is a condition
where there is an age-related physiological decrease in the number of eggs
which could impact the chances of pregnancy. Hereditary, lifestyle, and
environmental factors affect the natural onset of menopause. The average age
for menopause is 50 years, with 1% of women menstruating even after the age of
60. However, off late the number of women reaching menopause under 40 years of age
is on the rise. Studies have reported that nearly 1-2% of Indian women
experience signs of early menopause between the ages of 29 to 34 years.
Additionally, this figure goes up to 8% in the case of women between 35 and 39
years of age.
What
causes the ovarian reserve to diminish?
While today’s lifestyle habits such as smoking, junk food
consumption etc are major contributors to diminishing ovarian reserve, there
are several other factors which include: Genetic abnormalities (Fragile X and
other X chromosome abnormalities) Aggressive treatments (radiation for cancer) Ovarian
surgery, such as for endometriosis Factors leading to Premature Ovarian reserve
Primary ovarian insufficiency can occur because of X-chromosome abnormalities,
autosomal causes, galactosemia, autoimmune disorders, cancer treatment,
Turner’s syndrome, enzyme defects, and environmental toxins. In addition, the
innumerable rounds of ovarian stimulation done as part of infertility treatment
procedures without proper monitoring can also cause a decreased ovarian
reserve. Also, family history of premature ovarian failure is also a factor
seen in 10% of POF cases.
Detecting primary ovarian insufficiency In a country
with a population of 1.2 billion, it is estimated that a whopping 30 million couples
suffer from infertility. What is even more worrying is the rising incidence of
young women facing infertility. A condition which was predominantly seen among
older couples, infertility is now seen more frequently in women who are younger
than 35 years of age.
Case: An IT couple aged 32 years, married for 5 years visited
NOVA IVF Fertility, Pune to get treated for primary infertility. Apart from
scanty menses, the patient had no other complaints. On conducting an ultrasound
check-up, the egg number was found too low for her age (2 eggs/ovary). She was
advised to do an AMH test which revealed that her reserve had declined
drastically. Her AMH level was 0.3. She was advised early IVF and embryo pooling.
After doing two consecutive IVF cycles we got 2 good grade embryos which were transferred
and she conceived eventually and gave birth to single healthy baby.
Some of the major symptoms of primary ovarian insufficiency
include irregular menstrual cycles, primary or secondary amenorrhoea, hot
flushes, night sweats, loss of libido, etc. It is therefore strongly
recommended that young women in their late 20s and early 30s who face complications
in conceiving should immediately visit a fertility expert. Early detection
would provide better opportunity for early intervention.
Anti-Mullerian Hormone (AMH) Test – How to know your ovarian
reserve “Age and fertility of the woman go hand in hand. Since a woman’s egg
reserve tends to deplete with age, couples need to plan their pregnancy
accordingly. Doctors recommend Anti-Mullerian Hormone (AMH) test to determine
the fertility potential of a woman. AMH is secreted by the cells in the
developing sacs (follicles) and is a marker for ovarian reserve that is
assessed through a blood test. The level of AMH in a woman’s blood gives
insight into her ovarian reserve and helps in knowing the number of eggs and
the number of fertile years one may have in future” said Dr Karishma.
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