For many women considering their fertility options, assessing ovarian reserve, or the quantity of remaining eggs (oocytes), is an important step in making informed treatment decisions. Whether you’re having difficulty conceiving or want to consider egg freezing, knowing your ovarian reserve can guide decision-making.
Is fertility loss due to a reduction of the remnant ovarian reserve or, conversely, to the deterioration of egg quality?
Women are born with all the eggs they will ever have, around 1-2 million. That number continues to decline until menopause.
Immature eggs are stored in fluid-filled sacs called follicles. In an ovulatory menstrual cycle, many follicles will start to grow. With the amount of follicle-stimulating hormone secreted by the pituitary gland in the brain, only one follicle will dominate and ovulate a mature egg. The rest of the follicles are reabsorbed by the ovary, never to be used again.
Ovarian reserve refers to the quantity of eggs that are stored in the ovaries and can give you an idea of how many eggs you might achieve in an IVF or egg-freezing cycle. Importantly, it’s not a measure of the quality of the eggs and cannot predict your chance of conceiving either naturally or with assisted conception.
Assessing ovarian reserve
The two most common techniques used to assess ovarian reserve are
Anti-Müllerian Hormone (AMH) level test (blood test which should be done on days 2-3 of your menstrual cycle), and Ultrasound imaging of the ovaries to evaluate the antral follicle count (AFC) which involves a transvaginal ultrasound examination typically conducted on days five to nine of the menstrual cycle.
It is important to note that neither of the above tests reflect oocyte quality or predict the chance of conception or of having a live birth.
Assessing your ovarian reserve through AMH and AFC tests is a valuable step in your fertility journey. While these tests provide insights into egg quantity and your potential response to treatment, it is essential to note they do not reveal information about egg quality or guarantee success.
If oocytes or eggs are of poor quality, this sends signals that fertility is poor also affecting uterine implantation and conception outcomes. Early intervention to ensure healthy egg quality is essential to fertility outcomes.
The first section of my book addresses the importance of preparation which supports egg quality and improves the likelihood of conception culminating in a live birth. While every woman is different, I am often asked to give one or two major factors influencing low fertility. I would have to list diet (nutrition) and environmental toxins as two of the most relevant factors influencing, not only fertility, but also other parameters of health.
Other areas that greatly impact egg quality are smoking, alcohol consumption, caffeine, stressful work environments, working nights, and immune dysregulation which also involves gut microbiome.
Considering that women are born with all their eggs, keeping these as healthy as possible begins while they are developing inside their mother’s uterus. Sadly, we give little attention to our eggs while we are children or teenagers often making less than optimal lifestyle choices. However, as the immature eggs progress towards maturity, we CAN improve their quality. As this journey can take up to 12 months, the importance of pre-conception preparation becomes highlighted.
Whether you are seeking to conceive naturally or with the aid of technology, the quality of your eggs is an essential component. Begin by getting a copy of my book with will help you with the preparation as well as guide you through a healthy pregnancy culminating in the birth of a healthy baby.
