The modern world is rapidly becoming younger, we remain active much longer than a generation ago. And trends in childbearing over the past decades have undergone significant changes. An increasing proportion of women are ready to plan the birth of a child at a later reproductive age after solving and completing some of their tasks: career, housing and the creation of a base for material well-being. In the 19th century, by the age of 35(thirty five), a woman had a family and several children, in the 21st century, by the age of 35(thirty five), a woman is only thinking about creating a family and having children, not realizing the increased risk of infertility and adverse reproductive consequences.
There comes a time when a woman wants to become a mother. If pregnancy does not occur within a year of regular attempts, the doctor diagnoses infertility and begins to treat it. We at the Finnish clinic Scanfert know well how difficult it is to accept this diagnosis and how many psychological tasks this condition poses to the patient. And we are ready to meet these challenges .We know how.
Here we will review with you the concept of ovarian reserve, which is very important for understanding the problems of late reproductive age.
At 5 months, there are between 6 and 7 million primordial follicles in the human embryonic ovary. Then, up to menopause, their number decreases exponentially. Only 1 million oocytes remain by birth, and by puberty, there are from 3 hundred to 5 hundred thousand oocytes.
Ovarian reserve is defined as the total number of oocytes in the ovaries, taking into account their quality. Clinically more significant is another definition, according to which the ovarian reserve is the number of antral follicles in the ovaries, which can give rise to dominant follicles when stimulated by exogenous gonadotropins.
Studies conducted in a natural population without regular use of contraceptives have shown that natural fertility begins to decline after 30 ( thirty)years. This process accelerates after 35(thirty five) years and ends with sterility at about 41(forty one) years old.
The decrease in the total number of antral follicles occurs primarily due to small follicles with a diameter of up to 6 mm.(millimeters)
At the same time, there is a decrease in the quality of oocytes .
Prognostic factors of ovarian response:
- Age
- Antral Follicles Count
- Anti Muller Hormone
- Anamnesis (for example, if you know that women in your family have a climax early, before 45(forty five)-50(fifty) years old, then we can assume that it will start with you earlier too.
These factors must be taken into account in total. This is very important for the doctor who treats you. The ovarian reserve shows how great the possibility of conception is with you. Based on these indicators the doctor chooses the method and tactics of treatment, selects complex stimulant drugs and, if necessary, resorts to oocyte donation.
An accurate assessment of the ovarian reserve and prediction of the response of the ovaries to stimulation allows us to develop the most effective strategy for controlled ovarian hyperstimulation in ART cycles. A universal approach that does not take into account the individual characteristics of patients is dangerous due to an excessive response to exogenous Folliculo Stimulating Hormone in a long protocol with GnRH(Gonadotropine Realising Hormone) agonists and the development of ovarian hyperstimulation syndrome, which can lead to cycle cancellation. Given the extreme importance of safety and the economic component of the effectiveness of treatment for the patient and the doctor, ignorance of the ovarian reserve and an unexpected response to stimulation are unacceptable. I and other doctors at the Scanfert clinic always carefully examine patients and oocyte donors for this subject.
You can get further information by participating in our webinar.