The most frequent cause of low egg count is age, since the ovum reserve is gradually depleted as the woman gets older, but it is more accentuated from the age of 35-38.
Once a woman reaches menopause, around the age of 50, the ovarian reserve will be completely exhausted which means the end of her reproductive life.
The different sections of this article have been assembled into the following table of contents.
How does ovarian reserve work?
Before going into detail about the ovarian reserve and the causes of its decline, it is necessary to explain the basic functioning of the ovaries as far as oocyte production is concerned.
At the moment of embryonic development, when the future woman is only a fetus in her mother's womb, the formation of oocytes begins. This period ends before the birth of the woman, and as far as it is known today, it is not possible to prolong it.
This means that the woman is born with a certain number of oocytes (millions of them), and that these must be kept as a great treasure in the ovaries, until the moment they must be used when trying for pregnancy.
Apart from this, it is known that women ovulate only one oocyte a month on a regular basis. However, few people are aware of the fierce struggle of the oocytes, which fight to be ovulated. In general, nature seeks the conservation of the species, trying to ensure through competition that its processes are the most efficient.
In the case of reproduction, the idea is that in the creation of a new life the best sperm together with the best egg is used. Everyone knows the race in which millions of sperm participate, in which the best and fastest is able to penetrate the first oocyte, is lifted with victory and is involved in the creation of the new baby.
Something similar happens with oocytes. Dozens of inactive oocytes, in the reserve, are selected every month (as it was commented classically, now we know that even with a shorter cadence) so that in a process that lasts about 3 months only one of them gets ovulated.
The woman uses dozens of oocytes to ovulate usually only one of them. This is why, throughout a woman's life, millions of ovulations do not occur. On the contrary, menopause appears in a variable way at approximately 50 years.
Characteristics of the ovarian reserve
Thus, the number of oocytes that a woman has at any given time is basically the subtraction between the number of oocytes that the woman managed to generate before her birth (variable in each person) and the number of oocytes that the woman has used throughout her life to ovulate.
This is the concept of ovarian reserve and, as can be deduced from all that has been explained, it has the following characteristics:
- The ovarian reserve can never increase (as far as we know today). The increases that we sometimes see in the biochemical markers of ovarian reserve do not correspond to real increases of the same, but to variations of these parameters and to technical questions of the laboratories.
- The ovarian reserve will inevitably decrease over time, as women ovulate throughout their lives, spending dozens of oocytes each month.
- Certain external agents can reduce the number of oocytes in a patient (surgeries in which part of the ovary is removed, infections on the ovary, chemotherapy or radiotherapy, etc.). In general, anything that chemically or mechanically damages the ovaries will have the effect of reducing the ovarian reserve.
- The process by which oocytes are selected to compete in the ovulation process is irreversible. If the oocyte is not ovulated, it dies and suffers from what is known as Ovarian follicle atresia.
In addition, oocyte selection is independent of classical female hormones. This means that this process does not stop in pregnancy or with the taking of contraceptives. It even occurs in girls before puberty.
In other words, hormonal treatments such as contraceptives, in vitro fertilisation or the donation of oocytes only influence the growth of the oocytes, but not their activation and, therefore, do not influence the ovarian reserve.
Causes of low egg count
For all that has been said so far, it is easy to conclude that the main reason for the low ovarian reserve or low egg count is the age of the woman.
As time passes, not only the quantity of the eggs decreases but also their quality, which aggravates the fertility problem. This ovarian aging takes place in a very progressive way, but begins to be more evident from the age of 35.
However, there are young women who also suffer from low egg count, although less frequently. But not only the age causes a decrease in ovarian reserve. There are other factors, too, which have an impact on the egg quantity:
- Premature ovarian failure
- Diseases such as endometriosis, autoimmune disorders, chronic infections, etc.
- Genetic factors that determine a lower oocyte endowment or faster oocyte depletion
- Anti-cancer treatments such as chemotherapy and radiotherapy
- Ovarian surgery to remove cysts, teratomas, etc.
- Unhealthy lifestyle habits: stress, obesity, anorexia, tobacco, etc.
- Environmental pollution
If you are young and have little ovarian reserve, it doesn't necessarily mean that your oocyte quality is affected. Thanks to assisted reproductive treatments, You'll still have a better chance of getting pregnant with your own eggs.
Pregnancy with low ovarian reserve
Most women do not notice that they have a reduced ovarian reserve until they try to get pregnant.
If you have had unprotected sexual intercourse for some time and still don't get pregnant, it would be high time for a fertility study in which you might be diagnosed with low egg reserve.
In that case, and taking into account all the factors of you and your partner, several fertility strategies or treatments can be carried out for you to finally become a mother. Let’s discuss them below:
In vitro fertilization
In vitro fertilization (IVF) is the technique indicated for all women with a compromised ovarian reserve.
Thanks to ovarian stimulation, it is possible for you to avoid the process of oocyte selection that takes place every month and rescue the oocytes condemned to die. In this way, you will be able to develop several ovarian follicles during the cycle and then retrieve the mature eggs by follicular puncture.
If the ovarian reserve is very limited, it may be necessary to carry out several cycles of oocyte accumulation to increase the chances of success.
If you want to know in greater detail what this treatment consists of, we encourage you to continue reading the following post: What is IVF?
If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.
In more serious cases, with a practically exhausted ovarian reserve and an advanced maternal age, the indicated treatment would be IVF with egg donation.
It is very hard to have to agree to give up the genetic burden, but today egg donation has allowed thousands of women to become mothers.
In addition, the success rates of Egg donation are among the highest, as young, high-quality eggs are used. This makes the emotional toll with this treatment much lower than with IVF.
For more information on this, don't miss the following article: What is Egg donation?
Awareness campaigns on female fertility and delayed motherhood conducted by a multitude of clinics have recently led many women to become interested in the status of their ovarian reserve.
As a result, it is becoming possible to identify cases of diminished ovarian reserve in young women between the ages of 20 and 35. However, it is common that these women are not interested in becoming mothers yet, so it is advisable to do a fertility preservation before the ovarian reserve decreases more drastically.
The treatment consists of ovarian stimulation to obtain a multitude of mature oocytes and freeze them in liquid nitrogen for an unlimited time, until the woman decides to use them to have a child.
FAQs from users
How can I improve my egg count?
A woman's ovarian reserve cannot be improved. Women are born with a finite number of eggs, these are exhausted over the years and, unlike sperm, there is no mechanism for producing new eggs in the ovaries.
However, in order to optimize fertility treatments and obtain a good number of eggs in stimulation, it is advisable to follow healthy lifestyle habits, keep an adequate BMI, follow a healthy and balanced diet, practice sports and avoid toxic substances such as tobacco or alcohol.
What are the main causes of a low ovarian reserve?
The most common cause of a women's low egg count is age. This cause is physiological, unavoidable and increasing, since for socio-cultural reasons women are having children at a later age.
There are many others, either because the patient did not generate enough oocytes in her embryonic stage (genetic causes) or because of damage to the ovary (infection, ovarian torsion, endometriosis, surgery, radio or chemotherapy, etc...). These are more infrequent and usually require specialized centers for diagnosis, being equally irreversible today.
How do I know my egg count?
There are several ways to find out the status of a woman's ovarian reserve and whether it is in optimal condition. The most recommendable is to go to a gynecologist specialized in fertility and perform an ultrasound and blood test.
By means of the ultrasound, which should be done at the beginning of the menstrual cycle, an antral follicle count (AFC) can be done. There are also a number of biochemical markers that can be determined by a blood hormone analysis: FSH, antimullerian, B-inhibin, estradiol, etc.
Related Article: Ovarian Reserve Test.
What are the symptoms of a low ovarian reserve?
In principle, there is no sign or symptom that can alert a woman that she has a low ovarian reserve. This can only be discovered by a basic sterility test and altered hormonal results such as a low antimullerian hormone value or a high FSH value.
However, women with early ovarian insufficiency and/or very compromised ovarian reserve may have irregular menstrual cycles, with absent menstruation.
Suggested for you
One of the consequences of having little ovarian reserve is not obtaining the desired number of eggs to make an IVF cycle and increase the possibility of pregnancy. If you want to learn more about this and the possible solutions, don't miss the next post: Low responders in IVF cycles - management and best protocols.
Although not always, the low ovarian reserve can also be accompanied by poor oocyte quality. If this is your case and you want to get more information about it, we encourage you to continue reading here: Egg quality in Females - How to achieve high-quality oocytes.
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