In some situation depletion may be faster which are
- Genetic: X chromosomal microdeletion
- Family history
- Poor nutrition
- Gonadal dysgenesis ( Birth defect)
- Autoimmune disease
It is the estimation of number of oocytes in the womens’ ovary.
Ovarian reserve is declined due to
- Faster depletion
- PID (Pelvic inflammatory diseases)
- Repeated pelvic surgery
Assessment of ovarian reserve:
Ovarian reserve can be assessed by measuring serum FSH and E2 on D1-D3 of menstrual cycle. Number of antral follicle in early follicular phase is also a predictor of ovarian reserve. Optimum reserve is predicted if values are like this
D1-D3 FSH: < 10 IU/L and E2: < 100pg/ml
Antral follicle count: 7mm, 8-10 follicle
Other parameters for ovarian reserve assessment are
Inhibin B: 180 pg/ml or more
AMH : >1ng/ml
CCCT (clomiphene citrate challenge test): FSH<20 on D10
GnRH agonist stimulation test: 100 pg/ml or more
It is customary to inform the patient that if, during the early phase of a natural cycle, the FSH is >19 mIU/ml, the possibility of pregnancy occurring is almost nonexistent. By the time the woman reaches menopause at about age 48-53, the ovaries will contain few or no eggs.
Female age is extremely important when considering the probability of pregnancy. The real issue is egg quantity and quality, which then converts to embryo quality after fertilization. Increased infertility with age is a well-documented problem and most apparent in modern society.
Successful pregnancy outcome with treatment is largely related to female age, particularly when using the woman's own eggs.
Changes in quality of oocyte
Quality of eggs reduced along with age due to prolonged arrest in dictytene stage, prolonged exposure to environmental toxicants which cause mutation. As a result there is less fertilization and implantation. The relationship between the age of the female partner and fertility. The study found that the percentages of infertile couples were:
• By age 30 = 7%
• By age 35 = 11%
• By age 40 = 33%
• At age 45 = 87%
In a review of data from the various IVF centers in the USA, the Central for Disease Control reported that the live birth rate was 16% per cycle at age 40, and only 3% per cycle at age 44.
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