Everything you need to know about egg reserves – normal, diminished, and excessive
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Normal ovarian reserve

Every woman is born with a finite number of eggs at birth that progressively decreases with age. Ovarian reserve simply means the function and number of the remaining eggs left in the ovary. Ovarian reserve essentially defines the quantity and quality of the ovarian follicular pool.

Every month few eggs will be recruited out of which one attains dominance and which ovulates to get fertilized by the sperm to achieve pregnancy. The rest of the eggs undergo atresia which is natural degeneration of oocytes. Oocytes are eggs that have not yet matured.

It is a rule of nature that the best eggs are released first and the not so good ones are left for later yearsnature’s That is why it is easier to get pregnant at a young age as compared to women with advanced age.

Some women can have very less number of eggs than normal called diminished ovarian reserve while others have excessive ovarian reserve seen typically in women with PCO.

How many eggs does a woman normally have?
EGG reserve in babies
EGG reserve at puberty
egg resrve at 30
EGG reserve
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In Conclusion

Reproductive fertility planning is the need of the hour. In case of diminished ovarian reserve, it would not be a good idea to defer pregnancy but instead take advantage of any ART procedure like IUI or IVF. If IVF is considered then either freeze embryos for embryo banking for later use or complete a fresh transfer to maximize chances of success.

Diminished Ovarian reserve (DOR)

Ovarian reserve defines the quantity and quality of the ovarian follicular pool. Diminished Ovarian Reserve is the reduction in quantity of ovarian follicular pool and is matter of concern for women desiring a pregnancy

As a woman ages, the ovarian pool undergoes progressive decline from birth to menopause.

Though the cause of DOR in young women is not known, pelvic factors like endometriosis, extensive surgical pelvic dissection due to any cause can affect the follicular pool. Laparoscopy ovarian drilling done in PCOS women can also lead to diminished Ovarian reserve.

How do you diagnose Diminished Ovarian Reserve (DOR)?

If ultrasound shows diminished antral follicle count, then it is advisable to do a blood test called AMH. Diminished ovarian reserve on pelvic scan, with low AMH value and high FSH value strongly suggest marked reduction in ovarian follicular pool.

What to do if diagnosed with DOR?

Time is of essence and women need to be counseled regarding ART (Assisted Reproductive Technology) procedures like IVF or IUI which can reduce the TTP (Time-to-pregnancy) and establish pregnancy though chances are less because of the quantity and quality of eggs.

EGG
In Conclusion

Reproductive fertility planning is the need of the hour. In case of diminished ovarian reserve, it would not be a good idea to defer pregnancy but instead take advantage of any ART procedure like IUI or IVF. If IVF is considered then either freeze embryos for embryo banking for later use or complete a fresh transfer to maximize chances of success.

Excess Ovarian reserve (PCO)

On one end of the spectrum we have a state of diminished ovarian reserve wherein the number of eggs are less, and on the other side of the spectrum we have hyper-responders like women who have PCO and have more than the required number of follicles.

What is the problem? 

The problem here is that in spite of having too many, the follicles don’t mature and don’t ovulate resulting in infertility and or delayed periods.This is due to hormonal imbalance which prevents the follicle to grow, mature and ovulate.

There are other hormonal changes seen in women with PCO like weight gain, presence of fine hair growth over face, abdomen, back and limbs called hirsutism, skin changes called acanthosis nigricans which is hyperpigmentation of skin over back of neck, under arms, inner side of thighs. In addition, they also have glucose intolerance, menstrual irregularities and are good candidates to develop metabolic syndrome later in life.

How do you diagnose PCO?

Ultrasound scan shows multiple follicles around 12-15 or more in each ovary.  AMH levels are usually high.

What to do if diagnosed with PCO?

Lifestyle modifications like regular physical activity and exercise, adequate sleep, hydration and consumption of a healthy diet which is a mix of organic fruits and vegetables, lean proteins and carbohydrates.

Regular visits to your physician to check ovulation and plan fertility treatment and other medications as required.

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Dr Partha Das

Dr Partha Das is a highly skilled fertility/IVF Physician specializing in Reproductive Endocrinology and Infertility. Dr Partha consults and manages patients presenting with complex gynecological, male and female infertility issues and management of recurrent miscarriage and IVF failures.

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