Ovarian egg reserve, in simple terms, is the ''pool of eggs present in the ovaries at any given time.'' Indian women are at a reproductive disadvantage when it comes to ovarian egg reserve. Studies indicate that the ovaries of Indian women age six years faster than their Caucasian counterparts. Lesser number of eggs in the ovary means lesser chances of conception.
In an interaction with The Week, Dr Manish Banker, group director, Nova IVI Fertility explains how falling egg reserves among Indian women affects their fertility potential, how ovarian egg reserve can be tested and and why it makes sense to start family young.
The biological clock is ticking faster for Indian women. How does this affect one's chances of conception?
Studies indicate that nearly 1 to 2 per cent of Indian women experience signs of menopause between 29 and 34 years of age. Additionally, this figure goes up to 8 per cent in the case of women between 35 and 39 years of age. Of all the infertile couples, we see about 18-20 per cent of women under 36 years of age suffer from a low ovarian reserve or premature ovarian failure.
Premature ovarian failure (POF), also known as premature ovarian insufficiency, is a condition where there is a physiological decrease in the number of eggs, which could impact the chances of pregnancy. Ovarian reserve is the pool of eggs present in the ovaries at any given time. Lesser number of eggs in the ovaries reduces women’s fertility potential and makes it more difficult for them to conceive. A percentage of these women are found to be POF cases, and the only option for these women is to opt for IVF with donor eggs.
The X chromosome abnormalities, autosomal causes, galactosemia, autoimmune disorders, cancer treatment, Turner’s syndrome, enzyme defects, and environmental toxins are some other factors leading to POF. Family history of premature ovarian failure is seen in 14-30 per cent of cases.
What's the best age to conceive?
Ovaries of Indian women age six years earlier than Caucasian women. As the age of women coming for treatment is gradually increasing, we see more and more women with poor ovarian reserve when they come for treatment.
For women who have the risk of having a low ovarian reserve or POF at a young age, early diagnosis and treatment are needed to achieve a healthy pregnancy. In general, the ideal age for women to get pregnant is between 25 and 35 years. After 35, the ovarian reserve naturally begins to decline, and both the quality and the quantity of the oocyte (eggs) diminish with increasing age. Moreover, even if pregnancy occurs, advanced age can cause high risk pregnancy where miscarriages in the late trimester or birth defects in the baby can happen.
How is ovarian egg reserve tested?
The tests that help predict the fertility potential of women include Follicular Stimulating Hormone (FSH) test, basal estradiol and antral follicular count, AMH test, etc. FSH levels and basal estradiol levels are generally measured by a blood test between day 2 and day 5 of a woman’s menstrual cycle, as they can fluctuate within a month and also from month to month. However, these two tests are not very accurate.
The new generation Anti–Mullerian Hormone test is fast becoming the finest tool for specialists in India to determine the fertility potential of a woman. The AMH concentrations are least affected by menstrual cycle, therefore a blood test can be done any time. Experts recommend AMH test for any woman who is over 30 years of age and wishes to postpone childbearing, but eventually would like to plan pregnancy.
A very simple method of assessing ovarian reserve is to do an ultrasound of the ovaries and count the number of antral follicles.
What could be the biological purpose of a female foetus having millions of oocytes, a large number of which degenerate by the time she is born?
A newborn baby girl is born with a finite number of eggs in her ovaries. Between 16 and 20 weeks of pregnancy, the ovaries of a female foetus contain 6 to 7 million oocytes, which are reduced to about 1-2 million in number at birth. At the time of puberty, only 300,000 eggs remain out of which only 400-450 will ovulate, and the other thousands will degenerate. As the woman’s age advances, there is a rapid decline in not only the number of eggs, but also the quality. Degeneration rapidly progresses 10-15 years before menopause, and all are gone by menopause. The exact reason for why this happens is still a mystery, however, it is how human biology is. In fact, men have a biological ticking clock, too. Studies have proved that while sperm production is generally not affected by age, there is a decline in the quality of the sperms.
Is it possible to create eggs from stem cells?
With the current level of medical advancements, the use of stem cells is still in experimental stages in many aspects. There have been successful animal experiments in creating germ cells (sperms and eggs) from stem cells, but no live birth has been reported. This research has not been extended to humans. However, only time will tell whether these could prove to be successful in human beings too.