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Female Fertility

Female fertility is of prime importance in these changing times especially as the biological clockwork starts early in the foetal period and is not amenable to much improvement with external agents.

Each woman has a fixed number of oocytes during fetal development. At the fourth month of fetal development, the ovaries contain some 6–7 million oocytes which form the primordial follicle pool. At birth only 1–2 million primordial follicles remain (F. J. Broekmans et all 2009). After birth, this rate of follicle loss slows down, so that at menarche at least 300,000 to 400,000 primordial follicles remain. During the reproductive years, the continued and gradually accelerated decline cause numbers to drop below 1000 at the time of menopause.

Along with the decrease in quantity, quality also diminishes (at least after the age of 31 yr when fecundity gradually decreases). The loss of oocyte quality is believed to be due to an increase in meiotic no disjunction, resulting in an increasing rate of aneuploidy in the early embryo at higher female ages.

Most of these changes remain asymptomatic until the premenopausal years, when the actual cycle irregularities and the transition to menopause begin. Hence there is no clear indication to the average woman, planning to postpone her fertility, regarding the actual fertility state of her ovaries. Added to this biological programming is the burden of stress, lifestyle modification and other fertility impairing factors like endometriosis, pelvic infections, male factors etc.

This whole baggage has made the attainment of conception more difficult in the years trailing the thirties. There has to be an active effort from the medical fraternity to increase awareness of the fertility potential and ovarian reserve testing in women deliberately postponing fertility for social reasons.

Causes of decline in Ovarian Reserve

  • Age related
  • Endometriosis
  • Previous ovarian surgery
  • Pelvic inflammatory diseases
  • Chemo, radiotherapy
  • Genetic causes
  • Autoimmune causes

Along with the women showing history of any of the above symptoms, all women more than thirty who wish, for any reasons to postpone their fertility, need be tested for the ovarian reserve and counselled about the results of the same accordingly

The literature is crammed with the various types of tests used since years for the ovarian reserve testing. However the most relevant and effective tests today are Anti mullerian Hormone and Antral follicular count done in follicular phase of the menstrual cycle. These together give a reasonable idea about the estimated ovarian reserve to help couple plan their fertility.

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