What is the ovarian reserve?

The ovarian reserve defines the quantity and quality the oocytes located in a woman’s two ovaries. It refers to the reproductive potential remaining in these two ovaries. Men, on the other hand, have a continual renewal of sperm cells from puberty onwards.

A woman is born with approximately 2,000,000 eggs that are lost throughout her life.

At the beginning of puberty, most women have only about 400,000 eggs and by the end of their thirties, they have about 1,000,000 eggs. By their late thirties, this number drops further to about 27,000. At menopause, most women have only about 1,000 eggs left in their ovaries.

What factors affect my ovarian reserve?

Age is therefore an important factor to take into account if you want to become pregnant. To give you an idea, between the ages of 30 and 35, the probability of having a baby is 15% per cycle (month) while at 40 it is about 5%.

Other factors that can reduce your chances of getting pregnant include:

Smoking
Cancer treatments such as radiotherapy and chemotherapy
A pelvic infection

How do I know if I have a good ovarian reserve?

A reduction in the number of ovarian follicles in women of childbearing age indicates a low ovarian reserve and is an important cause of infertility in many couples.

In order to find out your ovarian reserve, it is recommended to carry out certain tests blood tests:

The AMH test is certainly the most important test as it tells you your oocyte stock. You can read our article on AMH to find out more.
Follicle Stimulating Hormone (FSH): This hormone is used for the maturation and growth of follicles. If this level is high, there may be ovarian failure. If the level is low, the problem may be related to the pituitary gland (other tests will be suggested in this case).
Estradiol: Secreted by the ovaries, it plays an important role in the regulation of menstrual cycles as well as in the quality of ovarian secretion. If FSH is is high and estradiol is low, an early menopause may be suspected.

In addition to measuring hormones by blood tests, ultrasound is used to count the small (antral) follicles in the ovaries. Some technologies help to determine the number of follicles present, which also fall within predefined size ranges (i.e. 2-10 mm).

This can be particularly useful for patients with a high number of antral follicles, as it allows clinicians to visualise and interpret the number of follicles present more effectively. Vaginal ultrasound is used to count the number of egg-releasing follicles, which helps predict the response to hormonal stimulation.

How can I optimise my ovarian function?

Many treatment options have been developed to improve ovarian function ovarian function in women with low ovarian reserve are now being used in clinical treatment.

HRT (hormone replacement therapy) in the form of the pill is the most common choice, of which there are two main types: the combined (oestrogen and progestin) and estrogen without progestin.

DHEA: Dehydroepiandrosterone (DHEA) is an anabolic steroid hormone that the he adrenal glands, the central nervous system and the cells of the human ovary naturally produce it from cholesterol.

DHEA supplements are used for skin ageing, depression, infertility, muscle strength, heart disease, erectile dysfunction (ED) and many other conditions, but there is no solid scientific evidence to support many of these other uses.

One study shows that three months after treatment with DHEA (50 mg/day), serum FSH levels decreased, AMH levels increased, the number of antral follicles increased, and the number of follicles increased and ovarian reserve was improved. However, the clinical efficacy of DHEA remains to be clarified.

Ovulation induction therapy: A number of ovulation induction therapies are available. Ovulation induction therapies are available for patients with low ovarian reserve, including induced ovulation and superovulation. The ovaries are put to rest with agonists or antagonists, which block the pituitary gland.

What to do in case of low ovarian reserve?

If your fertility test results show low ovarian reserve or low ovarian reserve, the diagnosis and proposed solutions will depend on several parameters:

Your age.
The number of antral follicles present in each ovary.
The degree of ovarian insufficiency.

One of the recommendations in the case of low ovarian reserve is not to wait before seeking a pregnancy. In Vitro Fertilisation would be a solution to stimulate the ovaries and obtain a good number of mature oocytes.

For some patients, our specialists may also recommend an ovarian regeneration cycle before ovarian stimulation to help the response of the antral follicles.

Finally, if the ovarian insufficiency is severe and IVF treatments have not been successful, the patient will be advised to have recourse to egg donation.