Ovaries harbor all the eggs that a female would produce during her reproductive years. Each month few start to mature as follicles under the hormonal triggers and finally one or two are ruptured and released as oocytes. Ovaries produce good quality oocytes in young women and as years go by the quality of oocytes diminishes and the fertilization potential drops. It is more than evident that with progressing age reproductive potential drops because of oocyte quality and hormonal imbalances. Generally women in their late thirties or early forties enter into a phase called “Perimenopause” i.e. transition to menopause. This stage is characterized by irregular menstrual cycles, fluctuating hormone levels, very high FSH levels as ovaries work extra hard for follicle maturation and low quality eggs cells. This stage of reduced fertility naturally progresses to ‘menopause’ or the ‘no fertility’ stage. This is a natural phenomenon and every woman undergoes this physiological stage. The problem arises when a young woman maybe in her early thirties encounters these symptoms and is trying to get pregnant.
What is premature ovarian aging (POA)?
It is defined as having a low ovarian reserve for what is expected of that age. Ovarian reserve is the capacity of ovaries to produce good functional eggs cells. Clinically it is reflected as high follicle stimulating hormone (FSH) levels or low Anti Mullerian Hormone (AMH) levels.
Characteristics of POA
• Decreased number of follicles per cycle
• Poor quality egg cells
• Higher miscarriage rates
• Poor response to fertility drugs
What causes premature ovarian aging?
• Autoimmune disorders – body produces antibodies that negatively impact thyroid function, lipid biosynthesis and hormones regulating ovarian function.
• Genetic disorders – Some studies have reported DNA mismatches (mutations) in a specific gene.
• Exposure to radiation – patients who have undergone radiotherapy have declined ovarian function
• Smoking and substance abuse lead to reduced ovarian function.
• Stress and unhealthy lifestyle in general disturbs a number of physiological functions and fertility is also negatively impacted.
Is there anything that can be done?
We were led to believe that women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age. The level of FSH or AMH is generally a good indicator of her ovarian reserve.
Harvard researchers have found evidence that female mammals can produce egg cells throughout life. Doctor Tilly, one of the leading researchers believes that from a purely biological perspective, the concept that a woman would continually generate new eggs during her reproductive years makes sense—since men constantly replenish their sperm.
Based on my own clinical experience and some studies on the subject, it seems that interpretation of AMH levels in relationship to the likelihood of conception are quite misleading. In one study two women had a spontaneous ongoing pregnancy despite undetectable AMH levels. In another study AMH levels were 65% lower in obese women compared to non-obese women. Obviously AMH levels can be influenced by weight loss and a healthy lifestyle. I have seen women with a very low AMH level and other women with a high FSH levels fall pregnant.
I personally believe that through balancing hormones naturally, supplements, a healthy diet and lifestyle the quality and production of egg cells can be influenced and therefore improved.
Nat Med. 2012 Feb 26. doi: 10.1038/nm.2669