If the uterus is considered the cradle of the world, then the ovaries are the repositories of the family gene pool.
From the school biology course, we remember that one female fetus in the womb has a staggering maximum number of follicles – about 9,000,000. This is the population of three megacities like Kyiv!
The bookmark of this huge potential takes place at 8-12 weeks of pregnancy. No wonder it was said in ancient times that during pregnancy a woman’s reproductive health is laid down two generations in advance – for children and grandchildren!
By the time a girl is born, an average of 2,000,000 remains in her ovaries, slightly less than the population of Kyiv alone.
By the time of the first menstrual period (menarche), the number of follicles becomes even smaller – about 400,000. Three Kyivs become the population of Frankivsk, Kolomyia and Kalush combined. It’s a teenage girl!
Given that in one menstrual cycle ovulates 1, maximum 2 dominant follicles, this reserve should be enough for more than one life. But not everything is so simple. Although nature is so wise that it foresaw almost all threats.
Doctors are well versed in natural processes. Preventive examinations by a gynecologist are focused, first of all, on monitoring the condition of the cervix and mammary glands, ie on the prevention and early detection of cancer.
Reproductive potential is mentioned rather retrospectively, in the context of its deterioration with increasing age of the patient. In modern conditions, it is rational to change approaches and not to divide the visitors of women’s clinics into the categories “pregnant-non-pregnant” and “plans-does not plan pregnancy”. Any woman of reproductive age should be considered from the standpoint of possible subsequent pregnancy, even if she does not think about it or has already given birth.
Assessment of individual reproductive potential should be clear to gynecologists in women’s clinics. In addition, the woman herself should be aware of this important issue and be interested in the examination.
Today’s social and economic levers provoke delays in pregnancy, sometimes indefinitely. Therefore, for some time a woman visits a gynecologist for completely different reasons, not interested in possible fertility risks. Especially when he sees the conclusion of the professional examination “healthy”.
Only at the reception of a reproductive therapist, when the issue of pregnancy planning can not be resolved independently or immediately, the conversation about the “ovarian reserve” begins.
The ovarian reserve was originally used by reproductive specialists not so much to assess fertility as to predict the ovarian response to ovarian stimulation.
The purpose of ovarian reserve testing was to identify patients at risk for premature ovarian failure who are more likely to have a reduced response to ovarian stimulation and a correspondingly reduced chance of pregnancy and live birth.
There are certain beacons (markers) of ovarian reserve, biochemical and ultrasound indicators, which have different prognostic value.
For the correct interpretation of markers it is necessary to understand the mechanism of growth (recruitment) of follicles. It is known that in order to ensure the dominance of one, then ovulatory, follicle and get the best quality egg, about 1000 follicles are recruited and regressed (atresiated) every month.
At the age of 35, a woman’s ovaries have 25-70,000 follicles. The rate of regression accelerates when it reaches a “critical mass” in the form of 25,000 spare (primordial) follicles, which accounts for an average of 37 years.
However, 10% of women do not fall under age standards. They will suffer from premature ovarian failure to the age of natural menopause.
Unfortunately, most patients turn to a reproductive therapist with complaints of menstrual irregularities, when not only fertility but also the effectiveness of assisted reproductive technologies (ART) is critically reduced or zero.
And it would be advisable to identify risk groups long before the manifestations of dysfunction. It is enough to pay attention to the anamnesis (cases of early menopause in the family, chemotherapy, ovarian endometrioma, removal of the fallopian tubes) and ultrasound signs of non-compliance.
Hypothetically, the chance of pregnancy is described mathematically by the total number of follicles – the follicular pool (total ovarian reserve, TOR). Whereas the true chance of ovulation and fertilization reflects the so-called functional ovarian reserve (FOR), which consists of recruited maturing follicles.
Of practical value is not so much the reserve as such, as its diminished ovarian reserve (DOR). Manifestation of reduced fertility and menstrual irregularities is premature or early ovarian failure.
Despite the projected decline in oocyte counts with age, fertility variability among peers may be significant. Correspondence of ovarian reserve to age is a relative concept. We must realize that the age norms for the number of antral follicles or other markers of ovarian reserve simply do not exist! Their correlation