What is a vorial reserve?
Over the past 20 years, reproductive medicine has made significant strides. This applies, above all, to the development of an individual approach to the implementation of various programs to stimulate ovulation and control the development of follicles. Modern approaches to the treatment of infertility are based on the importance of the fundamental basic physiologies of the reproductive system of women, offering a decrease in productive capacity and the ability to start with age.
It is very difficult to study articles with a specific age, which contains the concept of “ovulatory reserve”.
Ovarian reserve – an important part of the reproductive potential of women, which provides the ability of the ovaries to ensure the growth of full-fledged follicles containing healthy, capable of optioning the egg.
There are several other meanings of the term “ovarian reserve”:
1) The term identifies the number of follicles that are potentially able to respond to the stimulating effect of gonadotropins,
2) Binds the entire stock of oocytes, incomprehensible to this age period and is contained in the folklore regulations at all stages that find them, including the primordial stage (initial).
There are 4 stages of follicle development:
- Primordial (zero) stage. Primordial follicles are folklore that are formed in the early stages of pregnancy even longer before birth (their total number of anterior births is about 2 million pieces).
- Preantral (primary) stage. Primordial follicles slowly turn into preantral. Transformation of the first “portion” (about 10 pieces) of primordial follicles in prentrant events during puberty. At this point, the number of all follicles decreases from 2 million to 300 thousand due to apoptosis (programmed by the most organized cell death).
- Antral (secondary) stage. At this stage, there is a release of estrogen into the follicular cavity. The sharp growth of a follicle begins.
- Preovulatory (tertiary) stage. The egg in the follicle is located on the ovipositor hill. Such a follicle is considered almost mature.
Further development of the follicle – 24 hours before ovulation expresses a large number of estrogens, resulting in the level of luteinizing hormone, which is the trigger of ovulation. In the course of an ovulation in a wall of a follicle the bulge which at friction deduces a rupture and an ovum leaves a follicle is formed. If the egg is undamaged, it may become pregnant when it meets the sperm.
In the egg moments of the establishment of menstrual function is about 300 thousand follicles. An average of 400 oocytes ovulate throughout a woman’s reproductive period.
Only the most modern ones reach ovulation.
The realization of the maximum number of eggs is biologically programmed for the third decade of life. The vital supply of oocytes tightens affects the ability of women who are delayed, so this reproductive potential in many depends on the ovarian reserve. According to statistics, large women aged 20-30 are able to take a child on their own, from the age of 30 begins to use the unregistered history of ovarian reservation of women, reaching its peak in 35-37 years. By the age of 40, only 50% of them remain farmers, and after 43 years, almost all lose the ability to close, even if menopause has not entered – due to researchers of ovarian reservation. In connection with those present for the treatment of infertility requires the support of modern methods, which confirms its effectiveness in the rapid and successful achievement of pregnancy.
Consistently, probable patients are the most important physiological factor determining eovarian reserve. The ovary, representing its ancestral biological time, plays the main biological attack and ensures the functionality and safety of the reproductive system.
Age and ovarian reserve
Biologically, aging is universal and inevitable.
The interaction between genetic factors and various environmental influences determine the rate of aging of the reproductive system. Late reproductive period precedes menopause, in which there is a progressive decline in ovarian function. Clinically, this period is marked by a change in the intervals between menstrual cycles, biologically characterized by decreased fertility, and endocrinologically – by suppression of ovarian function. A person aged 40-50 years has a special mechanism, which D.Keefe (1998) calls the phenomenon of “reproductive altruism”, which provides the ability to conceive at an age when a healthy and young woman is able to fully care for their offspring.
Doctors at the Lada Reproductive Health Clinic advise and treat infertility in women – in most cases they avoid situations that delay the use of methods to restore natural fertility and recommend IVF in a timely manner.
- What are the reasons for the decrease in ovarian reserve of the ovaries?
- Natural age cause: progressive decline of follicles during life and regular ovulation.
- After complete consumption of eggs comes the period of menopause and menopause. Every year the quality of oocytes decreases and the number of chromosomal and other genetic pathologies in eggs increases.
- Genetic causes.
- Hereditary determined individual stock of eggs. That is why some women menstruate and are able to get pregnant before the age of 50, and some after the age of 30, and menopause and menopause begin.
- Medical intervention.
- All surgical operations on the ovaries and genitals of women: uterine fallopian tubes, ovaries.
- Of the toxic effects in the first place are important drugs. But no less important are the harmful external factors of the environment and nutrition.
- Smoking women.
- It has been established that smoking leads to a decrease in ovarian reserve and earlier onset of menopause in women.
Some autoimmune diseases (autoimmune thyroiditis, diabetes, etc.),
To assess the ovarian reserve on day 2-3 of the menstrual cycle is determined:
1. The level of sex hormones (follicle-stimulating hormone)
Age is a marker of oocyte quality, and FSH level is a marker of own follicular reserve.
2. Counting the number and estimating the diameter of the antral follicles by ultrasound;
Ultrasound can determine if you are in the process of follicle formation. Ultrasound should be performed on a specific day of the cycle, possibly several times to rule out the possibility of error. After confirming the diagnosis, the doctor must prescribe treatment, depending on the disorders of folliculogenesis. The main purpose of which is to stimulate ovulation and normalize the hormonal background of women.
3. Determination of ovarian volume by transvaginal ultrasound.
It is assumed that the decrease in ovarian volume and basal number of small antral follicles not only predicts the adequacy of the response to superovulation stimulators, but also objectively reflects the actual quantitative decrease in follicular reserve formed by primordial follicles.
4. Determination of antimullerian hormone in the blood – indicates a woman’s reproductive potential.
The level of AMG clearly correlates with the number of antral follicles, with the size of the pool of primordial follicles and decreases with age. AMG levels are used to predict ovarian response to stimulation in ART.
The generalization of clinical, biochemical and ultrasound characteristics allowed to formulate an idea of the indicators of normal, reduced and high ovarian reserve, which can be considered as prognostic factors for assessing the appropriate ovarian response to induction (stimulation) of ovulation IVF programs.
Thus, the time allotted to a woman to have children is limited. All women have different times. When deciding whether you still have time for a career or need to get pregnant urgently, it is necessary to pass the test for ovarian ovarian reserve. You can always do this in our clinic “Lada”.