Female Premature Ovarian Failure

For a woman, the age is the biggest factor affecting fertility. The older women are, the poorer eggs quality they have. Not only the fertilization rate, blastocyst implantation rate, pregnancy rate, but also even if they are pregnant, their abortion rate, fetal chromosomal abnormality rate, risk of delivery, are higher than younger women.
2020-12-17
Author: Stork Fertility Center

Modern people have the phenomenon of late marriages and late child-birth. For a woman, the age is the biggest factor affecting fertility. The older women are, the poorer oocytes quality they have. Not only the fertilization rate, blastocyst implantation rate, pregnancy rate, but also even if they are pregnant, their abortion rate, fetal chromosomal abnormality rate, risk of delivery, are higher than younger women. Through medical tests and examinations, we can know our ovarian function in advance, and let women who are on the journey of having babies to know their own natural conception rate.

Is there any way to know if our ovary is aging and how do we know if our ovarian function is aging?
There are several ways of testing and examining in medicine science that can be predicted in advance.
Below are some ways of evaluating the ovarian function:

Follicle-Stimulating Hormone, FSH

FSH is a gonadotropin, a glycoprotein polypeptide hormone. It is synthesized and secreted by the gonadotropic cells of the anterior pituitary gland, and regulates the development, growth, pubertal maturation, and reproductive processes of the body.

Reference

  1. Having the blood test on the first day to third day of our period, and it can be used as an indicator to evaluate the "ovarian reserve".
  2. This indicator has great variability, and it is recommended to continuously evaluate 2~3 cycles for reference.
  3. The reference of values is reduced for who have the ovarian surgery or endometriosis.

 

When FSH is above than 10, it is more predictive.
However, 75% of women's ovarian reserve has declined, and this hormone is still within the normal range.
Once it is detected that this hormone has risen, it is usually too late.

Anti-Mullerian Hormone, AMH

AMH is expressed by granulosa cells of the ovary during the reproductive years. It declines with age and oocytes. Due to its high sensitivity, stability and low volatility, it has become the most important indicator for assessing the ovarian reserve.

Reference

  1. As the age increases or ovarian reserve begins to decline, AMH will become lower and lower.
  2. It is low volatility that we can have the blood test in any day.
  3. Combining with FSH and AFC allows, it's more accurate for assessing the ovarian reserve.
  4. On average, AMH has declined to 50% when women aged from 30 to 37. However, FSH has only slightly increased. (AMH sensitivity is better than FSH)
  5. AMH is associated with the number of retrieval oocytes, fertilization rate, blastocyst quality, pregnancy rate, and abortion rate when doing In Vitro Fertilization (IVF).

 

Inhibin B

Inhibin B is a sensitive marker of ovarian follicle development and produced by granulosa cells in the ovary, is a heterodimeric glycoprotein suppressing synthesis and secretion of the follicle stimulating hormone (FSH). If the inhibin B on the third day of the period is less than 45 (pg/ml), it means that the ovary may not well respond to ovulation drugs. This hormone has great variability in the period, and it is recommended to evaluate on the second day to the third day of menstruation.

Antral Follicle Counts, AFC

At birth, a female fetus has 1 to 2 million immature eggs called oocytes inside her ovaries, which are all the eggs she will ever produce. By the time a girl enters puberty, about 200,000 of these eggs remain. Approximately 300 to 400 of the remaining eggs will be ovulated during a woman's reproductive lifetime.There is quantitative eggs are screened out in every cycle, but when it is ovulating, only one egg will win, and the other eggs will automatically apoptosis. Therefore, when the menstrual cycle comes, the number of follicles in the ovary can be checked by the transvaginal ultrasound. If the total amount of follicles on both sides is less than 4, it means that the amount of ovarian reserve is not much, which can be clinically correlates with AMH.

However, don't just trust the clinical values, because these indicators or the results of the test only present the status of the current ovarian function, rather than predicting the outcome of pregnancy. As long as we grasp the prime time of pregnancy and do not give up easily, I believe that the happiness in the future will not be too far away.

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