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If you’re trying to conceive, you might have encountered the term “ovarian reserve”. This refers to a woman's number and quality of eggs, and plays a pretty significant role in female fertility. Keep reading to understand more about egg count, how it impacts female fertility, and what you can do about it.
Understanding how many eggs you have and what lifestyle factors impact your ovarian reserve can help you make more informed decisions about your chances of conceiving.
Unlike men, who continually produce sperm for their entire life, women are born with all the eggs they’ll ever have. Around two million, to be precise. So, a woman's ovarian reserve is established before birth. As you age, your ovarian reserve gradually declines, as does your fertility.
Ovarian reserve is the number and quality of eggs in a woman's ovaries. “Diminished ovarian reserve”, on the other hand, is when you have fewer eggs compared to women your age.
Ovarian reserve can play a critical role in your chances of conceiving, especially if you’re undergoing in vitro fertilisation (IVF). Luckily, the number of eggs a person has isn’t the only factor that affects the ability to get pregnant.
So, how many eggs does a woman have? It’s different for every woman; there’s no way to know the exact number of eggs you have at any given time, but we have a pretty good idea of how many eggs the average, healthy woman has throughout her life.
Women have the highest number of eggs while they're still in their mother's uterus. A 20-week-old female foetus has about seven million eggs — fascinating, right? However, by the time you're born, this number drops to around one to two million.
Once you reach puberty and start having menstrual cycles, that number drops to somewhere between 300,000 and 500,000. Even though only one egg is typically released during ovulation, your ovaries actually prepare several eggs every month. And any eggs that aren't released will be re-absorbed into the body. This is why women lose so many eggs each month.
By age 37, you have around 25,000 eggs. Once you reach menopause (around 51), a woman still has approximately 1,000 immature eggs left. During menopause, your body stops producing the hormones necessary for ovulation, so these eggs can't be fertilised and turn into a pregnancy. So that means you never run out of eggs; rather, you run out of time and egg quality.
You may have heard that taking hormonal contraception, like the combined pill, can harm your chances of getting pregnant later. However, this isn’t true. These contraceptives prevent pregnancy by stopping ovulation and making it difficult for sperm to reach the egg. But, they don’t affect your ovarian reserve. That said, another misconception is that because contraception stops you from ovulating, that you’re preserving your fertility – this isn’t true either.
Your ovarian reserve gradually declines as you get older, and both the quantity and quality of eggs decrease.
With age, there's an increased risk of your eggs having chromosomal abnormalities, which means the egg is missing or has extra DNA or chromosomes. This can cause problems with implantation during pregnancy and congenital disabilities later on. It also carries an increased risk of miscarriage.
Although it may sound scary, getting pregnant at an older age doesn't mean your baby will have a genetic disorder. It's still possible to have a healthy pregnancy later in life, and your doctor can perform tests during the first and second trimesters of pregnancy to check if your baby is at risk of congenital disabilities. Your doctor will also keep a close eye on your pregnancy to make sure that you and your baby are healthy.
Age is only one factor affecting how quickly you lose your eggs or their quality. The rate at which your ovarian reserve declines depends on your medical history, genetics, and any medical conditions. And sometimes, it’s idiopathic, meaning there’s no apparent cause.
Lifestyle factors like smoking and excessive alcohol consumption can also impact your ovarian reserve negatively. Additionally, chemotherapy, radiation, and ovarian surgery can speed up egg loss. If you need to undergo one of these treatments, talking to your healthcare provider first is important. They can explain the potential consequences and offer options like egg or embryo freezing to help preserve your fertility (more on that below).
Although no test can tell you exactly how many eggs you have at any given time, some tests can help predict your ovarian reserve. These include:
Anti-Müllerian hormone (AMH) test. This blood test measures AMH, a hormone produced by cells inside the follicles of the ovaries that corresponds to egg count. The higher the level of AMH, the more eggs there are.
Follicle-stimulating hormone (FSH) and estradiol blood tests, which measure your ovarian function.
Antral follicle count, which uses a transvaginal ultrasound scan to count the number of follicles visible in your ovaries.
Knowing your egg count is especially important if you're undergoing IVF. The more eggs you have during the ovarian stimulation and egg retrieval process, the better your chances of success. Unfortunately, doctors can only develop the available eggs, and sometimes some are lost along the way. So, a low egg count is something to keep in mind.
If a woman wants to keep her fertility options open, she can consider egg freezing. This process involves collecting a woman's eggs, freezing them, and then thawing them later on to be used for fertility treatment.
Egg freezing helps to preserve fertility by freezing the eggs at their prime quality, and using them when the woman is ready to have a baby.
you have a medical condition (or are undergoing a treatment) that could impact your fertility, like cancer. There may be NHS funding options available depending on where you live.
you're worried about your fertility decreasing, but you're not quite ready to start a family.. This is known as “elective egg freezing,” and it isn’t available on the NHS, so you’ll have to do it with a private fertility clinic. Some employers offer support for elective egg freezing.
you're transitioning from female to male and want to preserve your fertility before starting hormone therapy or having gender reassignment surgery.
Getting pregnant can be a complex and emotional journey, and it's easy to feel anxious about the ins and outs of conception — especially when society loves reminding women about their "biological clock".
If you're planning on starting a family later in life or undergoing IVF, it's helpful to know how ovarian reserve may impact your chances, but remember that the number of eggs you have is just one piece of the fertility puzzle. If you're worried about your ovarian reserve or want to know more about how it can affect your chance of getting pregnant, get in touch with one of our fertility advisors.
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Written by our group of fertility experts and doctors consultants
Written by our group of fertility experts and doctors consultants
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