Low ovarian reserve rarely presents with obvious signs in its early stages. It is often discovered during investigations for fertility problems or as part of assisted reproductive technology programs. However, there are certain signs that deserve attention.
What are the signs of low ovarian reserve?
The following signs may be observed: shortened menstrual cycles with intervals of less than 26 days; lighter menstrual periods than before; difficulty conceiving after 6–12 months of regular sexual intercourse, especially if the woman is over 35 years old; a family history of early menopause.
These factors alone are not sufficient to establish a diagnosis, but they are warning signs, particularly if the patient is planning a pregnancy.
Why is age important?
Both the quantity and quality of eggs gradually decline with age. At birth, ovarian reserve is very high. By puberty, a smaller but still sufficient number of eggs remains. By the age of forty, the number of eggs has decreased significantly. As menopause approaches, only a few hundred eggs remain in the ovaries. Therefore, age is the main factor affecting ovarian reserve and reproductive potential.
What tests are necessary?
Only laboratory tests can accurately determine the true status of ovarian reserve. Its assessment is based on a combination of hormone levels and ultrasound examination.
Anti-Müllerian hormone (AMH) is one of the most widely used markers for estimating the number of remaining eggs. It can be measured on any day of the menstrual cycle. Normal values are approximately 1.5–4.0 ng/mL. Low values are often below 1.0 ng/mL or even 0.5 ng/mL. These levels indicate reduced ovarian reserve, but by themselves do not determine the actual chances of pregnancy. AMH levels should be interpreted together with other test results and the woman’s age.
To obtain a more complete picture, a gynecologist may order tests for follicle-stimulating hormone (FSH) and estradiol, which are measured at the beginning of the menstrual cycle. Elevated FSH levels indicate that the pituitary gland is working harder to stimulate the ovaries.
Antral follicle count by transvaginal ultrasound
Ultrasound examination assesses the number of small follicles visible in both ovaries at the beginning of the cycle, which is a direct indicator of ovarian reserve. The diagnosis of low ovarian reserve is established based on a combination of these findings, the patient’s medical history, cycle regularity, and any associated medical conditions.
Why does ovarian reserve decline?
The most common cause of low ovarian reserve is the natural aging process of the ovaries. Today, many women seek pregnancy after the age of 35–38. In this age group, the number of available eggs has already decreased. In addition, the proportion of eggs with chromosomal abnormalities increases, raising the risk of failed implantation, miscarriage, and chromosomal abnormalities in the embryo.
In some women, the decline occurs earlier or is more pronounced than usual. Possible contributing factors include: a family history of early menopause; cancer treatments; ovarian surgery; and certain autoimmune or genetic disorders. However, in many cases, the exact cause cannot be identified. This is referred to as idiopathic diminished ovarian reserve.
The Role of Lifestyle
No supplements or lifestyle changes can increase an already depleted ovarian reserve or raise AMH levels. Quitting smoking, limiting alcohol consumption, maintaining a healthy body weight, following a diet rich in fruits, vegetables, whole grains, and healthy fats, and engaging in regular physical activity do not replace medical treatment, but they can improve overall health.
Understanding your ovarian reserve, learning about its characteristics, and consulting with specialists at Bogolyuby Medical Center can transform a condition that is often perceived as a threat into an opportunity to plan your future freely and consciously.
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