02.03.2022

Ovarian Reserve: What it is, how it is measured, what influences it? 

Written by Justyna Wiraszka

Whether you are thinking of starting a family or you would like to know more about your fertility as a female, it is important to understand the topic of your eggs. When talking about female fertility, you might be confronted with medical terms such as the ovarian reserve, egg quality and quantity - but what do these terms actually mean? 

The term ‘ovarian reserve’ has been originally used to describe a woman’s reproductive potential and encompasses both egg quality and quantity. Egg quantity refers to the number of eggs, whereas egg quality refers to the condition of the eggs. Women’s ability to conceive changes over time. Increasing age can lead to challenges with getting pregnant, the term “biological clock” generally refers to the fact it is harder to get pregnant with increased age. There is plenty of evidence suggesting that the quantity and quality of eggs in females and sperm in males diminishes with age. Additionally, the biological clock can also mean social and psychological pressure you feel while not having a child by a specific age.

Same as many aspects of health, fertility is different for every individual. Each fertility journey is different. According to the NHS in England, 84 out of 100 couples will get pregnant within one year of regular intercourse (every 2-3 days throughout the month). It may seem like a lot of couples will get pregnant within 1 year of regular intercourse, but the journey of family planning is not always easy for everyone. As fertility is a vast and complicated topic we would like to bring you closer to what those terms mean and how you can measure your ovarian reserve. Finally, you will learn about a couple of factors that can affect it. 

What does egg quality and quantity mean? 


Egg quantity is the number of eggs women have. Did you know that the average woman is born with about 1-2 million eggs, yet once she reaches puberty she is left with about 400,000 eggs? By her late thirties the number of eggs is less than 50,000.

Egg quality, on the other hand, is determined by the genetic component of an egg. What is referred to as a normal egg is an egg that can result in a healthy and genetically healthy pregnancy. The egg can be euploid (normal) or aneuploid (abnormal). The egg should have 23 chromosomes, less or more than that means the egg is abnormal. Chromosomes are structures located inside the cells, made of protein and a single molecule of deoxyribonucleic acid (DNA). Passed from parents to child, DNA contains the specific instructions that make each type of living creature unique
 

What factors affect ovarian reserve? 

Now, a woman’s fertility depends on a combination of factors, - her age, genetic makeup and the environment she is exposed to. Let’s dive into some of these environmental factors below. 

Smoking

Cigarette smoke contains harmful chemicals that can affect the development of your egg cells - and ultimately their quality. Women who smoke are more likely to experience delays in getting pregnant, and smoking is also associated with negative effects on ongoing pregnancies. Aside from cigarette smoke, the use of recreational drugs and marijuana is discouraged as well - especially since studies report negative effects on the developing fetus. Smoking advances the onset of menopause, by between 1 to 4 years.

BMI

Studies have shown that there is a link between Body Mass Index (BMI), egg quantity and fertility. Being underweight can affect your menstrual cycle, leading to dysfunction, or the loss of menstrual bleedings for a longer period of time caused by loss of ovulation. A low BMI also increases the risk for infertility. On the flip side, being overweight or obese could affect your fertility as well, by increasing the risk of anovulation (absence of ovulation), infertility. 

Alcohol 

Heavy alcohol use may diminish your ovarian reserve and her fecundability (probability of getting pregnant within one menstrual cycle). According to the Centers for Disease Control and Prevention heavy alcohol consumption is defined as consuming 15 drinks or more, as a man and 8 drinks or more, as a woman per week. Various national and international health institutes (e.g.World Health Organisation, Centers for Disease Control and Prevention, National Health Service) recommend against the use of alcohol when pregnant and when trying to get pregnant - as no safe amount has been established yet.

Chemotherapy

Chemotherapy medication (typically used to treat certain types of cancer) is known to affect the ovarian reserve and increases the risk of egg damage - ultimately resulting in ovarian failure. The impact is of course chemotherapeutic agent-, dose-, and duration-dependent. Even though some patients will retain their ovarian reserve after chemotherapy treatment, many are affected by premature ovarian failure. Premature Ovarian Failure also known as premature ovarian insufficiency (POI) is a condition in which a woman's ovaries stop producing hormones and eggs at a young age. Women with POI ovulate irregularly, if at all, and may have abnormal levels of ovarian and pituitary hormones due to problems with their ovaries. Women with POI often have trouble getting pregnant. However, pregnancy is still possible, though rare. About 5% to 10% of women with POI get pregnant without medical treatment

Radiotherapy
Chemotherapy treatments are administered systemically; they can affect the entire body, whilst most radiotherapy treatments are localized. This reduced the toxicity to a limited area that is being treated. Pelvic radiotherapy can have a highly toxic effect on oocytes. According to NHS England it is extremely rare for women to retain significant ovarian reserve after pelvic radiotherapy.

Medical issues

Several medical issues have been shown to affect egg quantity, including chronic illnesses (Crohn’s disease, Systemic Lupus Erythematosus), polycystic ovarian syndrome, endometriosis, ovarian suppression, granulosa cell tumors, and a history of ovarian surgery. For more information about some of those chronic illnesses please refer to Bloom App. 

How do you measure ovarian reserve? 

Over the years, a number of tests have been developed to assess the ovarian reserve - those include Anti-Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH) and the Antral Follicle Count (AFC) tests. These tests, however, serve only as an estimate for egg quantity and are considered poor predictors for egg quality. Up till now, age remains the best predictor for egg quality. According to the American College of Obstetrics and Gynecologists (ACOG) female fertility is at a peak in the early 20s and starts to diminish after the age of 32. This decline is irreversible, and the speed at which a woman loses eggs varies considerably. 


What is the Bloom Ovarian Reserve Test? 

The Bloom Ovarian Reserve Test is designed to quickly reflect one of the key components of the body's ovarian reserve. It measures the Anti-Müllerian hormone (AMH), which is produced by cells surrounding the egg in the ovarian follicles, or egg sacs. AMH is an important hormone related to fertility. It can reflect the number of eggs present in the ovaries, called the ovarian reserve. The term “ovarian reserve” has been used to describe reproductive potential focusing on the number of eggs. 

Within 21 minutes your test result is available on your smartphone - including your personalized Bloom Ovarian Reserve Report. Depending on your medical history and the status of your ovarian reserve, the report and its recommendations can enrich your knowledge on the relationship between AMH, your age and the ovarian reserve status. Moreover, it provides information on fertility, possible lifestyle improvements, retesting, and can suggest when to follow up with a doctor. 

When should you consider taking this test: 

  • You are planning to start a family
  • You are interested in estimating your ovarian reserve
  • You are at risk of Early Menopause or Primary Ovarian Insufficiency (POI) due to
    • Family history, e.g. mother or sister has POI
    • Gynecological Surgery that can lead to POI or early menopause

 

To summarize

 
If you are thinking of starting a family in the future or are just curious about your ovarian reserve, measuring your AMH levels can provide valuable information. As mentioned above, there are many factors that can affect a woman’s fertility. Not only will you get the results live on your phone, but you will also get information on AMH, your fertility and next steps. Each time you test your results are stored in the Bloom App under the Reports section with a date and time stamp. This helps you track and compare your test results over time. At Bloom we care about making healthcare more accessible, this is why we want to help you to understand your body better and take a proactive approach to your health.

 

Want to learn more about the Bloom Ovarian Reserve Test? Click Here

 

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