Prevention of Decreased Ovarian Reserve in Females

Introduction:

The ovarian reserve describes the quality and quantity of the ovarian follicular pool. Primordial follicles are the reproductive units of ovaries in mammals, and it is composed of oocytes surrounded by layers of flattened granulosa cells. Decreased ovarian reserve indicates a reduction in the quantity of the ovarian follicular pool. A decrease in ovarian reserve is noted in females in their mid and late thirties. Researchers have stated that in a few cases, females of the younger age group may also have a decline in ovarian reserve. The decline in ovarian follicular pool quantity accelerates at the age of 37 to 40 and may reach below a critical count of twenty-five thousand. Studies have shown that women with lower ovarian reserve must undergo alternative pregnancy techniques like IVF (in vitro fertilization).

In this modern era, delayed childbearing is a common complaint of couples visiting the healthcare setup. The ovarian reserve test is the most commonly prescribed test in such cases. Following the report, the clinicians plan an alternative mode for pregnancy. Not only oocyte quantity but quality also plays a vital role in determining the probability of pregnancy.

What Are the Common Causes of Diminished Ovarian Reserve?

The following are common reasons besides the decrease in ovarian reserve:

• Aging: Aging is a natural phenomenon, and it directly affects a woman's fertility. Hormonal changes, age-related systemic disorders, and other psychological factors associated with aging are together responsible for affecting the quality and quantity of oocytes in females. It is thus commonly said that the biological clock starts ticking after the females reach their mid-thirties.

• Tubal Diseases: Tubal diseases include the condition where the fallopian tube gets damaged or, in a few cases, it may also get blocked. It is a major cause of female infertility. In females suffering from tubal diseases, pelvic inflammation, and infection are commonly noted phenomena and, thus, result in a decline in ovarian reserve.

• Endometriosis: It is a pathological condition categorized by the presence of a mass of tissue in the uterus's endometrium lining. This mass of tissues resembles the endometrium (the lining of the uterus). Endometriosis can lead to chronic inflammatory reactions that result in fibrosis and adhesion in various parts of the female reproductive system. These phenomena can affect the quality and quantity of ovarian reserves in females.

• Oophorectomy: It is a surgical procedure performed to remove one or both ovaries. The surgical removal of ovaries results in the diminished or complete absence of oocytes in these females.

• Chemotherapy and Radiation Therapy: These therapies are prescribed for cancer treatment. They result in a reduction in reproductive potential, menopause, and a decrease in ovarian reserve. Radiation and chemotherapy have deleterious effects on normal tissues as well, which is a proven side effect of these disorders.

• Other Causes: Rare genetic disorders like Fragile X syndrome (a developmental disorder associated with intellectual disabilities) and viral infections like mumps (a viral infection causing salivary glands inflammation) are also known to be causative factors of ovarian reserve declination.

What Are the Clinical Features Of Decreased Ovarian Reserve in Females?

The following are the common clinical features of decreased ovarian reserve in females:

• Difficulty in conceiving a child.

• Irregular or absent menstrual cycle.

• Heavy flow during menstruation.

• Frequent miscarriages.

Females experiencing these symptoms should visit a gynecologist and undergo a thorough medical checkup.

What Steps Could Be Followed to Improve Ovarian Reserve in Females?

Studies have proven that the following steps can help in improving the ovarian reserve in the female:

• Deleterious activities like cigarette smoking and alcohol intake significantly influence ovarian health. It has a negative impact on the reproductive health of females. Various studies have noted the effect of cigarette smoking on ovarian reserves; these studies state that in females addicted to cigarette smoking, accelerated egg loss is significantly noted. Therefore, it is advised that females of the reproductive age group should abstain from alcohol intake and cigarette smoking in order to improve their reproductive health.

• Psychological stress is another important factor influencing female reproductive health. Psychological stress causes hormonal imbalance. These hormonal imbalances directly affect the menstrual cycle of women suffering from psychological stress. Proper stress management is advisable in these females to improve their reproductive health. Antidepressants and family support can help relieve stress and help these women improve their ovarian reserve.

• High consumption of junk food leads to increased deposition of toxins in these individuals. Increased polyunsaturated fatty acid levels and lipid levels have a negative impact on reproductive health. Females of the reproductive age group should avoid junk food intake as far as possible.

• Obesity results in a reduction in reproductive potential, menopause, and a decrease in ovarian reserve. Obesity is also noted to have a negative impact on females of the reproductive age group. Maintaining an appropriate body mass index is of utmost importance in these females.

• Nutritional deficiency is also an important factor linked with female infertility. Females suffering from iron and folic acid deficiency frequently suffer difficulty conceiving. Iron levels of females should be checked at regular intervals, and prescribing iron and folic acid supplements help in maintaining the reproductive health of the women.

• Antioxidant-rich food items like fruit and vegetables should be included in daily diet. Antioxidants help in washing out toxins from the body, which results in an improvement in the menstrual cycle, and reproductive health is maintained.

• In recent times, laboratory procedures like the freezing of eggs have been followed by many women. In this technique, the eggs from the ovary of the woman are isolated and preserved in vitro. This improves the life span of the eggs. Then as per the individual's wish, the eggs can be fused through the in vitro fertilization methods whenever she plans to conceive.

What Tests Can Be Prescribed to Check Ovarian Reserves in Females?

• Medical history assessment is a traditional method to determine reproductive health in females. Medical professionals ask questions related to the menstrual cycle history, body mass index, and other nutritional deficiencies and determine the reproductive health of the woman.

• Ultrasonography helps in examining ovarian health and, thus, gives an idea about the reproductive health of the woman.

• Hormonal level tests also give a brief idea about the reproductive status of the women.

• New methods include ovarian reserve tests. Ovarian reserve tests check the levels of hormones like a follicle-stimulating hormone, estradiol, and anti-mullerian hormone. A blood test is prescribed between day two to day five of the menstrual cycle, and the levels of these hormones are checked to analyze the reproductive health and ovarian reserve in women.

Conclusion:

Prevention of decline in ovarian reserve is an important factor for pregnancy in subfertile females. Decreased ovarian reserve indicates a reduction in the quantity of the ovarian follicular pool. The ovarian reserve test is the most commonly prescribed test in such cases. In accordance with the report, the clinicians plan an alternative mode for pregnancy. Females of the reproductive age group should abstain from alcohol intake and cigarette smoking in order to improve their reproductive health. Antidepressants and family support can help relieve stress and help these women improve their ovarian reserve. Females of the reproductive age group should avoid junk food intake as far as possible.