Decreased Oocyte Reserve
Women are born with a certain ovarian reserve at the time of birth and use this reserve throughout the productive age after the ovulation process that begins with puberty. This number, which is determined at birth, cannot be increased later. Although there are promising studies to increase the number of eggs with stem cells, it is not yet used in clinical practice. However, this situation may be a solution in the coming years for women who want to have a child at an early age, whose ovarian reserve decreases or who has an advanced age.
It is not right here to establish a direct link between decreased ovarian reserve and premenapause or menopause. Fertility of women with reduced ovarian reserves may decrease or end very well, but they may continue to have menstruation for years. In this case, the answer to the question “I still have menstruation, I have not yet entered menopause, but I cannot conceive” is here.
The biggest determinant of the number of eggs is genetic inheritance. The presence of women with good fertility capacity and late menopause age in the family is promising.
The most common reason for the decrease in ovarian reserve is the advancing female age. The number of eggs that start to decrease gradually at the age of 30 starts to decrease dramatically after the age of 37 and decrease even after the age of 40-42. Pregnancy after 44 is extremely rare. When we look at it like that, the earlier we try to have children, the more things go naturally. However, due to the increase in the educational level of women and the progress in working life and career studies, the age of having children has progressed naturally all over the world.
Ovarian surgeries and endometriosis may also decrease ovarian reserve, except for advanced age. In ovarian surgeries, especially in operations for endometriosis, respect for tissue should be prioritized and surgical planning should be done in skilled and experienced hands to protect healthy tissue as much as possible.
Ovarian reserve may decrease significantly or be completely depleted after the treatments (radiotherapy and chemotherapy) applied in young cancers with increasing frequency. Here, oncology professionals have a serious consultancy role. In all possible cases, egg freezing should be recommended before treatments. This also applies to male patients and sperm freezing, of course.
Large cysts such as chocolate cysts (endometrioma), dermoid cyst, etc. in the ovaries also reduce the reserve.
Infections such as pelvic tuberculosis and severe pelvic infection also destroy the ovarian tissue.
As a lifestyle, cigarette addiction is one of the most important factors that reduce ovarian reserve. Smoking is considered to be harmful at every dose in this regard, but it appears that more than 10 drinks increase the risk significantly. It has also been observed that women with cigarette addiction statistically entered menopause 4 years earlier.