Anadolu Medical Center IVF Center Director Assoc.Prof., Stating that the quality of the egg is much more important than the number of eggs in order to have children, and the quality of the eggs also decreases with age. Dr. Tayfun Kutlu and Gynecology, Obstetrics and IVF Specialist Dr. Ebru Öztürk Öksüz answered questions about egg reserve in women.
Women's egg reserve decreases with age. Anadolu Medical Center IVF Center Director Assoc.Prof., Stating that the quality of the egg is much more important than the number of eggs in order to have children, and the quality of the eggs also decreases with age. Dr. Tayfun Kutlu and Gynecology, Obstetrics and IVF Specialist Dr. Ebru Öztürk Öksüz answered questions about egg reserve in women.
How many eggs is born on average when a girl is born?
When a baby girl is born, the number of eggs in her ovaries is approximately 1 and a half to 2 million. This number decreases until puberty and decreases to 300-400 thousand. Women ovulate every month after menstruation. When they are fertile, the number of eggs is around 300-400 thousand. These eggs are used every month, and when the eggs are exhausted, the menopause process starts.
Why does egg reserve decrease over time?
During each month, around 1000 eggs riot to set out and all try to grow, but since not all of them can stand out, usually 1 or 2 eggs take the lead in the female body every month. Those eggs are preparing to lay eggs. Women are born with 1 and a half to 2 million eggs, but around 1000 eggs are lost every month. However, not every woman is born with the same number of eggs, and does not enter puberty with the same number of eggs. Therefore, differences can be seen in the fertility periods of women.
What are the factors that affect and accelerate the reduction of egg reserve?
There are many factors that affect the reduction. The first is how many eggs we were born with. We can think of this as a bit of genetic luck. In fact, when more eggs come to life with genetic luck, even if the eggs are lost over time, the fertile period can be extended. However, smoking and stress can of course reduce the egg reserve during this fertile period. We also know that this reserve definitely decreases with age. We know that ovarian reserve is necessarily reduced when it comes to any operation for the ovaries, that is, any surgery that may affect the tissue of the ovaries, or any drug use. We also know that chemotherapeutic and radiotherapeutic agents used in some systemic diseases such as cancer significantly shorten the fertility period by reducing the most sensitive cells in our body.
After what age does the decrease in egg reserve accelerate?
In the past, we used to consider the age of 40 as a risky age, and we would say that after 40, the number of eggs decreased very rapidly. Over time, we accepted that 37 is a more risky age. Now, when we look at the data in the world, we can say that this decrease accelerates after the age of 35. Nowadays, the egg reserve of women, that is, the decrease in the number of eggs, and even more importantly, the problems in egg quality are coming towards earlier ages. Therefore, we can say that it is necessary to act faster after the age of 35 to have a baby.
Compared to 10 years ago, we started to see a serious shortage of egg reserves or the risk of early menopause much more. The percentage of this in the society started to increase a lot. As this increases, we recommend not to exceed the age of 35 to have a baby.
What are the reasons for the rapid decrease in egg reserve?
If there is premature menopause in the family, it is very important to be warned about genetic factors such as mother, aunt and sister. Because this may be a finding that shows us that there is a genetic predisposition to a lack of reserves in that family. In addition, women who require chemotherapy and have a systemic disease such as cancer may need to evaluate their ovarian reserve beforehand and freeze and store it if necessary. These types of treatments are factors that seriously reduce egg reserve.
Smoking and nutritional conditions are also very important. We attach great importance to healthy eating and avoiding smoking. Surgery to be undergone due to ovarian cysts or any other problem in the ovary is one of the biggest problems of women.
How many eggs must be in the "egg reserve" to have a child? Can a number be given?
Even one egg is enough to have a child. It's all about the quality of that egg, the fertility of the woman, and the creation of a beautiful embryo from that egg. In fact, one egg and one sperm is enough to conceive. Therefore, women with very low egg reserve can conceive spontaneously. However, waiting here is of course a bit risky. Because while you wait, the eggs are completely exhausted. That's why we move on to effective treatments for these women quickly. Of course, in effective treatment, we think that the more eggs we take, the more benefits will be.
A statement saying “so many eggs are necessary for pregnancy” would not be true, but the more eggs we have, the better for pregnancy. The more good quality eggs, the more embryos combined with sperm, the higher the chance to choose the best among them, the higher the chance to freeze and save for the next pregnancy after selecting the best ones.
When is this reserve "insufficient" to become a mother?
It is important to evaluate a patient with low egg reserve as a whole. In other words, current situations such as how long he has been married, how long he wants to have children, how his wife's sperm should be evaluated. The approach to a 20-year-old patient with low reserve is not the same as a 40-year-old patient with low reserve. You can evaluate a 20-year-old newly married patient with low reserves with a few months of egg follow-up, but at 40, you may need to make more radical treatment decisions. The fertility period of the patients should be evaluated very well. One should not be late and use the time well.
How to know that the egg reserve is insufficient? Any symptoms in the woman?
By counting the number of eggs in the patient's ovaries on ultrasound, we can tell whether the egg reserve is appropriate for the age of the patient. Of course, we also have some hormone tests that support us. The most important of these is Anti-Mullerian Hormone (AMH). If the Anti-Mullerian Hormone is looked at correctly, it can give us reliable results regarding egg reserve. It is also necessary to evaluate the patient's FSH and E2 values together on the second or third day of menstruation. All these tests and controls give us information about the patient's egg reserve.
What measures can be taken so that the egg reserve does not decrease rapidly or the quality of the eggs does not decrease?
There are many situations that we cannot control. We say to the patient “Stay away from stress” but this is not an easy thing in today's living conditions, especially for a working woman. However, even if exercise does not increase the number of eggs, it increases the quality. In other words, it increases the amount of oxygen in the tissue and reduces stress. This definitely contributes to egg quality. There are factors in our lives that we can change and factors that we cannot. Healthy eating, regular sports, protein-based nutrition, not smoking, and the use of some antioxidant drugs with the recommendation of the physician, especially after the age of 40, will definitely have a positive effect on the egg quality we will obtain in egg reserve.
Is the quality of the egg more important than the number?
Absolutely. The most important thing is egg quality. The most important meaning of egg reserve, ie the number of eggs, is how many processes we have and how easily we can move. In terms of pregnancy, it is always preferred by every physician to have 10 quality eggs rather than 2 poor quality eggs.
A decrease in the number of eggs warns you, not only the number but also the age. In fact, the most important factor is age. These are all factors that increase or decrease the chance of pregnancy. For example, you are 40 years old and your ovarian reserve is very good. This does not mean that you can delay pregnancy. Because age is a factor that negatively affects egg quality. Therefore, it is necessary to consider many factors together when evaluating. Egg reserve, age, the duration of the patient's marriage, how long he wants a child, whether he has any disease, surgeries, previous pregnancies and sperm are factors that should be taken into consideration. In other words, it is necessary to evaluate each patient as a whole. Not only egg reserve, every factor can change the treatment approach.
What is the healthiest age for childbirth?
We can say that the age between 25-35 is the best age for birth. Sometimes we start to age, even if we don't accept it. Our metabolism is starting to slow down. It is beneficial for couples who want to have a baby to take into account the age factor.