CHENNAI: Until now, Arundhati, like any woman in her early 30s, never bothered about how many more years she can wait to have children. But she got a wake-up call when a test conducted by her fertility specialist told her that she had run through most of her eggs. Taken aback, Arundhati was clueless on how this could be possible and wished she knew about this sooner.
Most women do not appreciate the true effect age has on their fertility. Most are ignorant of the fact that after 30, they’re more likely to have a decreased ovarian reserve, apart from other problems like pre-term birth, medical problems like diabetes, hypertension and hypothyroidism which can result in miscarriages and increased chances of anomalies in the child.
Thanks to advances in medical technology, a test called Anti-Mullerian Hormone (AMH) promises to pinpoint a woman’s chances of getting pregnant for the given age, how that might change, and whether there is a possibility of doing something about it. It is a simple blood test, which can help women check the status of their fertility and plan their family accordingly based on AMH hormone levels in their blood. Experts recommend this test for any woman who is over 30 years and wishes to postpone childbearing, and is planning for pregnancy later on. If her score is low, she might wish to re-consider her decision. If it’s normal, she can postpone childbearing but repeat the test every year to check for any drop in AMH levels. Until now, a woman’s ovarian reserve was checked using methods such as Follicular-stimulating hormone (FSH) test, basal estradiol and antral follicular count. In the FSH test, FSH levels are measured using a blood test between day two and five of a a woman’s menstrual cycle, but it can fluctuate from month to month. On the other hand, AMH concentrations fluctuate very little during the menstrual cycle and therefore a blood sample can be taken at anytime and any day of the menstrual cycle.
Women are born with about one million premature eggs. Egg quantity and quality are determined from the time of puberty onwards, and the number of eggs keeps diminishing as age advances. As per fertility experts, egg quantity and quality declines in the mid 30s and faster in the late 30s and early 40s. Normally, there is a slow decline in the number of viable eggs in the ovaries over time. However, a small number of women have a faster rate of egg loss. Low ovarian reserve would correspond to fewer eggs and therefore fewer chances of having babies. AMH is a hormone secreted by cells in developing follicles. As the number of these follicles fall over time, the level of AMH also decreases. Women with a family history of early menopause, a history of surgery to the ovary or severe endometriosis, and those who have had previous chemotherapy or radiation, are all at increased risk of early diminished ovarian reserve. However, a vast majority of patients with diminished ovarian reserve have no clinical risk factors, and they will often have normal menstrual cycles. The only way to identify these women is with the use of an AMH assay. AMH can give useful information about the quantity of eggs but the quality of eggs cannot be determined by this alone. By careful examination of the eggs and embryos during the in vitro incubation process, doctors/embryologists can get clues on the quality and about why pregnancy has not occurred previously. In the present scenario, with an increasing number of women delaying child-bearing, it is essential for them to check their chances of getting pregnant, for it can be much lower than they would like to believe.
(The contributing writer is clinical director at Nova IVI Fertility Chennai)