In the matter of preparing for pregnancy, many people are not necessarily pregnant if they want a child because of problems such as being too old, stressful in life, and environmental pollution.So how do you get pregnant?Still have to evaluate the ovarian reserve function first!

What is ovarian reserve?

Ovarian reserve refers to the number and quality of follicles that can be recruited in the ovary, which can reflect women's reproductive potential and endocrine function, and is responsive to gonadotropins in the ovary.

Simply put, when a woman is still a fetus, the number of follicles in the body reaches a peak of 600-700 million.About 200 million are left at birth, and it drops to 30 in puberty. In the end, only 400-500 follicles mature and ovulate [3].Ovarian reserve refers to the number of follicles left in a woman's ovaries. The more follicles there are, the greater the possibility of conception.

How should we evaluate ovarian reserve?

1. age

Age is the simplest and most intuitive indicator to assess ovarian reserve function.Ovarian reserve function will decrease with age, and the decrease will accelerate after the age of 32 years old, and the ovarian reserve function will decline sharply after the age of 37 years.

In the process of women’s aging, the first manifestation is the decline in fertility caused by the change of ovarian reserve, and then the menstrual cycle disorder and the endocrine function decline due to the change of the menstrual cycle.

2.Basal antral follicle number (basic AFC)

Basic AFC is the measurement of the number of antral follicles with a diameter of 2-4mm on the 2-9 days of menstruation by vaginal ultrasound, which can reflect the number of primitive follicles remaining in the follicle pool, and more intuitively and accurately reflect the ovarian reserve function.When the basic AFC is less than 5-7, the decline of ovarian reserve can be considered.

3.Basal FSH and basal estradiol levels

Basic FSH refers to the level of serum FSH in the early stage of follicles (days 2-4), which tends to increase with age. It is clinically used to predict ovarian responsiveness and evaluate ovarian reserve.

In clinical practice, basic FSH≥10 IU/L is often used as the criterion for decreased ovarian reserve; basic FSH≥25U/L indicates ovarian insufficiency; when basic FSH>40U/L indicates ovarian failure.

Basic E2 refers to the level of serum E2 on days 4-2 of the menstrual cycle, and its level gradually increases with the growth of follicles, which can be used as an indicator of ovarian reserve function.When the ovarian reserve decreases, it is manifested as a decrease in follicular reserve, and the serum basal E2 concentration drops to <73 pmol/L.Due to the feedback of the decline in basal E2, the serum basal FSH level increased.With the further decline of ovarian reserve, the increase in serum basal FSH level of follicles leads to the increase of basal E2 level to> 2 pmol/L.

Therefore, the basic E2 <73 pmol /L or> 2 pmol /L is generally used as an indicator of ovarian reserve hypofunction.

4. AMH

Among the endocrine hormone indicators for assessing ovarian reserve, AMH is the most sensitive hormone that changes with age and is relatively stable and not affected by the menstrual cycle. It is considered the gold standard for assessing ovarian reserve.

Its value reaches the highest in female adolescence, gradually declines after 25 years of age, and is lowest in women after menopause. When AMH ≤ 1.1 ng/mL, it indicates a decline in ovarian reserve.When the serum AMH detection value is lower than 0.65 ng/mL, it indicates that the egg stock is significantly reduced, which makes it difficult to get pregnant.

What to do if ovarian reserve is decreased?

We know that female ovaries have dual functions of reproduction and endocrine.Females generally have only one follicle per menstrual cycle that can stand out from the developed follicle clusters, continue to mature and release eggs.Decreased ovarian reserve means that the number and quality of eggs in the ovaries decreases, which can lead to decreased fertility, increased miscarriage rates, or premature menopause.

Therefore, many patients with impaired ovarian reserve will anxiously ask, "What can I eat to make the ovaries younger?"

The answer is: no!

Ovarian aging is irreversible, so how to complete the fertility needs before ovarian failure is extremely important!

Here are a few tips for reference:

• Relieve psychological pressure, especially for female patients of childbearing age. Decreased ovarian reserve does not mean that there is no ovulation at all, and there are still occasional spontaneous ovulation.
• Appropriate exercise and healthy diet, quit smoking and alcohol.
• Actively prepare for pregnancy. Experts from the American Association of Obstetricians and Gynecologists recommended in 2015: Women who are older than 35 years old who fail a pregnancy trial for more than 6 months should get a rapid infertility check and receive fertility treatment; and for women older than 40 years old, Because fertility is close to the stage of exhaustion, IVF treatment is recommended directly.