Problems With Eggs
(Decreased Ovarian Reserve)
(See also Overview of Infertility.)
The number of eggs may be low, or the quality may be poor.
The number and quality of eggs (ovarian reserve) may begin to decrease at age 30 or even earlier. They decrease rapidly after age 40. But age is not the only reason that the number and quality of eggs decrease. Abnormalities in the ovaries can also cause such a decrease.
In primary ovarian insufficiency (sometimes called premature menopause), the number of eggs in the ovaries decreases early. In a few women, primary ovarian insufficiency is the reason they have irregular menstrual periods or no periods.
Doctors may evaluate the following women for problems with eggs:
Doctors may measure levels of follicle-stimulating hormone (which triggers ovulation) and estrogen in the blood at a certain time during the menstrual cycle. Increased levels of follicle-stimulating hormone and decreased levels of estrogen suggest a problem with eggs. After measuring these hormones, doctors sometimes give women clomiphene (a fertility drug), then measure the levels of these hormones again. If levels increase dramatically, a problem with eggs is confirmed.
However, the most reliable tests for diagnosing problems with eggs are
Blood tests to measure levels of antimüllerian hormone, which is produced by the structures that contain the egg (follicles)
Ultrasonography with an ultrasound device that is placed in the vagina (transvaginal ultrasonography) to view and count the number of follicles
A low level of antimüllerian hormone indicates that the number of follicles is small. A small number of follicles (observed and counted during ultrasonography) means that pregnancy after in vitro fertilization is less likely.
However, pregnancy may be possible even test results are abnormal.
Because pregnancy may be possible, doctors suggest different treatments for each woman based on her circumstances and age. Such treatments include those used to treat problems with ovulation, such as clomiphene, letrozole (an aromatase inhibitor), and human gonadotropins.
If women are older than 42 or if the number or quality of eggs is decreased, using eggs from another woman (donor) may be the only way to achieve pregnancy.