Women may have infertility if the number of eggs in their ovaries is low and/or the eggs are not functioning well.
The number and quality of eggs in the ovaries may begin to decrease at age 30 or even earlier, and they decrease rapidly after age 40.
Doctors do blood tests to measure levels of hormones involved in the release of eggs and/or ultrasonography of the ovaries to view and count the number of follicles (small fluid-filled pockets that contain the eggs).
Treatment depends on a woman's circumstances and age and may include using eggs from another woman, particularly if a woman is over age 42.
(See also Overview of Infertility.)
The ovaries contain the eggs, and all the eggs that a woman will ever have are in the ovaries when she is born. No new eggs are produced later in life. 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 at a younger age. In a few women, primary ovarian insufficiency is the reason they have irregular menstrual periods or no periods.
Diagnosis of Problems With Eggs
Blood tests to measure levels of certain hormones
Ultrasonography
Doctors may evaluate the following women for problems with eggs:
Those who are 35 years or older
Those who have had ovarian surgery
Those who have responded poorly to fertility medications (such as gonadotropins) that stimulate several eggs to mature and be released
Doctors may measure levels of follicle-stimulating hormone and estrogen in the blood at a certain time during the menstrual cycle. (Follicle-stimulating hormone stimulates the release of eggs, called ovulation.) Increased levels of follicle-stimulating hormone and decreased levels of estrogen early in the menstrual cycle suggest a problem with eggs.
The most reliable tests for diagnosing problems with eggs are
Blood tests to measure levels of antimüllerian hormone (AMH), which is produced by the follicles (the fluid-filled pockets in the ovary that contain the egg)
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 but still possible.
However, pregnancy may be possible even if test results are abnormal.
Treatment of Problems With Eggs
Treatment based on a woman's circumstances and age
Because pregnancy may be possible, doctors suggest different treatments for each woman based on her circumstances and age. Such treatments may include those used to treat problems with ovulation
If women are older than 42 years or if the number or quality of eggs is decreased, using eggs from another woman (donor), if available, may be an option.
