As a fertility expert, women often ask me at what age they should begin to worry about the quality of their eggs.
The answer I always give them is ‘as early as possible’.
The fact is that egg quality is largely a factor of age and there is little you can do to change it. Unlike men who are continuously creating a fresh supply of sperm, every woman is born with a set number of eggs which were made as she developed in her mother’s uterus. As time goes by the quality of those eggs unfortunately declines – and more rapidly after the age of 36. In fact, egg quality is the single most important contributing factor in achieving a successful pregnancy. Frustratingly, for many women today, who choose to delay parenthood into their 30s or even 40s, they are unaware of the impact that declining egg quality will have on their future fertility.
There is no simple blood test or scan to assess the quality of a woman’s eggs, although there are several procedures which are offered – usually as part of a wider range of investigations into reasons for infertility.
Egg release (ovulation) can be assessed either by urine ovulation tests done a few days before the middle of your menstrual cycle or by a blood test to check the level of progesterone a week before a period starts (ie on day 21 of 28 day cycle or day 28 of a 35 day cycle).
The number of eggs you have can only be assessed indirectly by ovarian reserve tests as eggs are too small to be individually counted!
Three ovarian reserve tests are commonly used:
- FSH level in the blood carried out on days 2-4 of the period (without having taken any hormonal medication like the Pill, the month before) – a low result (<10 ) is a good result
- AMH level (this can be done at any point in the cycle) – a high result, ideally over 8 is a good result
- A vaginal ultrasound scan of your pelvis to assess the antral follicle count in the ovaries – again a high result ideally 10 or more is a good result
It’s advisable to do at least two ovarian reserve tests as each test can vary from month to month. Finally, it’s important to know that an abnormal ovarian reserve test does NOT rule out the possibility of pregnancy (whether conceived naturally or following treatment). Also, the best test of fertility is to actually try naturally for a few months and see what happens!
That doesn’t mean to say that there aren’t any options for women and couples who want to plan their family around their career, but are concerned about egg-quality.
Our advice at The Evewell:
Firstly, don’t leave it too late to start investigating fertility. There are many factors, such as general gynaecological health, that influence your long term chances of successful pregnancy. Too often undiagnosed endometriosis or heavy periods lead to avoidable fertility treatment years later. At The Evewell, we take this to the heart of everything we do and tell our patients that optimising fertility is just part of a journey that should start at 18 and continue through their fertile years.
Secondly, young women should consider fertility preservation. Thanks to recent advances in egg and embryo freezing technologies fertility preservation by freezing eggs or embryos offers an alternative option for women that are not yet ready for a pregnancy but wish to reduce the age-related decline in fertility. Although frozen eggs or embryos aren’t always a guarantee of a future successful pregnancy, this is becoming increasingly popular with women who want to take greater control of their fertility.
About the author
Dimitrios Psaroudakis is a leading fertility consultant at The Evewell, a new, fully-integrated centre of medical excellence – dedicated to caring for and protecting all aspects of fertility and gynaecological health.
To learn more please call 020 3974 0950 or visit www.evewell.com