Egg quality plays a key role in female fertility. Healthy eggs have the best chance of developing into an embryo, implanting in the uterus, and leading to a successful pregnancy.
It is important to note that there is no specific test to determine egg quality. Instead, in medical practice, various tests are combined to give us information about female fertility.
Modern methods for determining egg quality include ovarian reserve testing, hormonal tests, as well as transvaginal ultrasound. The age of the woman is also taken into account, because it is directly related to the quantity and quality of the eggs.
AGE AND EGG QUALITY
As we age, the number of eggs with chromosomal abnormalities, that is, containing too few or too many chromosomes, increases. If fertilization occurs with such an abnormal (aneuploid) egg, the embryo will inherit the abnormality. Most aneuploid embryos will either fail to implant in the uterus or get miscarried. In some cases, the fetus survives but suffers from chromosomal defects. An example of this is Down syndrome, where children have an additional 21st chromosome.
By age 30, about 70% of a woman’s eggs are chromosomally normal. At age 40, only about 35% of eggs are healthy. This is one of the reasons why fertility declines with age.
Unlike men, who create sperm continuously throughout their lives, women are born with a fixed number of immature eggs (1-2 million). Of these, only a few hundred mature and can be fertilized.
It is normal for ovarian reserve to decline with age. Sometimes this process starts earlier (before the age of 40). We call this condition premature ovarian insufficiency. A distinction must be made between “premature ovarian insufficiency” and “premature menopause”. Premature menopause means, there is a complete stop of ovulation. With premature ovarian insufficiency, ovulation occurs, but much less often. The eggs released during ovulation, however, are of reduced quality.
In case you might have premature ovarian insufficiency, your OBGYN will recommend some hormonal tests (Anti-Müllerian hormone, FSH, LH), as well as ultrasound of the ovaries. Depending on the results and your comorbidities, you will be presented with treatment options.
1.Antimüllerian hormone (AMH). AMH is secreted by the granulosa cells of the follicles in the ovaries. Its concentration is proportional to the number of follicles. Therefore, the more follicles there are, the higher the concentration of AMH will be.
2.Follicle stimulating hormone (FSH). FSH is critical for follicle development. It is secreted by the pituitary gland and stimulates the maturation of follicles in the ovaries. A high concentration of FSH on day 3 of the cycle is associated with a smaller ovarian reserve.
- Estradiol (E2). It is tested together with FSH on the 3rd day of the menstrual cycle. A premature rise in estradiol early in the follicular phase is caused by increasing FSH levels in women with declining ovarian reserve.
Transvaginal ultrasound allows doctors to estimate the number of antral follicles in the ovaries. It is usually performed between the third and twelfth day of the menstrual cycle and involves counting the total number of follicles between 4 and 9 millimeters in both ovaries. Follicles are eggs that can potentially mature and be released during ovulation. A lower number of follicles means you may have problems with egg quality and quantity.
After interpreting your test results, your obstetrician-gynecologist will suggest an action plan tailored to your health condition and personal preferences.
If you have any concerns about your fertility, you can consult New Life Clinic’s reproductive specialists.