Ovarian Treatments

Ovarian Treatments

Fertility Doctor Tina Koopersmith

Discusses The Ovarian Reserve

A woman’s ovarian reserve is an essential factor in determining fertility. Ovarian reserve refers to how many eggs a woman has left in her ovaries to reproduce. Diminished ovarian reserve refers to having few eggs left in a woman’s ovarian reserve, however, just because there are few eggs, does not mean that the woman is infertile.

Our experienced fertility doctors will evaluate your specific situation and individual fertility, and guide you through the process to determine the best course of action to reach your fertility goals.


Ovarian Treatment Options


Menstrual Cycle

Menstrual Cycle

Menstrual Cycle

Many women are aware that their menstrual cycles shift and change as they age. They may be surprised, however, to learn that their menstrual cycles provide clues that the ovary is changing and aging. As women get older, their menstrual cycles can shorten and become more regular, even to the point when they can pinpoint exactly when their periods may start. This can be a beginning sign of ovarian aging. If periods were regular and then become irregular, this can be a sign of advanced ovarian aging. If a woman begins missing periods, this is a telling sign that she might be going through menopause soon.

It’s important to let your doctor know about changes in your period, so an effective fertility treatment plan can be developed that considers your ovarian age and not just your chronological age.


Ovarian Reserve

Ovarian Reserve

What Is The Ovarian Reserve?

Ovarian reserve is a term to explain and estimate how many eggs are left in the ovary. At birth, women have about two million eggs stored in their ovaries. Once puberty starts, each month a cohort of eggs begins to mature, but only one egg is able to ovulate. The other eggs just stop growing and then disappear. For some women, this cohort is always only a few eggs, but for other women, it could be more than 20 eggs. Those with a small cohort are said to have “diminished ovarian reserve.” Indeed as all women age, the cohort of eggs that grows monthly gets smaller.

For the average woman, the fertility curve starts to gradually change in her early 30s, with more rapid changes later in that same decade. Normal menopause can occur as early as 40 or as late as 60, with the median age at 51. For those who are destined to have menopause at 60, it is unlikely to have diminished ovarian reserve until very late; conversely, women with premature or early menopause will show evidence of diminished ovarian reserve (smaller number of eggs) in their 20s.

It’s important to evaluate a woman’s ovarian age, as it helps us make treatment decisions and better indicates your likelihood of success with a given treatment modality. We do this by examining several different factors, including:

  • AMH (Anti-Mullerian Hormone) levels -- hormone made by the remaining eggs
  • FSH (Follicle Stimulating Hormone) and Estradiol levels -- hormones made by the pituitary and ovary, respectively
  • Antral Follicle Count - a measurement of the cohort of eggs in the ovary in any one cycle as visualized by an ultrasound
  • Medical history
  • Menstrual history

AMH

AMH

AMH

Testing for AMH (Anti-Mullerian Hormone) levels is one of the first fertility tests we perform when a woman inquires about her fertility, because it can help determine how many eggs she has left in her ovaries.

AMH levels are determined through a blood test that can conveniently be done on any day during your menstrual cycle. AMH is made by primordial follicles in the ovaries, or eggs that are not yet ready to respond to hormones, grow or ovulate. The higher your AMH level, the more eggs you have in reserve that may grow into mature eggs some day.

Women with high AMH levels respond extraordinarily well to fertility medications; they can be called “hyper-responders.” However, in women with extremely high AMH levels, there may be many small eggs in the ovaries, but the high AMH levels could be inhibiting ovulation. Women with low AMH levels may have fewer eggs in their ovaries, so only a few eggs grow, even under the influence of strong fertility medications. Your doctor will use this information to customize your dosing of fertility stimulation medications, which can help maximize your response during treatment.

It’s important to understand that AMH levels DO NOT correlate directly with pregnancy rates. Rather, AMH levels are one vital factor that can help to more accurately determine your ovarian age and how many eggs your fertility doctor has to work with.


FSH & Estadiol

FSH & Estadiol

FSH & Estadiol

If you are undergoing fertility treatments, you will hear the term “Day 3 Blood Work” frequently. When analyzing a woman’s fertility, the third day after a woman’s period is an important day to look at her blood work.

During “Day 3 Bloods,” three hormones are evaluated: FSH, LH, and Estrogen.

  • FSH represents Follicle-Stimulating hormone that is released from the pituitary and stimulates the ovary to grow an egg.
  • LH refers to Luteinizing Hormone, which is vital in the final maturation and release of a follicle, and it also ensures ovarian production of hormones.
  • Estrogen, produced by the ovary, is also measured; it rises as the eggs develop each month.

FSH and estrogen interrelate, as do LH and estrogen. Normal FSH numbers are between 4 and 8. We like to see estrogen levels under 50, and the LH level should be relatively close to the FSH level for optimal fertility.

Ultimately, measuring these hormone levels, taking into account your age and clinical history, will allow your fertility specialist to better assess the current status of your reproductive health, and formulate a custom treatment plan to help you successfully conceive.


Ovarian Follicle Count or Antral Follicle Count

Ovarian Follicle Count or Antral Follicle Count

Ovarian Follicle Count or Antral Follicle Count

An ovarian follicle count is done to determine how many eggs can be retrieved from a woman’s ovary for use in fertility treatment.

During days 2-4 of a woman’s cycle, it’s important to perform an ultrasound on the ovary to assess her follicle count. If a woman has a large ovary, typically there are an abundance of eggs. Conversely, if a woman has a small ovary, there may be fewer eggs.

Fertility medication is given to encourage one or more eggs to grow to maturity and be released during ovulation. The medications can only help grow eggs that are already in place and ready to respond. Fertility medications cannot grow more eggs than are already present and counted on Day 3. Your fertility doctor will carefully analyze your follicle count during each cycle and try to prescribe JUST the right amount of medication to get the desired outcome without over-stimulating the ovaries.


Together We'll Find A Way

Our experienced fertility doctors will evaluate your specific situation and individual fertility, and guide you through the process to determine the best course of action to reach your fertility goals.

We look forward to meeting you, learning about you, and helping you to be healthy and happy. To schedule an appointment you can call the West Coast Women's Reproductive Center at (818) 616-9277 or make an appointment online.

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