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Monday, April 6, 2015

How To Decide When To Have A Baby, According to Measured Ovarian Age

Some women are able to be fertile until they are quite old, others are running out of usable eggs even though they are quite young. There are tests of the age of your ovaries, but then usually it's only fertility patients who get these tests; and while very interesting it doesn't typically change medical care to know whether you are still fertile unless you are seeking pregnancy. Those wondering how close to menopause you are, or even more interestingly, when to time having a baby. You might make a different decision if you know your ovaries are running out of eggs, rather than if you had plenty of eggs and could easily postpone while you work on that job change, that new marriage, or that bucket list. And that was one of the questions a recent Practice Committee of the American Society for Reproductive Medicine opinion tried to answer for you: how to use tests of ovarian aging. Generally speaking, the most eggs we will ever have is during the 4th or 5th month of fetal life! Then we begin to lose egg through illness, medications, ovulation and ovarian surgery. And we're not sure how to preserve the numbers we have, birth control pills and pregnancies don't change our fertile egg numbers or lifespan a bit.  Your age of menopause is the day you run out of eggs, but often women will prematurely enter menopause only to find themselves cycling again in the future, which is what is known as POI or premature ovarian insufficiency.. So the obvious question is, will this happen to you, or to phrase it a different way,: Women want to know are they loosing eggs. And if the eggs are still able to be fertilized. Since an egg going from it's latent state to fully ready for fertilization takes 3 months, this question isn't as straight forward as it seems. Older women, younger women, many of us have the same question, what is the age of the ovary so one could plan pregnancy. Women seeking fertility and women seeking not to be fertile, and women wanting to establish if these hot flashes are menopause or something else all want to know: just how many eggs do they have left. Their Gynos want to know as well, and how we can determine this is that has been as critical as knowing that running out of eggs may have really occurred. We tend to have clues, the age of average menopause, the age your mom went through menopause, and other factors. Ultrasounds have been used to look at how many growing eggs are in the ovary at the start of the menstrual cycle to determine if you have many eggs or fewer than you should, and this is literally a count of follicles that are between 2 and 10 mm in size. The measurements of your estrogen levels have been used to just name a few tests, and just the plain old obvious: are you still having regular periods. Now new blood tests may be what you need to determine if you have any ovarian reserve, or to put it bluntly, do you have any eggs left. So you may need a series of measurements. One set is really not enough, and beginning these tests in your 30s may help them be more useful.. One random blood test is just not enough to say where you are in the menopausal process. Just like you can’t say if a kid has grown just because they seem tall in their class, you have to know what the height was at the beginning and the end of that school year. Two tests that we now use are FSH, and AMH (some doctors also use inhibin B, it wasn't endorsed by the recent committee opinion). If you know your basal (at the point you are starting to look)  FSH and anti-mullerian hormone (AMH) levels and  then your later levels, you may have a clue. Otherwise there seems to be a pretty big variation in what levels are associated with some fertility. and if you have to do IVF the physicians need to harvest many more eggs than you need for a spontaneous conception. Theoretically we can get pregnant with only one egg being ovulated, but for IVF the reproductive team may prefer to have 10 or 20 eggs to pick from.  Once done with birthing children, if having a hysterectomy some gynos have suggested that measuring the age of your ovary may help to plan whether to keep your ovaries or not. An old ovary with not many fertile eggs has less a role in your total health than an ovary that is quite fertile still.There are other endocrine organs aging as well, and perhaps you need those tests at the same time.

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Thank you for your comments and questions. This blog is not intended to replace medical care, but is informational only. We hope you will become a follower or visit Womens Health Practice. We offer a variety of unique services including MonaLisa Touch, Coolsculpting, Labiaplasty, and Gynecoloigic Clinical Research Trials. For more information on menopause see http://www.amazon.com/Menopause-Make-Peace-Change

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