Determining Your Ability To Still Have A Baby

Many women successfully get pregnant with their own eggs and have children in their 40s. 

We are born with 2 million eggs (1-4 million probably). We ovulate 400. Our eggs die at a predictable rate that is determined by genetics and other factors. 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. Some women become infertile in their mid 30s. Since the age at first birth in the USA is now 30, it is important to discuss fertility with our young patients so that they can plan pregnancies with an eye to this! We know that 1 in 5 women has not yet attempted to have a baby by age 35, so with the ages of motherhood and menopause potentially colliding, we have a lot to discuss!

Ovarian age testing is usually about getting pregnant, however, for those who have symptoms of hot flashes testing may be indicated for those wondering how close they are to menopause.

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, smoking, and ovarian surgery. Low vitamin D may also affect your test level.AMH testing is now used before and after cancer treatments to determine the effect of the treatment on a young woman's fertility.

 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. But it can change the numbers on your tests, especially AMH

Gynos use an FSH test (pituitary hormone), and estrogen test (of the estrogen made by the follicles of the ovaries, and an AMH test (anti-mullarian hormone, also made by the follicles) to determine the fertility level. The normal values of these tests varies depending on many factors that include age and the time of the cycle. If you have recently been on pills you may not be able to rely on the levels in the AMH test for 3-4 months. If you have a value of AMH from 5-10 and you are over 42, you have a 75% chance of being in menopause within the next two years. If your AMH value was actually over 30 you only have a 2.5% chance of being in menopause by the next two years. 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 at an abnormal rate. 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. We as a society haven't decided how to best use ovarian age/ovarian reserve testing, but some argue that each woman has a right to know that this testing is available.

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 how fertile you are so that we can advise about diet, exercise, bone and heart health. How a gyno determines 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 at the time of an ultrasound (usually done early in the cycle) 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.

PCOS patients may have abnormal AMH levels

PCOS is well understood from the standpoint of what happens, the genetic component is also understood, but the real biology or what doctors call 'pathobiology' is not well understood. The newest theory has to do with abnormal AMH levels. And many are using AMH testing of indicative of PCOS. 

Repeat testing of ones ovarian age may be indicated.

 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 at least 4 and others in the past said they would like 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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