The majority of us don’t ever really start to obsess about the quality and quantity of our eggs until we start to think about having a family in our thirties. Most of us understand that we are born with all of our eggs, but that is about it. It is only when we are faced with infertility, that we begin to realise how important those tiny, precious little oocytes are and how quickly they are diminishing!
We wanted to really get our head around the importance of understanding egg quality and quantity, so we turned to the embryology team at IVF Spain and asked them to answer our questions.
What is “egg count” and how does it affect fertility?
Well, first we need to go right back and tell you that a baby girl growing in her mother’s womb has an incredible 5-6 million eggs! By the time she is born, 80% of the eggs will have already diminished down to 2-3 million. She will then lose upwards of 1,000 eggs per month until menopause, with the rate of loss increasing after 35. As each day passes, your eggs will continue to age, just as you do, and sadly, as they age, the chances of them producing a baby will decrease.
When you realise that trying to conceive is going to be harder than you thought, you immediately want to know how many eggs you have left. How do you test this?
The AMH test
AMH stands for the anti-müllerian hormone (AMH) and is secreted by the oocytes (eggs).
By testing this hormone (with a blood test), it gives the doctor an approximate idea of the amount of viable eggs left in the ovaries of a patient. AMH does not determine the egg quality. By evaluating ovarian function and ovarian reserve, the doctor can offer the patient the right treatment to maximise the chances of achieving a pregnancy.
The production of anti-müllerian hormone progressively decreases with age, and this decrease is an indication that the ovaries are aging.
A normal AMH level is one that sits within range
It is very important to remember though that a reference range can vary between clinics, so make sure you speak to your consultant to fully understand the results of your AMH test. But here is a guide:
AGE AMH level (pmol/l)
20-29 years 13.1 – 53.8
30-34 years 6.8 – 47.8
35-39 years 5.5 – 37.4
40-44 years 0.7 – 21.2
Ovarian fertility potential pmol/l
High: 40.04 – 67.9
Satisfactory AMH: 21.98 – 40.03
Low AMH: 3.08 – 21.97
Very low AMH: 0.0 – 3.07
Antral follicle count
An antral follicle count is a transvaginal ultrasound that allows your doctor to visually count the number of active egg-containing follicles that are developing on both of your ovaries. With this count, your doctor is able to estimate your total egg count.
Are these tests a real indicator as to whether or not you will get pregnant using your own eggs?
Not always. We have encountered cases where the AMH was normal, but the ultrasound did not show many active follicles. In contrast, we have also encountered cases where the AMH was low but the ultrasound showed an acceptable number of follicles to start treatment, which was then carried out successfully.
On too many occasions, we hear from patients who have been given a diagnosis of a low AMH and are told that they will need to use a donor egg. However, it is important to understand that the reproductive capability with a patient’s own eggs is not solely down to the AMH level.
For patients with a low AMH we carry out other tests, for example ultrasounds in successive follicular phases of the patient that allow us to find the ideal time to start treatment, that is, a time when the ultrasound shows enough active follicles to start the stimulation.
Furthermore we have mastered follicular pre-activation techniques and other resources that improve egg quality, and of course we rely on other tests that help us determine other equally important factors for achieving a pregnancy, such as the genetic viability of the embryo, the endometrial receptivity and immunity.
As experts in reproductive medicine and fertility we would like to advise patients not to get too obsessed about the AMH level.
When we talk about egg quality, we mean whether or not the egg is genetically normal (euploid) or abnormal (aneuploid). A good quality egg should contain 23 chromosomes. However, as a woman gets older, more of her eggs have abnormal chromosomes, which is a major cause of miscarriages, IVF cycle failure or genetic disorders such as down syndrome. These abnormal eggs are just not able to fertilise and develop correctly.
Is there a test for egg quality?
Sadly there isn’t a way to assess egg quality, but we know that the quality lessens as the woman ages.
When are your eggs ‘in their prime’?
Women have the highest number of good quality eggs and are most fertile in their 20s, which is quite annoying to hear, as your twenties are when you are just starting to explore life. Your twenties are for starting careers, travelling, having fun – for many of us, starting a family is usually on the agenda once we hit our thirties. However, if you are reading this as a woman in your thirties or forties, please do not think you no longer have a chance of achieving a pregnancy.
Are there any symptoms of the declining of the ovarian reserve?
Unfortunately, when symptoms appear, many times the reserve has diminished. Most women never even notice the changes.
Some of the possible symptoms that a woman can exhibit are a shortening of the cycle. If the woman normally has a 28-day cycle, sometimes, over a few months the number of days can decrease to 26, 24 and even down to 21 days. This is a sign of a declining reserve.
Other times a woman may have hot flashes, insomnia and sometimes will even miss a period. These signs are typical of perimenopause.
Can a woman improve the quality of her eggs by making lifestyle changes?
Even with a low ovarian reserve, fertility treatments can be successful in achieving pregnancy. There are also things you can be doing to maximise egg quality and improve your fertility. A well-balanced diet, not smoking, proper exercise and maintaining your weight in the normal range (BMI 18 to 24.9) are the best preparations you can make.
As annoying as this sounds, try and manage your stress levels, if you can, as stress can produce hormones such as cortisol and prolactin that can interfere or halt ovulation, which also hinders egg production.
Stay hydrated too, as good egg health is aided by oxygen-rich blood flow to the ovaries. Staying hydrated will maintain this blood flow, as will yoga.
If you have any further questions about understanding egg quality and quantity, then please do get in touch, at firstname.lastname@example.org, or reach out to the clinic at IVF Spain directly.