It is known that while women are still in their mother's womb, the eggs they will use throughout their lives develop and they are born with them. Afterwards, there will be no new egg production.
It is a normal and physiological process that the number of eggs in the ovary decreases with increasing age. The number of eggs that a girl has in the womb at the age of 5 months is approximately 6-7 million, this number decreases to 1-2 million at birth, gradually decreasing in childhood and ovulating one egg per month from adolescence, this decrease continues until menopause, consuming an average of 350-400 eggs per month. These eggs are stored in fluid-filled spaces called follicles within the ovaries. When the little girl enters the reproductive age, monthly menstrual cycles begin. During each cycle, the ovary develops an egg. Rarely, there may be more than one. If this egg combines with the sperm cell from the man, pregnancy occurs. A woman's chances of getting pregnant are actually highest around the age of 25. The pregnancy rate decreases with age, and this decrease accelerates after the age of 35 and decreases significantly after the age of 40. Even for women who have had children before, becoming pregnant becomes almost impossible after the age of 45. Personal differences will of course play a very important role, but in general, even if in vitro fertilization treatment is performed after the age of 45, the pregnancy rate is below 5%. Decrease in ovarian capacity and therefore loss of reproductive function is not the same as menopause. The woman may menstruate, but her chances of becoming a mother have decreased. The answer to the question of why I am still menstruating and why I cannot have children lies in this physiology. Women with a family history of early menopause need to be especially careful. In these women, ovarian capacity is exhausted earlier. There may be difficulties in having children approximately 10 years before the genetically programmed menopause age. For example, a woman who will enter menopause at the age of 40 will have difficulty having children from the age of 30. For this reason, women, especially those whose mothers and sisters have premature menstrual periods and early menopause, should not postpone becoming mothers.
Apart from advanced age and genetic effects, other factors that may cause an early decrease in ovarian reserve are:
1. Endometriosis itself and chocolate Cysts can affect ovarian reserve and pregnancy capacity through various factors. 2. Previous radiotherapy and chemotherapy: Especially the fact that teenage cancers have become treatable has caused reproductive problems to be seen more frequently in those who survive.
3. Previous ovarian surgeries: No matter how carefully the ovarian cyst removal surgery is performed, the capacity will decrease as it will reduce the number of eggs. especially chocolate known as cyst endometriosis Removing cysts may reduce ovarian capacity on that side. It is essential that such surgeries be performed by competent surgeons and with maximum respect for normal tissues. This issue can sometimes be a disadvantage in laparoscopic operations. Especially for those with bilateral dermoid or chocolate cysts, the issue of open surgery and maximum care for the tissue should be well discussed with the physician.
The logic of success in in vitro fertilization applications is largely related to the number of eggs collected. Apart from very extreme numbers, the ideal is to try to obtain 5 or more eggs. According to research, when fewer than 5 eggs are obtained, the chance of selection decreases and pregnancy rates may be lower than expected. In women with a small number of eggs collected, drug therapy changes often do not provide a significant advantage. In women who have had long protocols (lucrin and similar drugs) in their previous treatments, different drugs called short protocols can be tried. While sometimes a partial increase in the number of eggs can be achieved by increasing the drug dose, this increase is not actually reflected in the pregnancy rates as desired. There are studies showing that the number of eggs can be increased in women with poor ovarian response by using the drug called Clomiphene, which has been used for a long time, and treatments called aromatase inhibitors, administered in pill form. Studies have also been published showing that ovarian response improves with acupuncture. If none of these provide benefit, drug-free treatment, which we call natural cycle, can also be tried.
Can a woman produce new eggs?
Contrary to classical information, new studies have shown that there are also stem cells in women's ovaries. Studies on new egg production and pregnancy using these cells are carried out in experimental animals. Thus, we hope that in the very near future, women with reduced ovarian reserve will also have the opportunity to become mothers.