Is life still good after 35?
Fertility test: how many eggs are left?
Professor Nawroth, it is said that women run out of eggs at some point. Is that correct?
Yes, the egg supply is finite. Although there were studies a few years ago that suggested the opposite, the body does not produce egg cells as far as we know today. They are created in large numbers in the female fetus. Part of it dies before birth, and it continues after birth. From puberty onwards, women have a certain number of cycles until the eggs are used up. That can happen at different speeds.
Can a doctor tell how many eggs a woman has left?
The current ovarian reserve can be determined most precisely by counting the follicles in the ultrasound and determining the anti-Müllerian hormone (AMH) in the blood. The two values show whether a patient has an egg reserve appropriate to her age. That says roughly something about the period of time in which the woman is still fertile.
However, you have to look at the values in combination, because the number of follicles and the AMH value are only meaningful together with the age. For example, if a 30-year-old has no more detectable AMH, her egg reserve will last for around ten years. Then the last menstrual period occurs, the menopause. For a 35-year-old without any detectable AMH, it will only last about six years.
This time span should not be confused with your current fertility - these two things are very often mixed together.
What's the difference? What is fertility?
Fertility is the chance of getting pregnant right now. It has nothing to do with the number of remaining eggs, but more with their quality, and that depends primarily on age. If one woman has only a few eggs left and another has a large number of them, it is still possible that both of them will get pregnant at the same rate.
What do you think of fertility tests that determine ovarian reserve?
Many laboratories and doctors offer such tests, but their content does not make sense. They try to provide information on fertility regardless of the question. Thats not OK. If a 40-year-old has great AMH, it doesn't mean she's particularly fertile or has a long time to have children. Because: Because of the age of the 40-year-old, around 60 percent of the egg cells that ovulate have abnormalities in their genetic material. This reduces the chances of pregnancy and increases the rate of miscarriages.
If the AMH value is low, however, the test evaluation often contains a text module such as "If the AMH value is less than 0.1 ng / ml, pregnancy is no longer possible." That is wrong and only leads to uncertainty. A low AMH level alone does not rule out pregnancy.
What is the purpose of determining the egg reserve?
It is important, for example, in fertility treatment: the hormones that are supposed to stimulate ovulation are dosed according to the level of the AMH value, among other things. The values also help to estimate the number of egg cells to be expected in the case of artificial insemination or social freezing. If the AMH is low, fewer eggs will be obtained. Before chemotherapy, for example, if the woman is considering freezing egg cells or ovarian tissue, the ovarian reserve is determined in order to be able to assess the functional state of the ovaries. On the other hand, we mainly advise on fertility based on age: the quality of the egg depends on it.
Do women have to pay for the examination themselves?
In the case of fertility treatment, the health insurance fund usually pays. If the examination is carried out at her own request without any understandable medical reason, the woman has to pay for it herself. It is also used, for example, to find out whether the menopause has already started and the woman no longer needs to use contraception. But even there these tests make no sense: If bleeding still occurs without hormone-containing drugs, there is basically still a chance of pregnancy, the level of which can be predicted without hormone tests depending on the age. If the woman is currently taking the pill, the AMH value is difficult to interpret anyway because it drops by up to 30 percent.
Can women maintain their fertility longer?
A healthy lifestyle can help you maintain fertility for longer. It can't go back up, but lifestyle affects how quickly it goes down. Fertility can only recover after chemotherapy - but this is an exceptional situation.
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