11 Questions to Increase Egg Reserve and Quality

A woman's egg reserve decreases with age.

A woman’s egg reserve decreases as she ages. In addition to the number of eggs, which is crucial for conceiving, the quality of the eggs is much more important, and egg quality also decreases with age. Anadolu Medical Center’s IVF Center Director Assoc. Dr. Tayfun Kutlu and Obstetrician, Gynecologist, and IVF Specialist Dr. Ebru Öztürk Öksüz provided answers to frequently asked questions about egg reserve in women.

How many eggs does a girl have at birth on average?

When a baby girl is born, the number of eggs in her ovaries is around 1.5 to 2 million. This number decreases by the time she reaches puberty and drops to 300-400 thousand. Women ovulate each month as part of their menstrual cycle. During their fertile years, the egg count is around 300-400 thousand. Each month, some of these eggs are used, and when the eggs run out, the menopause process begins.

Why does egg reserve decrease over time?

Each month, around 1,000 eggs begin to mature, but not all of them make it. Usually, 1 or 2 eggs lead the process and prepare to ovulate. Women are born with 1.5 to 2 million eggs, but they lose around 1,000 eggs each month. However, not every woman is born with the same number of eggs or enters puberty with the same count. Therefore, differences in fertility durations are observed among women.

What factors affect and accelerate the decrease of egg reserve?

There are many factors that influence this decrease. Firstly, the number of eggs a woman is born with plays a significant role, which can be considered somewhat of a genetic luck. If a woman is born with more eggs, her fertility can last longer even though she loses eggs over time. However, factors like smoking and stress can also reduce egg reserve. Additionally, it is well-known that egg reserve decreases with age. Any surgical operation that affects the ovaries, any medication that impacts ovarian tissue, can also reduce egg reserve. In some systemic diseases like cancer, the use of chemotherapy and radiotherapy agents can reduce the most sensitive cells in the body, significantly shortening fertility duration.

At what age does the decrease in egg reserve accelerate?

In the past, 40 was considered a risky age, and it was said that egg count drops sharply after the age of 40. Over time, we have accepted that 37 is a more risky age. Looking at global data, we can now say that egg reserve decreases more rapidly after the age of 35. Not only does the number of eggs decrease after 35, but egg quality issues are also becoming more prominent at younger ages. Therefore, it is advised to act more quickly when trying to conceive after the age of 35.

Compared to 10 years ago, we are now seeing much more serious egg reserve depletion and early menopause risks. The percentage of this occurring in society has increased significantly. As a result, it is recommended to try to have a baby before turning 35.

What are the reasons for rapid decrease in egg reserve?

If there is a family history of early menopause, especially from maternal relatives such as the mother, aunt, or sister, it is important to be cautious about genetic factors. This could indicate a genetic predisposition to lower egg reserve in that family. Women who have systemic diseases like cancer and require chemotherapy may also need to have their egg reserve evaluated beforehand, and if necessary, have their eggs frozen for preservation. Such treatments are significant factors that can severely reduce egg reserve.

Smoking and dietary conditions are also crucial. We emphasize the importance of healthy eating and staying away from smoking. Ovarian cysts or any other problems in the ovaries that may require surgery are among the biggest issues for women.

What should be the ideal egg reserve?

How many eggs should there be in the "egg reserve" to conceive? Can a number be given? We are looking for an answer to this question. In fact, one egg is enough to have a child. It is entirely about the quality of that egg, the woman’s fertility, and the ability to form a good embryo from that egg. Essentially, for conception, one egg and one sperm are sufficient. Therefore, women with very low egg reserve can still conceive naturally. However, waiting can be a bit risky since there is a chance that the eggs may completely deplete. That's why we quickly move to effective treatments in these cases. The more eggs we collect, the more beneficial the treatment will be.

It would not be accurate to say, "This many eggs are needed for pregnancy." However, the more eggs we have, the better for pregnancy. The more high-quality eggs that are fertilized with sperm, the more embryos we have, which gives us the chance to select the best ones, freeze them, and store them for future pregnancies.

When does this reserve become "insufficient" for motherhood?

It is important to evaluate a patient with low egg reserve as a whole. Factors such as how long the woman has been married, how long she has been trying to conceive, and the sperm quality of her partner must be assessed. The approach to a 20-year-old patient with low egg reserve is not the same as to a 40-year-old. A 20-year-old woman with low egg reserve who has been married recently might be evaluated with a few months of egg monitoring, but for a 40-year-old, more radical treatment decisions may be required. It is essential to evaluate the patient's fertility period very well and not waste time.

What are the symptoms of low egg reserve?

By counting the number of eggs in the ovaries through ultrasound, we can determine whether the egg reserve is appropriate for the patient’s age. We also have supporting hormone tests. Among these, the Anti-Mullerian Hormone (AMH) is the most important. If AMH is properly assessed, it can give us reliable results regarding the egg reserve. Additionally, FSH and E2 values must be evaluated together on the second or third day of the patient’s menstrual cycle. All these tests and checks give us information about the patient's egg reserve.

What precautions can be taken to prevent rapid decrease in egg reserve or deterioration in egg quality?

There are many factors we cannot control. We tell patients to "stay away from stress," but in today’s living conditions, especially for working women, it’s not an easy task. However, exercising may not increase the number of eggs, but it does improve their quality. It increases the oxygen levels in the tissue and reduces stress, which undoubtedly contributes to better egg quality. There are factors in our lives that we can change and some that we cannot. Healthy eating, regular exercise, a protein-rich diet, not smoking, and especially after the age of 40, using antioxidant medications under the guidance of a doctor can positively affect the egg quality we achieve in the egg reserve.

Is egg quality more important than the number of eggs?

Absolutely. The most important factor is egg quality. The significance of egg reserve, or egg count, is how much time we have for the process and how comfortably we can move forward. In terms of pregnancy, having 2 high-quality eggs is always preferred over 10 low-quality eggs by any doctor.

The reduction in egg count serves as a warning; it's not just the number but also the age that matters. In fact, age is the most important factor. All of these factors can either decrease or increase the chances of pregnancy. For example, if you are 40 years old and have a good egg reserve, it doesn't mean you can delay pregnancy. Age negatively affects egg quality. Therefore, when making an assessment, many factors need to be considered together. Egg reserve, age, the length of the marriage, how long they have been trying for a child, any underlying medical conditions, surgeries, previous pregnancies, and sperm quality are all factors that need to be considered. Every patient should be evaluated as a whole. It’s not just the egg reserve; every factor can change the approach to treatment.

What is the healthiest age for childbirth?

We can say that the age range of 25-35 is the best for childbirth. Even if we don’t accept it, we begin to age. Our metabolism starts to slow down. Couples who want to have children should definitely take age into account.