Ovarian reserve

Ovarian reserve is a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization resulting in a healthy and successful pregnancy. With advanced maternal age the number of egg cell that can be successfully recruited for a possible pregnancy declines, constituting a major factor in the inverse correlation between age and female fertility.

While there is no known method for assessing the ovarian reserve of individual women, indirect determination of ovarian reserve is important in the treatment of infertility.

The ovary is generally thought of as an egg bank from which the woman draws during her reproductive life. The human ovary contains a population of primordial follicles. At 18–22 weeks post-conception, the female ovary contains its peak number of follicles (about 300,000 in the average case, but individual peak populations range from 35,000 to 2.5 million).

The size of the initial ovarian reserve is strongly influenced by genetics. Also, elevated androgen levels during prenatal development have an adverse effect on the early establishment of the ovarian reserve.

Each menstrual cycle one egg cell is released by ovulation. In addition, the remaining follicles that were recruited towards maturation are lost by atresia. Few if any egg cells are replenished during the reproductive years. However, this loss by the menstrual cycle only accounts for approximately up to 10 egg cells per month, thus accounting for only a small fraction of the actual loss of egg cells throughout the lifetime.

One additional contributory mechanism for the decline in the ovarian reserve with age appears to be a decreased gene expression of proteins involved in DNA repair by homologous recombination such as BRCA1, MRE11, Rad51 and ATM.

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