Your diagnosis
The Importance of Ovulation and Egg Quality
If a patient has normal menstrual cycles, it is typically assumed that she ovulates. If there are cycle alterations, such as menstrual delays or irregularities, there may be an ovulatory problem. An ultrasound and a hormone analysis can help the doctor make a diagnosis.
Depending on the type of polycystic ovaries, a certain treatment will be necessary. When the patient is overweight, the first step would be dietary measures. Otherwise, treatment involves inducing ovulation with subcutaneous injections of FSH (follicle-stimulating hormone), monitoring follicular development with ultrasound and timing sexual intercourse to coincide with ovulation.
This condition is caused by an excess secretion of prolactin, the hormone that causes milk production, putting the patient in a state similar to lactation. It can be treated with medication.
It is important to note that in patients who are over the age of 35, egg reserve starts to decline. At this age, only about 10 % of eggs remain.
The quantity and quality of the ovarian reserve decrease with age and ovarian age does not always match biological age. The initial number of follicles a woman is born with is fixed (unlike men, where sperm are produced throughout their life) and as the years pass, the number of eggs that can be fertilised correctly and lead to a full-term pregnancy, decreases.
To assess the ovarian reserve, a transvaginal ultrasound with antral follicle count (AFC) is performed in the first days of the cycle and an analytical determination of anti-Müllerian hormone (AMH) levels is done, which can be performed at any time during the ovarian cycle. This is obtained from a simple blood test, the results of which are compared to those established as normal for each age.
AMH is a hormone that assesses a woman’s fertility. Previously, values from analyses of women on other continents were used for reference. However, due to a study conducted by Institut Marquès, we now have specific values for the Spanish population, allowing for a precise evaluation of fertility for women in Spain.
Any woman can find out about her ovarian reserve firsthand thanks to useful and easy-to-use tables created by Institut Marquès, which anyone can download here.
Although the study was only conducted with Spanish women, with 10 443 participants aged 20 to 45, the results are believed to be closer to the European population than the American or Asian tables used previously.
The study, published in the journal of the Spanish Society of Gynaecology and Obstetrics (SEGO), shows significant differences compared to data from other countries as well as between Spanish autonomous communities, although no pattern can explain these differences.
Other analytical parameters to consider are basal hormones (FSH, LH, and oestradiol) present on the second or third day of menstruation.
If hidden ovarian failure is diagnosed, the treatment will be In Vitro Fertilisation with donor eggs.
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