Women today need to play multiple roles according to the demands of society. They need to be independent in today’s world , manage their career and also at the same time fulfill their reproductive commitments. The knowledge that fertility declines with advancing age is important so that they complete their family without having to go through extensive and expensive fertility treatments in future.

The ovarian reserve simply describes the number of eggs remaining in a woman's ovaries at that point of time.

Women are born with fixed number of eggs. These are approximately in millions at birth, many of these are lost during childhood. At puberty only 3-5 lakhs are left. During every menstrual cycle 10-30 eggs are recruited for growth on daily basis but only one becomes mature for fertilization. The rest die off resulting in loss of hundreds of eggs every year. Also not all eggs are of same quality. Many of them are genetically abnormal and will either not fertilize or will result in abnormal embryo.

Scenario in Indian women compared to Western

Indian women attains menopause around 42 to 45 years when compared to Western average of around 55 yrs. As compared to the western women fertility declines faster in Indian women.

Symptoms of diminished ovarian reserve

• Difficulty getting pregnant
• Late or absent menstrual periods
• Shorter menstrual cycles than average 28 days
• Miscarriage

Factors accelerating decline in  Ovarian reserve

• Age - The quality and quantity of eggs decline with age.
• Previous history of Chemotherapy and Radiation for cancer
• Obesity (BMI Higher than 30)
• Surgery on ovaries for Ovarian cancers, endometriosis, large cysts, excessive drilling in PCOS. 
• Smoking, Alcohol, Exposure to toxic chemicals.
• Auto-Immune disorders
• Genetic abnormalities
• Unexplained

Treatment: 

No treatment can improve Ovarian reserve but Quality of eggs may be improved by Diet, Exercise, life style modifications, Anti-Oxidants and Multivitamins.

Complimentary Therapies - Acupuncture, Yoga and Meditation.

In extremely low AMH - oocyte donation is an option.

There are some Ovarian Reserve tests which correlates with the fertility status of a women. These tests are available in Fertility Centres.  The purpose of Ovarian Reserve testing is to accurately evaluate a couple’s chance of success with fertility treatments, particularly IVF. One can consult a Fertility Specialist who can guide based on the test results whether one can postpone the pregnancy or prioritise it. These tests needs to be repeated every year as there can be drastic decline in some cases due to various reasons.

Single women with accelerated decline of ovarian reserve can opt for oocyte freezing as a method of fertility preservation.