Women in their late 30s to mid 40s can face age-related fertility problems. Poor ovarian reserve and poor egg quality are common diagnoses for this population of women who seek help for fertility. When a woman hears she has diminished or poor ovarian reserve, she feels a sense of dread and fear that her chances of getting pregnant are now over. But is this really the case and is there room for hope?
With acupuncture and Chinese medicine there is always hope as the main philosophy of our medicine embraces the idea of the body's innate ability to heal itself. One of the goals of a fertility treatment with acupuncture and Chinese herbs is to improve the whole health of a patient; to improve the internal environment and thus improve the body's function.
This concept of improving the internal environment to improve pregnancy rates is mirrored in scientific research that appeared recently in Reproductive Biology and Endocrinology. In this study, Gleicher (1) states that the term poor ovarian reserve does not reflect the true state of a woman's overall potential to have a baby. Based on his research, he is of the opinion that a woman's eggs do not age, as previously thought, rather the ovarian environment ages and it is this decline in the function of the ovaries that affects the quality of the eggs.
Unlike men, who create new sperm every 90 days, women are born with all their eggs that have the potential to become a baby. The majority of these eggs are called primordial follicles. They are in a dormant state until puberty is reached when a woman starts releasing an egg each month (ovulation) and having periods. Between puberty and menopause, primordial follicles remain in this dormant state until activated to start the maturation process on the way to ovulation.
Once activated, the primordial follicles, (also known as non-growing follicles (NGFs) go through around four months of maturation. Many follicles are recruited to go through this process at the same time. One becomes dominant and will ovulate while the others die off.
When primordial follicles enter aging ovarian environments, it stands to reason that, compared to younger ovaries, problems with the maturation and development process occur that effect both the number of eggs reaching maturity as well as the quality of the eggs and, ultimately, their chance of becoming a healthy embryo.
Fertility tests to assess ovarian reserve are not able to calculate how many primordial follicles a woman has left. They are only able to look at the eggs that are in this maturation process. High FSH (follicle stimulating hormone), low AMH (Anti-Mullerian Hormone and low AFC (Antral Follicle Count) are indicators that the ovarian environment is aging and the eggs in this four month maturation process are less capable of being fertilized. These tests are not the final word on a woman's chances of getting pregnant and should not be seen as such.
So how can you improve the ovarian environment and increase the chances of getting pregnant? In his work, Gleicher uses DHEA to improve the ovarian environment. How it works is not clear but he has seen increased pregnancy rates in women with poor or diminished ovarian reserve. Acupuncture and in particular, Chinese herbs can also be used to improve the ovarian environment and increase the chances of pregnancy. And not only can they improve the ovarian environment, they also improve the overall health so when a woman finally gets pregnant, she is more likely to have a healthy pregnancy and baby.