World Ovarian Cancer Day 2021: An expert throws light on the understanding of Ovarian Reserves

Ovarian cancer seldom shows any major symptoms; this can result in late diagnosis, hence, causing complications during the treatment process.
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Females have a pair of glands, called ovaries, that are laden with eggs, which when fertilised by sperm can form an embryo. Throughout their lives, ovaries help maintain levels of different hormones such as oestrogen and progesterone that are key to maintaining homeostasis. The organ, however, is also susceptible to diseases such as cancer. Ovarian cancer seldom shows any major symptoms; this can result in late diagnosis, hence, causing complications during the treatment process.

World Ovarian Cancer Day is observed on May 8 to spread awareness about the organ and the disease. In line with the same, let’s delve into ovarian reserves, how it is an important fertility indicator, and what aspiring mothers with ovarian cancer can do to preserve their fertility.

What is ovarian reserve?

In brief, ovarian reserve is the number of viable eggs present in the ovaries at a given time. The pair of ovaries are the primary organs of the female reproductive system responsible for producing an ovum, otherwise known as the ‘egg’. Females are born with about a million immature eggs or follicles. Before puberty, ovaries are just long bundles of tissues present in the body; they age and mature with time. By the time the female matures sexually, the follicles in the ovaries are reduced to about 300,000. The number of follicles continues to decrease progressively until the female reaches the age of 35, after which there is a sharp decrease.

With advancing age, the number of eggs that have the potential to impregnate the female declines, highlighting the inverse relationship between age and female fertility. It’s not just the quantity that goes down with the maternal age it’s also the quality of the eggs. Ensuring a healthy lifestyle by keeping a check on one’s physical and mental wellbeing can help extend the window. If the quality and quantity of eggs are not adequate, natural conception can be challenging.

How can you check your ovarian reserve?

There are several tests available that can assess a woman’s fertility potential or ovarian reserve. This can be done either by counting the number of eggs present or by estimating their quantity basis hormonal levels. Females can take tests measuring Follicle-Stimulating Hormone (FSH) and Antimüllerian hormone (AMH), or taking the clomiphene citrate test – all testing for hormonal levels. Ultrasound is an imaging technique that can assess antral follicle count, that is, check for the number of viable eggs, or testing the response to hormone medications such as gonadotropins. These tests can also help in diagnosing Diminished Ovarian Reserve or DOR. It occurs when a female’s ovaries have lost their reproductive potential, causing infertility. Generally, DOR has been observed in females nearing menopause but the rate of decrease differs from case to case. DOR can also be caused by genetic abnormalities, ovarian surgeries, lifestyle factors, aggressive medical treatments or injuries and sometimes it can even be idiopathic. 

The results of these tests help specialists to determine proper treatment and medication plan which can result in a successful conception. Although there are no definite treatment options available to cure or reverse DOR, Assisted Reproductive Technologies (ART) such as in-vitro fertilization (IVF) can be recommended to become pregnant.

Preserving fertility in ovarian cancer patients

The technique for preserving fertility in people affected by ovarian cancer varies from person to person – this depends on the kind of cells that are cancerous, when the disease was detected and how much it has spread in either or both ovaries, and the treatment suggested. If the disease is discovered early on, egg freezing is a champion technique that can safeguard eggs that can be collected before starting with treatments such as chemotherapy. Alternately, modern medicine has found ways to develop germ cells, which are primordial, basic entities, into eggs. Eggs obtained by these methods can be used by the female herself after the disease has been conquered; IVF becomes integral here.

In case of an advanced prognosis, the uterus may also be compromised, thus, leading to the surgical removal of ovaries and the womb. Here, surrogacy can help.

No matter what the extent of the spread is, it is imperative that women with ovarian cancer have conversations with doctors about their aspirations and motherhood dreams.

About the author: Dr Kshitiz Murdia, CEO & Co-Founder, Indira IVF

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