Friday, 29 August 2014

Why do women end up having poor quality eggs , leading to infertility?

Dr. Anita Mani
anitadane@gmail.com
Infertility& Surrogacy Specialist at Gift IVF Centre




There are no visible symptoms which can tell that your eggs are diminishing in quantity and quality, but in some women periods become less frequent , or scanty. The factors which leads to poor egg quality are explained below.

Age
Women are born with a fixed number of eggs, about one million eggs. As the  years pass, the number and quality of the eggs diminish and eventually gets depleted. With age, a women’s fertility declines. So the chances of  conceiving will go down after the age of 30 and will considerably reduce after the age of 40. These aged eggs may have chromosomal defects which will result in unhealthy embryos. The incidence of downs syndrome is considerably high in older women. The miscarriage rate is also more due to the  same reason .

The trend of late marriages and postponing pregnancy for a long period even after marriage is one of the major causes of infertility. 




Genetic 
Sometimes chromosomal abnormalities can also play a role in the  poor quality eggs. 
Turners syndrome patients do not have ovulation , as they have only streaked ovaries.
Donor egg treatment is a very good option for them.


Diet 
Poor diet may result in nutrition deficiency , which can reduce egg quality, as the fluid surrounding the egg and the granulosa cells ( surrounding cells supporting the egg)  , need optimum amount of nutrients  to make egg fertile. Intake of antioxidants like decaffeinated green tea  has been found to boost fertility. Taking plenty of fruits and raw veggies will provide vitamin c and vitamin E , which are crucial vitamins for enhancing .
fertility.

Exercise 
Excessive exercise can have a negative effect on fertility,  but moderate exercise forms like 30 minutes brisk walk  daily , can increase blood circulation and increase the egg quality .
Yoga is an excellent choice to elevate the  egg quality.

BMI
Optimal BMI has shown to have better success during IVF , with better quality eggs and embryos. It is worth trying to keep weight optimal .


Stress
Any form of stress reduces the  chance of conceiving , as adrenalin is antagonistic . The average age of menopause is coming down every decade with increasing stress in women. We are seeing many working women patients , going thru premature menopause .

Smoking / alcohol
Even passive smoking reduces chance of IVF success by one third  and the same happens with natural cycle. Alcohol intake is also unadvisable  to women and has to strictly avoided.


Medical diseases
Diabetes is a very common condition which deteriorate the egg quality and due to this reason, we see very poor fertilisation rates of eggs in diabetic patients. Disorders like autoimmune thyroid diseases adversely affect fertility , as the level of anti thyroid antibodies in follicular fluid surrounding the egg will be high , reducing the chance of fertilization.Antiphospholipid syndrome is seen in Upto 30 % of infertile women .Renal failure can cause ovarian failure. Pituitary tumours can impair fertility.


Drugs/ medicines
Certain medicines taken for treatment of epilepsy and  hypertension, can impair fertility. Medicines like aspirin , sildanafel , heparin etc can increase blood circulation to ovary , and thus the egg quality and number is diminished .

Gynaecological disease
Diseases affecting ovaries , endometriosis is known to be the  top most culprit in damaging the ovarian structure and the outcome is reduction of follicles .In PCOS , Follicles  often get arrested half way in development and doesn't develop into  mature follicles .Ovarian cancer can damage ovaries resulting in infertility.

Radiation
Exposure to X-rays and radioactive elements and radiotherapy will significantly  damage the  eggs causing genetic mutations , often the repercussion is abnormalities in babies born to them .The effect of Hiroshima and Nagasaki bombing are still haunting  in the form of many abnormalities .





Chemicals 
Insecticides like endosulphan  deteriorates the  egg quality and aftermath is  still birth,  miscarriages, IUD, abnormal children or infertility in women.

Chemotherapy

If chemotherapy is administered for treatment of any form of cancer , it can affect the ovarian function , and many a times  result in total ovarian failure . Hence the  option of egg or ovarian tissue freezing  should be considered before starting chemotherapy.

Surgery
Ovarian cystectomy performed for endometriotic cyst ( chocolate cyst ) may involve removal of ovarian tissue or destruction of ovarian tissue follicles because of cautery used . This can result in loss of follicles. Removal of ovary for malignancy , torsion , or for cysts will reduce the follicles to unilateral ovary , but single ovary is enough for pregnancy.

Investigation
The infertility work up to find out fertility includes  tests to determine the quantity and quality of ovarian reserve by doing antral follicle count and checking blood level for  FSH, LH  and AMH levels .



It is better not to  post pone pregnancy for too long .After 40 the success rate in IVF is also very low. In case there are not enough good quality eggs, IVF using donor eggs can be performed .


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