??????????????♀?, ?????????????? ???? ???????????????? - ???????? ???????????????????? ???????????? ???? ??????????????

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We had couple Mr and Mrs. Sudharani 6 months back approaching one of our GarbhaGudi centre along with her husband. She was 31 and 7 years younger than her husband. They had difficulty in conceiving after 5 years of marriage. When they wanted to consult a doctor, her mother in law had told them not to do so and suggested to try Pooja, Homa, Havana, Astrology, and Alternative medicines, etc. Even in an era of digital transformation and advanced technology, we have challenges like above case where we spent about two hours counselling couple to make them understand – Biological clock?? and it’s challenges. Crazy isn’t it.

On the contrary, life for Indian women has changed in many ways as well. Pursuing our ambition and career is making us postpone our marriages and delay our childbearing. Do we know our biological clock is ticking away, sometimes even ahead of our age. This scenario of ‘early ovarian aging’ is not very uncommon these days where women in their late 20’s and early 30’s confront the shocking truth of prematurely aging ovaries not giving them enough time to settle into their marriages or even plan their pregnancies at their convenience.

Let’s have a look into the above case study in detail to understand better.

???????? ?????????? : Smt. Sudharani (name changed) approached one of our centre along with her husband. She was 31, and 7 years younger than her husband. They had difficulty in conceiving after 5 years of marriage.

When all the medical investigations and scans were done, she was found to have very low reserves in the ovaries i.e very few eggs left in her ovaries. It was also revealed that Sudharani’s mother had attained Premature Menopause at the age of 39 only!

Our doctor explained her that as there was a history of premature menopause in her family, she should be extra cautious and approach for medical advice early if they face difficulty in conceiving. If age is >35 years, it is always recommended to consult a doctor after 6-8 months of marriage as age is very precious for a lady.

She had thyroid problems also, so it was corrected before resorting to other infertility treatments. She was given a few medications & injections for the good egg to develop. She was monitored carefully once in 2-3 days by scans and blood tests. Once the egg developed well, IUI was done and she conceived in the same cycle. 9 months of pregnancy?? was uncomplicated and she delivered a healthy girl child. The entire family was joyful and happy???? about this.

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?????? - ?????????????????? ?????????????? ?????????????? is a condition where a lady has ovarian function stopped before 40 years, it usually happens at 48-52 years of age. Before the stage of ovarian failure, woman will be having poor ovarian reserves in the early 30’s itself. So we should not waste our precious reproductive age without approaching a doctor. Usually, premature ovarian failure runs in the families and as a genetic predisposition. So if your mother has Premature Menopause, you should be extra careful!!

With proper guidance and correct treatment at right time, we can treat POF easily. otherwise, we need to resort to donor egg which many of us may not opt for.

A recently published study in Fertility Sterility 2019 has compared the ovarian function of Indian women and Spanish women undergoing and concluded that the ovarian age of Indian women is 6 years ahead of Spanish women which could further imply that Indian women are at significant risk of running into a considerably shortened reproductive life span and fast-approaching menopause.

An extreme form of ‘early ovarian aging (EOA)’ is ‘premature ovarian failure’ (POF) which is seen in approximately 1% of the general population as compared to 10% of the population of EOA. These women can have irregular periods or scanty and infrequent periods. POF is more difficult to treat than EOA for which most often the available option is ‘donor eggs’. Certain medications like DHEAS used to increase the number of eggs during fertility treatment, is not of much use in this case.

Certain investigations can identify women at risk of advanced ovarian age. These can be blood tests and an ultrasound scan. Of the many blood tests available, serum AMH and basal FSH are the most important. AMH (Anti Mullerian Hormone) is the most sensitive and is a direct marker of ovarian reserve. Note that it may show low values even when your basal FSH is in the normal range indicating that the available number of eggs has reduced to a greater extent already. Basal FSH is an indirect marker and is always done on the second day of the periods. Follicular phase FSH usually ranges from 2.0 to 8.0 IU. Values above 12.0 are abnormal and imply decreasing ovarian reserve. The blood tests can be complemented with a transvaginal ultrasound scan which measures the small follicles of size 2-9mm in both the ovaries. An AFC count of less than 5-6 is pointing to decreased ovarian reserve. These ‘ovarian reserve screening’ tests enable women to know about their ovarian age and to make an informed decision regarding their conception plans and seek assistance whenever appropriate.

Certain women are at risk of EOA. Women???♀? who have a family history of early menopause, previous pelvic surgeries, radiation therapy or chemotherapy for cancer treatment, endometriosis, autoimmune conditions, and certain genetic conditions are predisposed to early ovarian aging and these women sometimes require facilities like ‘egg banking’ or ovarian tissue cryopreservation to preserve their fertility or if they plan late conceptions.

????????????????????: The frequently cropping issue of fertility decline at an early age among Indian women???♀? calls for a campaign for creating awareness regarding this recent trend. It saves many women from guilt and regret that may at times haunt them for life for the decisions they made unknowingly. The lack of awareness of such an entity may create many hurdles in seeking appropriate fertility care. Many couples find it difficult to come to terms with the fact that they are running out of time. This denial creates mistrust with the fertility clinics and makes them all the more resistant to seek fertility assistance when it is crucial and when the ‘???????????? ???????????? is gone by nothing much can be done apart from using donor eggs.

 Article by

?Pushpalatha M S | Cofounder | Director

GarbhaGudi Group of Companies

#26, Patalamma Temple street, Near Metro Station, South End Circle, Jayanagar, Bengaluru-560004

M: +919886749270,E: [email protected]

W: www.garbhagudi.com |  www.ggirhr.com

https://www.dhirubhai.net/in/pushpalathams