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Understanding the Full Spectrum of Ovarian Aging

Developing A Comprehensive Assessment Holds the Key to Addressing Fertility Concerns

May 26, 2020
Teresa Dietrich-O'Donnell

Many couples choose to spend their peak fertility years building careers and saving money, putting off family planning until their thirties. The decision to postpone childbearing necessitates an understanding of ovarian aging. The complex nature of ovarian aging means that an understanding of the influence of genetic and environmental factors is currently the best way to determine how conception may be impacted by the decision to wait.

Although more research is needed, several genetic and environmental factors contributing to advanced ovarian aging have been identified. While identifying these factors is an important step in addressing infertility resulting from ovarian aging, tests assessing ovarian aging and associated conditions are a long-term goal of ovarian research.

What Do We Know About Ovarian Aging?

Lack of Research on Ovarian Aging Impacts Our Health

Ovarian aging is a natural decline in the quality or quantity of eggs (oocytes). Premature ovarian aging (POA) is a marked decline in the ovarian reserve (reproductive potential determined by quantity and quality of eggs) relative to the age of the woman. POA represents part of the vast spectrum in ovarian aging--because the process is specific to each woman, assessment is necessary to determine where each individual falls on the spectrum of ovarian aging. 

Surprisingly little is known about the process of ovarian aging. This lack of knowledge has a negative impact on our ability to develop comprehensive assessments. New studies involving non-human primates have attempted to address this knowledge gap by identifying genetic patterns that indicate ovarian age, laying the foundation for a test that could diagnose infertility.

There are some health risks associated with premature ovarian aging, which is often correlated with premature menopause. These health risks, including increased risk of cardiovascular and neurological disease, represent one of the many reasons why ovarian aging needs to be better understood. 

A woman on a white seat with her head rested on her arms
The variation in ovarian aging among women suggests potential genetic markers for POA.

What Factors Contribute to Ovarian Aging?

Nature or Nurture, Which One Influences Us More?

Genetic influences on ovarian reserve include a family history of premature menopause, trisomy 21, and conditions impacting the X chromosomes. Autoimmune disorders, such as thyroid autoimmunity, may also negatively impact ovarian reserve. While these genetic influences aren’t preventable, they’re key to assembling a comprehensive health history that could help medical professionals and fertility specialists address conception difficulties.

There are a number of preventable environmental factors that contribute to POA as well as to normal ovarian aging. The impacts of smoking, chemotherapy, pelvic surgery, and some pelvic inflammatory diseases can be avoided or mitigated. 

A woman holding a pill and a glass of water
Ovarian aging can potentially be addressed through hormone therapies.

Addressing Concerns About Ovarian Aging

The Uncertain Nature of Treatment

POA leads to fertility issues, including increased risk of miscarriage among those who conceive, but there are adverse genetic side effects of natural ovarian aging that must also be considered.

As the ovaries age, genes that regulate cellular stress become less active, increasing the risk of damage or genetic impairment. Without assessments capable of determining where a woman is in the process of ovarian aging, health professionals are missing essential information they need in order to provide the best possible care.

Current management of ovarian aging relies on hormonal replacement therapy (HRT). Estrogen and progesterone medication can reduce the side effects and symptoms of ovarian aging and menopause, but there is a lack of research addressing the long term effects and benefits of HRT.

Ovarian aging impacts every woman eventually. With a more in depth knowledge of the spectrum of ovarian aging, health care professionals can develop key resources for helping women address their specific concerns ahead of time. 

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