From the Guidelines
Follicular reserve is primarily influenced by age, genetics, and various environmental and lifestyle factors, with age being the most significant determinant, as evidenced by a study published in the Journal of Clinical Oncology 1. The factors that influence follicular reserve can be broken down into several key categories, including:
- Age: The most significant determinant of follicular reserve, with the rate of decline in egg quality and quantity accelerating after age 35 1
- Genetics: Family history of early menopause or certain genetic conditions, such as Turner syndrome or fragile X premutation, can affect ovarian reserve 1
- Environmental exposures: Radiation, chemotherapy, and certain toxins can damage follicles directly, while smoking accelerates follicular loss, potentially advancing menopause by 1-4 years 1
- Lifestyle factors: Body weight extremes, chronic stress, and certain medical conditions, such as endometriosis, ovarian surgery, and pelvic infections, can reduce follicular reserve through direct damage to ovarian tissue or disruption of hormonal balance 1 It is essential to understand these factors, as diminished ovarian reserve can affect fertility potential and reproductive lifespan, and maintaining a healthy lifestyle may help preserve follicular reserve, as suggested by a study published in the Annals of Oncology 1. Some of the key evidence-based recommendations for preserving follicular reserve include:
- Avoiding smoking and reducing exposure to environmental toxins 1
- Maintaining a healthy weight and limiting alcohol consumption 1
- Managing chronic stress and avoiding certain medical conditions, such as endometriosis and pelvic infections 1
- Considering fertility preservation options, such as oocyte and embryo cryopreservation, for women at risk of diminished ovarian reserve due to medical treatment or other factors 1
From the Research
Factors Influencing Follicular Reserve
The factors that influence follicular reserve can be categorized into several groups, including:
- Reproductive history
- Sociodemographic factors
- Lifestyle factors
- Iatrogenic factors 2
- Genetic factors, such as structural X-chromosome changes and variants in genes involved in follicle formation and maintenance 3
- Epidemiological factors, such as smoking, which can account for about 5% of the risk of early menopause 3
- Hormonal and molecular pathway alterations during early folliculogenesis, which can affect the progression of the pool of primordial follicles 4
- Presence of endometriosis, which can potentially decrease ovarian reserve 5
Modifiable Factors
Some factors affecting ovarian reserve are modifiable, and addressing these factors may help preserve ovarian reserve 2. However, further interventional studies are needed to evaluate the effects of these strategies on ovarian reserve.
Assessment of Follicular Growth
The regulation of follicle growth relies on a complex array of biochemical signalling factors, and assessing a woman's non-growing follicular pool, or ovarian reserve, is important, especially with the rising average age of childbearing in many developed countries 6. Several measures of ovarian reserve are available, including markers of follicle recruitment, selection, and ovulation.