Many women don’t realise that the one organ in the body that ages the fastest is the ovaries ! Ovarian ageing is completely uncorrelated with the rest of the body , and this is because the ovaries are born with whatever eggs are ever going to be produced during the woman’s lifetime. These eggs gradually die , and when the ovary runs out of eggs, the woman becomes menopausal. Now, everyone understands the menopause—that the periods have stopped because there are no more eggs left. But well before the menopause , there is a phase called the oopause, which is a result of declining egg quality .
This results in an entire spectrum of reproductive dysfunction or reproductive failure , but it is also something that a lot of doctors are not aware of .
For example , when the egg quality starts declining , what happens first is that the woman still has regular periods and she does get pregnant in her own bedroom, but because the eggs are not of good quality and contain genetic abnormalities because they have gotten older , she ends up having miscarriages . This means the first manifestation of poor egg quality is often recurrent miscarriages or recurrent pregnancy losses, but this is a diagnosis that is often overlooked.
This is because most doctors don’t think about this possibility , even though we know that the commonest reason for a miscarriage is a genetic problem in the embryo and that the commonest reason for a genetic problem in the embryo is older eggs because these eggs accumulate genetic abnormalities over the life span of the woman .
Over time, as the egg reserve keeps on getting worse, these women then find that they cannot even get pregnant in their bedroom, and this then presents itself as infertility. Again, this is often a diagnosis that is missed because these women usually have regular periods, and they assume that just because they have regular periods, their egg quality must be fine. However, the truth is that their regular periods are the result of the hormones produced by the ovaries, and this is a completely different compartment from the one that produces the eggs. Some of these women will do IVF, but the IVF success rates in these women are also much lower than they would be in other women , because while it is possible for the doctor to super-ovulate them to produce eggs, often the quantity and quality of eggs are not great, as a result of which they do not produce good-quality embryos. Often the embryos arrest, and even if they do produce what look like top-quality blastocysts—good embryos—these embryos don’t implant because of their genetic abnormalities, which means the diagnosis now becomes recurrent IVF failure or recurrent implantation failure. Again , the problem is that it’s hard to pinpoint this particular diagnosis, so it’s often one of exclusion, and many doctors fail to consider this possibility.
The next step during this journey of ovarian ageing is that the ovarian quality declines so much that the hormones being produced by the ovary start dropping , as a result of which the periods start becoming irregular. This phase is called anovulation, and especially when this occurs in older women, it’s fairly easy to make a diagnosis of what is called premenopause or occult ovarian failure. When this progresses even further and the ovary stops producing hormones completely, it then presents itself as menopause.
The point is that the common denominator in this entire spectrum of reproductive disorders, which present in completely different ways, is ovarian ageing or ovarian senescence. This diagnosis is often missed, and it’s something that a doctor needs to specifically look at , irrespective of whether the patient presents with recurrent pregnancy loss, infertility, repeated IVF failure, or irregular cycles.
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