What Happened to My Eggs? A Brief Review of Premature Ovarian Insufficiency (POI) or Premature Ovarian Failure (POF)

A woman is born with a certain number of eggs and as far as we know she will not make any more eggs over the course of her life.  Each month the number of eggs decreases:  pregnant or not pregnant, with or without menstrual periods, on or off birth control pills.  Once the number of eggs drops critically low, no more menstrual periods will occur and the woman is said to have menopause.  Although the average age of menopause is 51, the fact is that 1/250 will go through menopause before age 35 and 1/100 before age 40.  The early onset of menopause before age 40 is called Premature Ovarian Insufficiency (POI).

Although most women ovulate a single egg per month, some estimates suggest that she may lose between 100 and 1000 eggs during that same month.  The loss of eggs is therefore a normal, natural process that every woman faces.  There are no medical techniques known to help a woman keep up her egg count number.  In this battle, nature always wins.  The number of eggs that a woman has can be estimated with 3 medical tests.

The first test, a pelvic ultrasound, can provide an "antral follicle count", basically a traffic report of how many little egg sacs have started to develop that menstrual cycle.  These egg sacs will compete with the largest one shutting down the brain hormones and eliminating the competition, thus resulting in usually a single ovulation.

The second test is a blood test called anti-mullerian hormone (AMH).  This test measures the amount of hormone produced by the very small follicles (egg sacs) in the ovary.  The higher the AMH the more eggs are deemed to remain in the ovary and the further away menopause is felt to be.

The third test measures a follicle-stimulating hormone level (FSH) on the second or third day of the menstrual cycle.  Coupled with an estradiol level, this gives some estimate of the woman's brain's impression of how many eggs remain.

Evaluation of egg reserve at an earlier age, especially for women who have a family history of early menopause, may help in planning a reproductive future.