Wednesday, 16 April 2014

Does IVF cause premature menopause?

Women are born with a certain number of eggs and IVF  stimulation of ovaries to produce extra eggs in single menstrual cycle might logically let your ovarian reserve exhaust and push you enter early menopause!

Normally, women with menstrual cycle length between 28 to 30 days ovulate 12 times/year producing one egg for every cycle. So, she uses only 12 eggs per year. However, one IVF cycle demands the harvest at least 15 eggs or more for one IVF cycle through stimulation of ovaries with hormones, so as to make use of best few eggs. 

Now, multiple IVF cycles (in case of recurring failure) might make use of dozens of eggs. Mathematically, the ovarian reserve of women undergoing the above process should deplete than normal and she should find herself standing on the last leap of her menstrual cycle, staking her long-term fertility.

However, the laws of medical logic annul all such absurd facts. Scientifically, ovaries are the pair of egg reservoirs situated in pelvic region of women. Eggs are the cells which are also called genetic blue prints that create babies with male sperm. Ovaries have specialized structures called follicles to store, protect, and nourish eggs.

Between 18-22 weeks of gestation, a female fetus contains about 2,000,000+ follicles in its ovaries and each follicle contains one egg. However, the fetus loses 80 % of its eggs at the time of birth and it is left with only approx 3,00,000 eggs in her ovaries. From puberty to menopause, she loses almost all her follicles. During her lifetime menstrual cycle, a woman normally ovulate around 400 eggs, releasing one mature egg each month.

Most of the immature follicles inside ovary do not mature to release eggs. So, around 99.99 % follicles do not serve any biological purpose by not releasing eggs.

How ovary functions during menstrual cycle?

With the start of menstrual cycle, the pituitary gland secretes Follicle Stimulating Hormone (FSH) to stimulate the ovarian follicles. In response the follicles start growing and out number of follicles one follicle (called dominant follicle) carries the mature egg. This mature egg is released during ovulation. Meanwhile, the other follicles which fail to mature are lost in the process. These follicles die in a natural process called atresia.

How ovary functions during IVF?

During IVF, women are injected with high amount of FSH, higher than the body normally produces. High FSH matures higher number of follicles to produce potential eggs in single cycle. This is done to retrieve maximum number of eggs in one cycle for embryo formation. 

This is the reason why IVF treatment will not deplete your ovarian reserve because, the stimulation matures the follicles which would otherwise die. This is why the IVF treatment does not cause premature menopause. Even if you have multiple IVF cycles, it would not affect your ovarian reserve.

However, the other parallel truth is infertile women have higher risk of early menopause because of already poor ovarian reserve. It is due to the biological functioning of their bodies and it has nothing to do with IVF or number of IVF they are subjected to. So, if you are infertile and you enter menopause after IVF then please understand that it was not IVF which exhausted your ovarian reserve. You would have entered early menopause anyway, even without undergoing IVF.

Dr Neeraj Pahlajani

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