Reproductive Aging
Between 1996 and 2008 the physician group at SRM has published 21 studies on reproductive aging.
The physician group at SRM was in academic medicine at the University of Washington (UW) for a number of years before SRM was launched in 2004. In the 1990’s we focused our research on ovarian aging and were responsible for much of the original published research that is the basis for the diagnosis and treatment that is now taken for granted in relation to reproductive aging. At SRM we continue our work in reproductive aging assisting women with age related infertility achieve accurate diagnosis and work up, understand their options, and ultimately make the best decisions for their family building.
Cutting-edge research and discoveries
At the UW we obtained several NIH grants that supported this important research. The basic study design we used in a series of studies was to compare ovarian function in normal women with regular menstrual cycles in two age groups: 20-25 years [controls] and 40-45 years [the study group]. The studies were intensive as the women had daily blood samples, frequent ultrasounds, and we aspirated the single follicle and obtained an egg much like what is done in IVF. We ran multiple endocrine tests on the blood samples and the follicular fluid plus we studied the chromosomes within the egg. The major findings were:
- older women have regular ovulatory cycles that are 3 days shorter on average [25 compared to 28 days] because the time from menses to ovulation is advanced
- follicle development in the older group is robust with normal size and a trend toward higher serum estradiol levels; progesterone levels after ovulation are normal as well.
- the follicular fluid was superior in the follicles from the older women as if her body was trying to compensate for the older egg.
- the major problem in older women is the egg [oocyte] that most of the time [85%] doesn't separate its chromosomes into 23 even pairs leading to infertility and an increase in the rate of miscarriage.
- the subtle elevation of FSH in the blood on cycle day 3 is due to a decrease in a new hormone called inhibin that normally suppresses FSH.
- an antral follicle count has less variation month-to-month than FSH, is not different between the ovarian pairs, and it is a very good estimate of egg [oocyte] number.
Subsequently, another NIH grant we received sponsored a unique study wherein we obtained ovaries from women from birth to menopause and developed a modern laboratory technique to count the actual number of eggs in the ovary. This entailed collecting ovaries from the morgue and the NW Organ Procurement Network from young girls and women who died as well as from surgery specimens throughout the Northwest. The only prior study in the world's literature on actual egg number was smaller and published in 1950 using a rather crude technique by today's standards. We obtained ovaries from 122 females. Our study was published in 2008. The major findings were:
- at birth female infants have .5 to .6 million eggs [primordial follicles] in their ovaries that decreases to nearly zero at menopause.
- there is no difference at any age between the right and left ovaries in terms of egg number.
- there is a constantly increasing rate of egg loss from birth to menopause.
In 2001 Dr. Soules chaired an international conference that reached a consensus on a staging system for reproductive aging. The Stages of Reproductive Aging Workshop [STRAW] system is summarized in this graph.
PLACE GRAPH HERE
