Slow ovaries is a conversational term used by some IVF doctors, GPs and other healthcare practitioners to explain, in easy language, that a woman’s ovaries take a little longer to ovulate than most.
This terminology may also be used during a stimulated IVF cycle to explain ovaries which are slower to respond to the drugs used to encourage the ovaries to produce eggs.
To better understand the concept of slow ovaries it’s important to know a little bit about the ovary and how it works.
How do my ovaries work and how does that contribute to slow ovaries?
The ovaries are a gland and they belong in the reproductive system.
The ovaries have three main functions:
- they house the follicles in which ovum (otherwise known as oocytes or, more easily, eggs) grow
- they produce a bunch of hormones which are central to women’s health
- they are the site where ovulation occurs
The ovaries respond to hormones produced by a gland up in the brain. This gland is called the anterior pituitary gland.
The anterior pituitary gland produces two hormones which are crucial to the normal functioning of the ovary. These hormones are:
- Follicle Stimulating Hormone (FSH)
- Luteinising Hormone (LH)
FSH and LH, produced in the anterior lobe of the pituitary, a gland in the brain, reach their ‘target tissue’ via the blood stream.
As the target tissue, the ovaries have FSH and LH receptors on them. When the two meet, they bind and that prompts the ovary to kick into gear.
FSH stimulates the ovary to recruit follicles and get them to grow. Normally one follicle will win this race and that is called the dominant follicle.
The dominant follicle is the follicle that is ovulated.
When FSH levels are high, the ovaries are also producing another hormone called estradiol.
Estradiol is a form of oestrogen associated with reproduction.
When estradiol levels reach their peak, the FSH starts to fall and the anterior pituitary produces LH.
LH is the hormone responsible for two main things:
- final maturation of the follicle (in the last 48 hours before ovulation)
- triggering ovulation
Under normal circumstances, that whole process should take around two weeks to complete – or the first half of the menstrual cycle which normally lasts around 28 days.
When it takes longer than that it might be because your ovaries are slow to respond.
Sometimes this is called sluggish ovaries and other times it is called slow ovaries.
You mentioned follicles and eggs – what are these?
Follicles are clusters of cells which house an oocyte or ovum, which is another name for an egg.
Follicles also house granulosa cells and theca cells.
Both of these cells are important to ovulation because they convert hormones essential to normal reproductive function.
What is my ‘ovarian reserve’ and what does it mean?
The ovarian reserve is an estimation of the number of follicles which remain in the ovaries.
As women age, their follicle count declines and when there is fewer than one thousand follicles it is likely menstruation has ceased and menopause has commenced.
Therefore, the number of follicles is intrinsically linked to the likelihood of reliable ovulation and the predictability of the menstrual bleed.
As a woman’s ovarian reserve declines so does the prospect of regular, reliable ovulation.
The Anti-Müllerian Hormone (AMH) test, plus other blood markers and scans, can help determine a woman’s ovarian reserve.
Declining ovarian reserve, and the lower hormone profile associated with it, is another cause of slow ovaries.
So if my ovarian function declines as I age, when am I at my most fertile?
This is one of the most fascinating aspects of female fertility and it goes like this:
- primordial germ cells form and lodge in the correct spot in the embryo by 5-6 weeks gestation
- by 6-8 weeks gestation these cells commence mitosis, or rapid duplication
- by 16-20 weeks gestation the ovaries will house the most follicles that person will ever have – a total of 6-7 million in both ovaries
- between 20 weeks gestation and birth (around 40 weeks), two-thirds of those eggs will die off (‘arrest’) leaving around 2 million at birth
- between birth and puberty (between 10 and 14 years of age) over 1 million oocytes arrest leaving around 300 000 for the remainder of that woman’s reproductive life
- women, on average, are considered most fertile between 21 and 32 years of age
- after 32 years of age, a slow decline of ovarian reserve commences – increasing in pace as she approaches her late 30s
What is a reasonable time frame for follicular recruitment and slow ovaries?
It is a popular misconception that the dominant follicle begins and ends its life within that cycle – about 14 days from menstruation to ovulation.
The truth, however, is that follicular recruitment takes place over several menstrual cycles – somewhere around 85 days. This process is called apoptosis.
Recall, that follicles are continually ‘arresting’. When they are saved from arrest – and utilised – that is called apoptosis.
Therefore, the follicle that becomes the dominant follicle, only becomes that if it has gone through apoptosis.
It is true that the dominant follicle is only recruited within the menstrual cycle for which it will be used. It is recruited just after the commencement of menstruation.
A woman with slow ovaries may have a delay in the process of follicular recruitment.
So what does all that mean for acupuncture, herbal medicine, lifestyle modification and sluggish ovaries?
Working with someone who has slow ovaries involves the acupuncturist assessing that woman’s unique presentation of signs and symptoms.
Analysis of those signs and symptoms will lead to a Chinese medicine diagnosis.
The object is always to regulate the menstrual cycle and, given we now know that follicular recruitment takes place months before ovulation, a reasonable time frame for treatment should always bear that time frame in mind.
Your fertility acupuncture practitioner will offer guidance and advice along the way including appropriate lifestyle modifications which may assist this process.
To find out how his approach might help you, please be in touch with Peter Kington acupuncturist in his New Farm rooms.