Normal Ovarian Ageing

The ovarian ageing process comprises a continuous wastage of follicles and oocytes commencing already before birth and leading to the ovaries become devoid of follicles at the end of the fifth life decade. The continuous recruitment allows the presence of a permanent cohort of antral follicles, which by neuroendocrine control at the hypothalamo-pituitary level will result in the monthly ovulation of a fertilizable oocyte and the menstrual cycle. The oocyte started her meiotic division at the time the ovaries were created, and at ovulation this meiotic division of the nuclear material is completed, enabling fertilization and subsequent embryo development. The quality of this monthly ovulated oocyte may be the key factor in the low average level of, and variation in, fecundability in the human.

The use of tools like AMH and the AFC has enabled the estimation of the quantitative follicle reserve status, but assessment of oocyte quality remains largely illusive at the current time. It is the latter that is the big avenue to open as it may revolutionize strategies on infertility prevention strategies, infertility treatments, and fertility preservation.