If my mother went through menopause at an early age, does that mean that I will also?
Could I lose my fertility when I am younger? As a fertility specialist, these are questions that
I get often. Hi, I am Doctor Randy Morris M.D. I am a board certified reproductive endocrinologist.
This is what most people call a fertility specialist. Today on infertility TV I am going
to discuss how the function of your ovaries is affected by genetics and how it runs in families
In order to understand fertility and menopause, you first need to understand a little about how
eggs form in the ovaries. Eggs first appear in the ovaries when the fetus is about 11-12 weeks old.
The number of eggs in the ovaries increases rapidly until about 28 weeks. At that point,
new egg production stops and the existing eggs start degenerating. This process of degeneration
continues after birth. As a result, the number of eggs remaining in the ovaries is constantly
declining. The number of eggs that remain in the ovaries is referred to as ovarian reserve.
Fertility doctors try to measure ovarian reserve in a number of different ways. First,
there are blood tests. AMH, which comes from the ovaries, is higher when there is a healthy reserve
of eggs and decreases as the reserve declines. FSH, which comes from the pituitary gland,
is the opposite of AMH. Low levels are seen in people with good ovarian reserve and high
levels occur when reserve is poor. Ultrasound can also be used to estimate reserve. Each egg
in the ovary is surrounded by a group of cells. This is called a follicle. During maturation,
some fluid is produced in the follicle which can be seen with ultrasound. By counting the
number of follicles that are visible at the beginning of your period, doctors can get
an estimate of ovarian reserve. If they see more follicles, then your reserve is better
Menopause or ovarian failure occurs when the reserve of eggs
has been depleted. The average age for menopause is 50. Some women, however,
will see their supply of eggs drop more quickly. If ovarian failure occurs before the age of 40,
we call it premature ovarian failure. Prior to complete ovarian failure,
women may experience less severe stages. So there is a spectrum of ovarian function. You
may hear doctors talk about decreased ovarian reserve or premature ovarian insufficiency.
Women who have decreased reserve may experience infertility, lower pregnancy rates with fertility
treatments, irregular periods and sometimes their periods will stop coming.
What causes some women to have premature decline in the function of their ovaries? There are likely
a number of causes but genetics is probably the most important. Genes control every stage of the
production and development of eggs and how long they stay around. Mutations and variations in
the genes will result in some women experiencing a lowering in their reserve at an earlier age.
Scientists have discovered hundreds of these genes so far but more are being discovered all the time.
Since genetic mutations and variations are inherited,
that means it is possible for these problems to run in families. How common is this? Recently,
researchers conducted a study in the state of Utah. Utah has a database that links
the medical information from millions of people with their family ancestry. In fact,
over 2 million people in the database have at least 3 generations of information available.
First they looked at people with a diagnosis of premature ovarian insufficiency or POI
which they defined as women under the age of 40 with an FSH over 20 or an AMH less than
0.08. They identified about 400 individuals with POI who had at least three generations
of ancestry information in the database. These 400 individuals had 2,132 first-degree relatives, over
5,000 second-degree relatives, and over 10,000 third-degree relatives.
What did they find? About 6% of the women with POI had a relative with POI also. This
is way more than would be expected in a group of women. Overall, premature ovarian insufficiency is
found in less than 1% of women. Close relatives were more likely to be affected. For example,
a first degree relative such as a daughter or a sister was over 18 times more likely
to have ovarian insufficiency. A second degree relative, such as a granddaughter,
aunt or niece was over 4 times more likely to have POI. a 3rd degree relative such as a
great granddaughter or cousin was still over 2 and a half times more likely to have POI
What does all of this mean? If you have a relative with ovarian insufficiency,
you are at greater risk to have it yourself. The closer the relative,
the greater the risk. So yes, if your mother went through menopause at an early age,
you have a higher chance that you could too. If you have ovarian insufficiency, there is a
greater chance that your sisters or daughters or their children might develop it as well.
At the current time, there is no known method to prevent this decline in ovarian function but
with this information, people may want to make different decisions such as trying to conceive
children at an earlier age or maybe freezing eggs or embryos before the problem becomes severe