What are the causes for small ovaries and does it affect fertility?

Following your visit to a gynaecologist or an infertility specialist sometimes, they say your ovaries are smaller. Every woman is born with a fixed number of eggs and they start declining as they reach menopause. At the time of their first menstrual cycle, there are close to 400 000 eggs and by the time they reach menopause, there are hardly any or less than a thousand eggs. Two ovaries are present on either side of the uterus. After menarche, every month one egg is selected and that gets ovulated around the 12th to 14th day of the menstrual cycle. If it is fertilized, then it gives a pregnancy but if it is not fertilized, then a menstrual cycle follows. 

In this selection process, hundreds are selected but if there is a disturbance in the selection method the eggs get over early in that situation we might get smaller ovaries. This problem can be genetic, can be a childhood nutrition problem or sometimes it can be an interplay of growth hormones during the period between 8 to 10 years. so a variety of causes can produce small ovaries but when these small ovaries are diagnosed it tells us the results are lower and this can be confirmed by another test called anti-mullerian hormone.

When the ovary volume is lower you can also have a low anti-mullerian hormone and if you are in the age group of 25 to 30 and you have lower ovarian volume and a lower anti-mullerian hormone or AMH it is very important for you not to postpone your pregnancy because your results or your eggs might get exhausted in the next few years. 

There is another situation where you find small ovaries as the woman reaches 37 years and as they come closer to 40 years the volume of the ovaries becomes smaller because the number of eggs in the ovary gets diminished from 400 000 at the time of your first menstrual period to less than a thousand at the time of menopause so essentially smaller ovaries can be classified into two groups. smaller ovaries where the chances of pregnancy are reasonably satisfactory, there should not be any delay and then you have the second group closer to 40 years who are at the end of their reproductive life. Here, the chances of pregnancy with smaller ovaries are significantly low. In other words, what I wanted to convey in this is, assessing ovarian reserves is an important component of reproduction, and if they are compromised then career women should not postpone their pregnancy but seek medical help to get an early pregnancy. 

One thing that has not been beaten by technology is age and smaller Ovaries. As of today, we do not have solutions. So it is prudent and wise on the part of the career woman to prioritize if the doctor says your ovarian volumes are low or your ovarian reserves are low or your AMH values are low. In that situation, they have to prioritize their life goals between career and motherhood. It all depends on their individualization but this is a word of caution about the importance of that information because seldom do we realize that technology has limitations and some of the areas of limitations in reproduction are age, small ovaries, or low AMH where there are very few options available.

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