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It is known that ovum of women of which they will use lifetime develops during their intrauterine life and they are born with these ovum. No ovum is produced after then. Reduction of ovum in the ovaries by aging is a normal and physiological process.

Number of ovum that a girl has while she is 5 months old during intrauterine life is about 6 to 7 million; this number decreases to 1 to 2 million at birth, slowly reduces during childhood and such reduction continues by spending 350 to 400 ovum through ovulation until menopause. These ova is stored in spaces with fluid called follicles in the ovaries. When a girl enters into fertility age, menstrual cycles starts monthly.

The ovary develops one ovum per cycle. This may be more rarely. If this ovum combines with sperm cell from man, pregnancy occurs. The highest age for pregnancy for a woman is about 25 years. Pregnancy ratio reduces by age and this reduction accelerates since 35 years and significantly reduces after 40 years. To be able to get pregnant becomes almost impossible for women who had births before. Personal differences will play an important rule for sure, but pregnancy rate is below 5% even in-vitro fertilization is applied after 45 years. Reduction in ovary reserves and loss of fertility function accordingly does not mean menopause. The woman may have menstrual cycle, however, chance for pregnancy reduced.

The answer of the question "I have my periods, why can not I have child?" lies under this physiology. Women who have early menopause in their families should be careful in particular. Ovary reserve is consumed earlier in these women. Some difficulties may be experienced at 10 years from genetically programmed menopause age; for example, a women who will enter into menopause at 40 years starts to struggle to have child since 30 years. Therefore, ladies who have early menopause in their mothers and sisters should not postpone to get pregnant.

Besides advanced age and genetic factors, other factors that may cause early reduction on ovary reserves are as follows:

1. Some different factors such as endometriosis disease and chocolate cysts may affect ovarian reserve and capacity to get pregnant.

2. Radiotherapy and chemotherapy: Since cancers appeared within young ages have become treatable, this has caused reproduction problems more frequently for survivors.

3. Previously undergone ovary operations: No matter cyst removal operation is performed carefully, capacity will increase because number of ova will decrease.

Especially, removal of endometriosis cysts known as chocolate cysts may reduce ovarian capacity in thet side. It is essential that such surgeries should be performed by competent surgeons by caring normal tissues maximally. This subject may be a disadvantage in laparoscopic operations. Open surgery of those who have bilateral dermoid or chocolate cyst and maximum care on normal tissues should be discussed well with the physician.

The success in in-vitro fertilization applications is significantly associated with number of ova collected. Except excess numbers, to try to obtain 5 ova and over is ideal. According to the researches conducted, selection chance decreases when ova less than 5 is obtained and pregnancy ratios may be lower than expected. Changes in drug treatment in women whose ova are collected do not provide a significant advantage in general. Different drugs called short protocols may be tried in women whom long protocols (lucrin and similar drugs) are applied during previous treatments. While partial increase may be provided in number of ova by increasing the drug dose, this increase does not reflect to pregnancy ratios in fact. There are studies that number of ova may be increased in women with poor ovarian response by using the drug named Clomiphene which has been used from of old and by treatments applied with tablets called aromatase inhibitor.

There are studies published that ovarian response improves by acupuncture. If no benefit is provided from these above, a drug-free treatment called natural cycle may be tried. May new ovum production be achieved in woman? Despite classical information, new studies have shown that there are root cells in women's ovaries. Studies to perform new ovum production and obtain pregnancy over these cells are performed on experimental animals. So, we hope in a near future that women with reduced ovarian reserve may become mother. 

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