Egg Quality: Women become less likely to become pregnant and more likely to have miscarriages because egg quality decreases as the number of remaining eggs dwindle in number. These changes are most noted as she reaches her mid-to-late 30s. Therefore, a woman’s age is the most accurate test of egg quality. An important change in egg quality is the frequency of genetic abnormalities called aneuploidy (too many or too few chromosomes in the egg). At fertilization, a normal egg should have 23 chromosomes, so that when it is fertilized by a sperm also having 23 chromosomes, the resulting embryo will have the normal total of 46 chromosomes. As a woman gets older, more and more of her eggs have either too few or too many chromosomes. That means that if fertilization occurs, the embryo also will have too many or too few chromosomes. Most people are familiar with Down syndrome, a condition that results when the embryo has an extra chromosome 21. Most embryos with too many or too few chromosomes do not result in pregnancy at all or result in miscarriage. This helps explain the lower chance of pregnancy and higher chance of miscarriage in older women. Egg Quantity: The decreasing quantity of egg-containing follicles in the ovaries is called “loss of ovarian reserve.” Women begin to lose ovarian reserve before they become infertile and before they stop having regular periods. Since women are born with all of the follicles they will ever have, the pool of waiting follicles is gradually used up. As ovarian reserve declines, the follicles become less and less sensitive to FSH stimulation, so that they require more stimulation for an egg to mature and ovulate. At first, periods may come closer together resulting in short cycles, 21 to 25 days apart. Eventually, the follicles become unable to respond well enough to consistently ovulate, resulting in long, irregular cycles. Diminished ovarian reserve is usually age-related and occurs due to the natural loss of eggs and decrease in the average quality of the eggs that remain. However, young women may have reduced ovarian reserve due to smoking, family history of premature menopause, and prior ovarian surgery. Young women may have diminished ovarian reserve even if they have no known risk factors. There are medical tests for ovarian reserve, but none have been proven to reliably predict the possibility of becoming pregnant. These tests do not determine whether or not a woman can become pregnant, but they can determine that age-related changes of the ovaries have begun. Women with poor ovarian reserve have a lower chance of becoming pregnant than women with normal ovarian reserve in their same age group. No single test nor any combination of tests is 100% accurate. Tests of day-3 FSH, antimüllerian hormone, and estrogen levels involve blood sampling on the 2nd, 3rd, or 4th day of the menstrual cycle. High levels of FSH or estrogen indicate that ovarian reserve is low. However, many women with diminished ovarian reserve will have normal levels of FSH on day 3, so a normal day-3 FSH does not confirm normal ovarian reserve. Other tests of ovarian reserve that are sometimes utilized include the clomiphene citrate challenge test (CCCT) and ultrasound assessment of follicle numbers, called the antral follicle count. Infertility Evaluation and Advanced Maternal Age Infertility usually is diagnosed if a woman has not become pregnant after 1 year of unprotected intercourse (i.e., no contraceptive measures used). However, if she is 35 or older, the evaluation should begin after 6 months of trying unsuccessfully to conceive. If a couple has an obvious medical problem affecting their ability to conceive, such as absence of periods (amenorrhea), sexual dysfunction, a history of pelvic disease, or prior surgery, they should begin the infertility evaluation immediately. Fertility tests may include ovulation detection and evaluation of the fallopian tubes, cervix, and uterus. The male partner will have a semen analysis. Most testing can be completed within 6 months, and appropriate treatment can be started immediately after the evaluation is completed. Women who have a medical disorder, such as high blood pressure or diabetes, should talk with their clinical care provider before attempting pregnancy. It is important that health problems are under control. The clinical care provider may suggest a change in medication or general health care before pregnancy as there are increased risks for older women. Conditions such as high blood pressure or diabetes develop more commonly in women who conceive after age 35. Special monitoring and testing may be recommended during pregnancy. Preconception counseling is often beneficial as well. Children born to women over age 35 have a higher risk of chromosomal problems. Women can choose to discuss these risks with their clinical care provider or a genetic counselor prior to attempting pregnancy. Prenatal testing may be performed after conception to check for certain birth defects. Amniocentesis and chorionic villus sampling are two methods of prenatal testing. Blood testing and ultrasound also may be used as screening tests for certain birth defects. Many parents want to know as much about the pregnancy as possible so they can make informed decisions. Best Fertility Care Centre, Advanced Fertilty Care Centre , Ashwini Hospital Moondrumavadi Madurai -07 , Maternal and Child Health Care Centre.