Normally, women’s fertility peaks in our early to mid-20s. In our early 30s, fertility starts declining gradually.

Women are born with all the egg cells (called oocytes) that they’ll need throughout their lifetime. Scientists refer to this as a woman’s “ovarian reserve.” At puberty, hundreds to thousands of these eggs start maturing, and you begin using and losing these cells with ovulation and menstruation. As you age, the reserve depletes and fertility declines. This age-related natural decline in our fertility accelerates in our mid- to late 30s, and by the time we are in our late 40s and early 50s, the chance of getting pregnant is close to zero.

Some of us—10% of all women, in fact—do not follow this normal pattern of fertility, and end up losing ovarian reserve much sooner than is normal. This condition is known as premature ovarian aging (POA). The ovaries of women with POA lose their ability to develop healthy eggs with good potential to be fertilized normally and grow into healthy babies much earlier than the average woman.

Ovarian reserve is not the only factor influencing female fertility, but it is one of the most important. This, along with its high prevalence and silent nature (we’ll discuss that below), make POA a major condition affecting women for whom children are a big part of their life plans.

What’s My Fertility looks for signs and risk factors of POA

POA typically doesn’t have any noticeable symptoms. You might sense that something isn’t right if--and only if--you are trying to get pregnant and are unable to, despite regular intercourse. Other than that, POA is usually “silent.” This is why most women with POA don’t know that they have it until the condition has progressed substantially.

There are, however, risk factors for POA, such as:

  • Having an autoimmune disease,
  • A history of miscarriages
  • Family history of POA or early menopause

These and other risk factors are covered in our preliminary screening questionnaire, which you can take here, free of charge and with no lab tests required.

Blood tests for POA

Simple blood tests can also identify women at risk of POA. What’s My Fertility offers a preliminary assessment with no blood test results required, and a complete screening using bloodwork. Though a preliminary assessment can identify ed flags, we recommend that all women undergo blood tests for a complete risk assessment.

When you provide blood test results, What’s My Fertility compares your AMH and FSH levels against the hormone levels expected at different ages. Because what’s normal changes with age, we’re analyzing your results against what’s normal at your age, rather than an arbitrary, age-independent “normal” level. This age-specific way of looking at hormone levels is an innovation introduced by our physicians to better diagnose infertility patients more than a decade ago, but it’s also very much applicable to POA risk screening.

What causes POA?

There are multiple factors that appear to contribute to POA, including autoimmunity (immune system attacking itself—in this case, the ovaries), genetics, or other factors, although more research is needed to understand the entire mechanism of POA.

One of the many potential root causes of POA appears to be in the FMR1 gene and its variations. Women with so-called low FMR1 alleles--one of a number of alternative forms of the same gene--have ovaries that age prematurely. This means that women with lower FMR1 alleles lose their eggs at an accelerated rate compared to women who do not carry a low form of FMR1. This is why What’s My Fertility looks at your FMR1 counts.

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