Why are young women in India facing reduced ovarian reserves?

For some years now, fertility issues among young couples have been flagged by experts. Of late, however, doctors are also beginning to notice another trend: diminished ovarian reserve among young women in India.

Diminished ovarian reserve is a condition when a woman has fewer eggs in her ovaries compared to what is considered normal for that age group. The condition, also known as low egg count, can make it difficult to get pregnant. Women are born with all the eggs they will ever produce. While, with age, the number of eggs decreases, some factors lead to women having fewer eggs than they should at a particular age.

A 2023 study, published in the Journal of Human Reproductive Sciences conducted at JIPER, Puducherry that looked at 166 women aged over 21 and under 35, found that 40% of the women showed poor ovarian reserve. Of these, 62% were between the ages of 31 and 35.  

Understanding the issue

Even 10 years ago, says Ranjit Chakraborty, head, department of gynaecology and obstetrics, Woodlands Hospital, Kolkata, this was not an issue. “Many young couples now increasingly live away from home, and one of the issues with this is extremely unhealthy diets with fast foods being predominant. Add to this environmental, chemical, and lifestyle factors, and this has also created a crisis of Polycystic Ovarian Syndrome (PCOS) in over 50% of young women, which directly impacts ovulation,” he says.    

Dr. Chakraborty said that at least 30% of the patients he sees are young women with various fertility issues, including poor ovarian reserves. He added that tests in young women aged between 18-20 also show unnaturally low ovarian reserves which lead to fertility and pregnancy issues in their future. 

“Our lives are becoming increasingly sedentary, which is adding to the issue”. He explained that endometriosis, as well as obesity, smoking, drinking, and other lifestyle factors could also contribute to diminishing ovarian reserve in young women. 

Urban vs rural

Experts point out that there seems to be an urban element to this: there are increased issues of premature ovarian failures and ovarian insufficiencies amongst younger patients in urban areas. However, medical professionals also note that urban women get tested more frequently and seek treatment for fertility issues, which perhaps may be a reason behind the increased detection in urban areas. The same issue in rural women may remain underreported due to lack of awareness and intervention, they note. 

“Over the past five to seven years, we have seen a rise in the poor ovarian reserves in women between the ages of 31-35 years. The age of marriage has gone up, and many are now, and taking time to plan families. While there is a natural decline in ovarian reserve with age, environmental and lifestyle factors are exacerbating the issue,” says Aaheli Maiti, fertility specialist at Birla Fertility and IVF, Kolkata.  

Dr. Maiti also highlighted the need for far more research in this area, about just how and why women in India are experiencing poor ovarian reserve issues.

“We are constantly being exposed to endocrine disrupting chemicals (EDCs) which can be found in 90% of the things that we use daily including food, pesticides, make-up products, fabrics etc. If we keep getting exposed to these chemicals at high amounts daily, then there is a change they could damage primordial follicles, disrupt the growth of new follicles, and negatively impact hormone production,” Dr Maiti added. 

Better physical, mental health

Doctors stress the importance of focusing on both physical and mental health and for the need to make better lifestyle choices in order to help stave off issues such as diminished ovarian reserves. A focus on physical exercise and healthy balanced diets, reducing the amount of fast food and ultra-processed food is important for those with sedentary jobs, they point out. Experts also note the need for women to go for early fertility checks in order to better understand their ovarian reserves and take steps if needed as early as possible, as well as to be able to explore options such as egg freezing if and when necessary.