Ovarian function is a frequently mentioned issue in clinical practice, which is valued by doctors and of great concern to patients. I. Understanding the ovaries and ovarian function The female reproductive system includes the external genitalia, the internal genitalia and their associated tissues. The internal genitalia include the vagina, uterus, fallopian tubes and ovaries, of which the fallopian tubes and ovaries are also known as uterine attachments, and clinically it is often said that ultrasound of the uterus and attachments is to look at the uterus, fallopian tubes and ovaries. The ovaries are the gonads of women and have both reproductive and endocrine functions, which play an important role in maintaining the normal physiological cycle of women and producing offspring. The reproductive functions of the ovaries include follicular recruitment and development, follicular maturation and ovulation, and the formation and degeneration of the corpus luteum. This process is normally the necessary foundation for the formation of the mature oocytes of the female gametes necessary for human reproduction. The endocrine function of the ovary refers to its secretion of sex hormones (estrogen, progesterone, androgen) and peptide hormones and growth factors, which are extremely important for reproduction and the body. Second, the importance of ovarian function From the perspective of reproductive medicine, ovarian function is directly related to female fertility. Estrogen can maintain the normal development of the vulva, vagina and uterus as well as the normal female pelvic floor structure, which not only enables the reproductive organs to function accordingly and prevents prolapse of the pelvic organs and the functional damage they bring, but also promotes a comfortable and harmonious sexual life. Normal ovarian function is necessary to produce good eggs and normal ovulation for fertility to be possible. In patients with poor ovarian function, not only is it difficult to conceive naturally, but the success rate of using assisted reproduction techniques is also reduced. Because of poor ovarian function, the quantity and quality of eggs will be affected. As the saying goes, a clever woman cannot cook without rice. Without a good seed, how can she produce a healthy baby? Because of this, some patients with very poor ovarian function can only choose IVF with donor eggs for fertility. In addition to this, ovarian function also affects the overall physical and mental health status of women and plays an important role in the health and well-being of all women. Its role can be summarized in two categories, one is to maintain beauty and the other is to maintain health: 1. Ovarian secretion of estrogen can promote the development of female secondary sexual characteristics, maintain women’s beauty and physical appearance, which is beneficial to women’s physical and mental health and has a positive impact on women’s lives and work. 2. Estrogen also regulates the body’s metabolism, protects the heart, brain and blood vessels, promotes muscle protein, promotes bone density and prevents osteoporosis, and has significant effects on many systems of the body, including the nervous system, the genitourinary system and the skin system. We just need to know that the incidence of cardiovascular disease is lower in pre-menopausal women than in men, and gradually after menopause the incidence is comparable to that of men; women with menopause (perimenopause) have gradually increased skin wrinkles, increased fat in the abdomen and hips, easily gain weight, are emotionally unstable, agitated and irritable, depressed and annoyed, prone to osteoporosis, etc.; patients with polycystic ovary syndrome (abnormal ovarian function) may have If you have a change in personality, you will understand how important ovarian function is. The following indicators are commonly used to assess ovarian function: 1. Age It is a natural rule that ovarian function declines with age. The ovaries of a female fetus have approximately 6 to 7 million oocytes at 20 weeks of embryonic life. When a woman is born, only 1 to 2 million oocytes remain, and by puberty only 300 to 500,000 oocytes remain. During the reproductive years, a woman will ovulate approximately 400 to 500 mature eggs during her lifetime; by the time she reaches menopause, only a few hundred oocytes will remain. The decline in the number and quality of eggs signals a decrease in ovarian reserve and function. The best time for women to have children is between the ages of 18 and 35. The decline in ovarian function accelerates between the ages of 37 and 38, and women gradually enter perimenopause after the age of 40. It is important to note that some women have poor ovarian function even though they are not yet 40 years old, becoming premature ovarian failure. 2, menstruation One of the important functions of the ovaries is to maintain a normal physiological cycle, and if the ovaries are functioning normally, then menstruation will be normal and regular. The first menstrual flow is called the first menstrual period. The first menstruation usually occurs between the ages of 13 and 14, but it may be as early as 11 or as late as 15 years old. Normal menstruation is cyclical in nature. The first day of bleeding is the beginning of the menstrual cycle, and the interval between the first two menstrual days is called a menstrual cycle. It is usually 21 to 35 days, with an average of 28 days. The duration of each menstruation is called the menstrual period, which is usually 2~8 days, with an average of 4~6 days. The volume of menstrual blood is the total amount of blood lost during one menstrual period, and the normal volume is 20~60 ml. Menstrual blood is dark red in color, and in addition to blood, there are endometrial debris, cervical mucus and shed vaginal epithelial cells. The menstrual blood contains some anticoagulant fibrinolytic substances, thus the menstrual blood does not clot and the clots appear only when the bleeding volume is high. Generally, there are no special symptoms during menstruation. Some women may experience discomfort in the lower abdomen and lumbosacral region or painful contractions of the uterus. You can compare your menstrual cycle with your own, too long or too short, too much or too little is not normal. It is important to note that the menstrual cycle should be viewed as a whole in multiple cycles. Occasionally, a delay or postponement of a menstrual cycle or a change in volume may be due to various factors such as environment, diet, medication, emotions, etc., and can continue to be observed. If there is a gradual shortening of the menstrual cycle and a decrease in the volume of menstruation, you should be alerted to a decrease in ovarian function, especially in women of advanced age who are preparing for pregnancy. The AFC (number of sinus follicles) is a clinical test that allows the patient to have a vaginal ultrasound on the third day to look at the AFC of the left and right ovaries respectively. If the number of AFC on one or both sides is greater than 12, it may indicate polycystic ovary syndrome. 4. Basal sex hormones: The six sex hormones measured on day 2-4 of menstruation, including follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), prolactin (PRL), progesterone (P), and androgen (T). Ovarian function is mainly based on FSH, LH and E2. The higher the value of these three, the worse the ovarian function. Generally, FSH values greater than 10 IU/L often indicate a decline in ovarian function. 5. Reproductive hormones are usually checked together with basic sex hormones, including anti-mullerian hormone (AMH) and serum inhibitory hormone B (INHB). AMH is not affected by the menstrual cycle and decreases with age. AMH values less than 0.5-1.1ng/ml indicate a decline in ovarian function. Studies on AMH levels in Chinese women of different ages showed that the mean AMH level in normal women was 2.35 ng/mL at age 20-31, 1.58 ng/mL at age 32-34, 1.30 ng/mL at age 35-37, 0.96 ng/mL at age 38-40, 1.03 ng/mL at age 41-43, and 0.67 ng/mL at age >43. In women with PCOS, the mean AMH level was 4.38ng/mL at age 20-31, 3.47ng/mL at age 32-34, and 3.30ng/mL at age 35-37. Its predictive value was better than that of basal sex hormones. Basal INHB <45pg/ml suggests decreased ovarian reserve and ovarian hyporesponsiveness, its sensitivity is better than basal sex hormones and it is the earliest indicator of change. 6.Other include ovarian blood flow measurement, ovarian volume, etc. The doctor will determine the ovarian function of the patient based on a combination of these factors, and then provide the appropriate treatment plan with the medical history and specific situation.