There are two important concepts in clinical practice regarding ovarian hypofunction: decline in ovarian reserve (DOR): ovarian reserve includes the number and quality of eggs and can be judged by those factors mentioned previously. Premature ovarian failure (POI), considered a special case of declining ovarian reserve, is a clinical syndrome caused by ovarian deficiency before the age of 40, characterized by menstrual disorders (amenorrhea or scarcity) caused by high gonadotropins and and low estrogen. 2008 American Society for Reproductive Medicine POI diagnostic criteria biochemical index FSH > 40 IU/l. 2016 European Society for Human Reproduction and In the guidelines for the management of POI published by the European Society of Human Reproduction and Embryology in 2016, POI was strictly redefined: menstrual scarcity or amenorrhea for at least 4 months; two FSH levels >25 IU/L (tested 4 weeks apart). This corresponds to the different classifications of causes of ovarian function decline: 1. Physiological ovarian reserve decline Age is an important predictor of ovarian reserve, and it has this function because, with age, ovarian reserve is gradually declining, including both quantitative and qualitative changes. The graph below shows the trend of the gradual decline in egg count with age in previous studies. The ovary of a female fetus has approximately 6 to 7 million oocytes at 20 weeks of embryonic life. The total number of follicles is determined at her birth, averaging 1 to 2 million, and then gradually degenerates, leaving only 300,000 to 500,000 follicles by the time she reaches puberty. Normally, about 20 follicles are recruited and grow each month, with only one dominant follicle eventually developing and expelling, and the rest being occluded. With cyclic follicle recruitment, ovulation and atresia, the ovarian reserve gradually declines and begins to decline at an accelerated rate at 37-38 years of age. The number of follicles in the basal follicular pool and the rate of follicular depletion determine the rate of ovarian reserve decline. From reproductive age to menopause, there are approximately 400 eggs that develop and mature, and each ovulation has a conception rate of about 20%, which cumulatively results in a pregnancy rate of about 90% a year, which is why infertility is defined as one year of non-contraceptive failure to conceive. Theoretically, the number of follicles is far more than needed for fertility potential, but due to genetics and other factors, there are great differences in individual ovarian function. 2. Factors leading to early decline of ovarian function (1) genetic factors: chromosomal abnormalities, genetic mutations, genetic susceptibility, etc., (2) injury: surgery, radiotherapy, immunological factors (positive autoantibodies such as adrenal antibodies and thyroid antibodies), smoking and passive smoking, endometriosis, inflammatory destruction, etc., (3) idiopathic: unknown causes. The prevalence of POI is 1%, currently due to the global phenomenon of delayed reproductive age, as well as China’s two-child open policy, the former is more often seen clinically, that is, physiological ovarian reserve decline, and age, aging problems, its crack we can refer to another organ, the skin: there will be some good, suitable for your skin care products, more importantly, persistent daily care, do not stay up late, do not smoke, reasonable diet, vitamin supplements, daily sun protection, and antioxidants starting at an older age, very godlike. So, for patients with better ovarian reserve, how do you maintain ovarian function? Their answers are as follows: 1. Avoid factors that may lead to premature ovarian failure; 2. Refer to skin care, pay attention to your lifestyle, balanced diet, moderate exercise, relaxed and calm mood, you can use some antioxidant supplements (vitamin C, vitamin E, etc.), be careful to use them under the guidance of a doctor, for example, vitamin E can be toxic when taken in large quantities for a long time. For those who have poor ovarian reserve and want to improve ovarian function, or want to improve egg quality during pregnancy preparation, an article on how to improve egg quality has been pushed out before, you can refer to: How to Improve Egg Quality. In summary, the following are the main points: 1. good lifestyle (do not smoke, drink less and do not stay up late), balanced diet (eat more fresh fruits and vegetables, appropriate amount of vitamins), appropriate exercise, peace of mind; 2. away from harmful factors, including away from computer radiation, less painkillers, avoid unclean sex, timely treatment of gynecological diseases, less abortion, etc.; 3. medical intervention: Western medicine: ① antioxidant drugs: including Touche ( In fact, it is a complex of multiple antioxidants and vitamins and nutrients), coenzyme Q10, vitamin E, vitamin C, etc. Oxidative stress is an important cause of aging, and the human body has its own antioxidant system to fight against oxidative stress that occurs every moment. As we age, the oxidative-antioxidant imbalance increases, and the free radicals and molecules related to oxidative stress in the body cannot be removed in time, which will cause damage to our own tissues. Insisting on the use of antioxidant drugs has a good protective effect on ovarian function, and is used during pregnancy preparation It can reduce the formation of aneuploid oocytes and improve egg quality. ②DHEA: DHEA is an important intermediate product in the synthesis of ovarian and adrenal hormones and has been widely used in recent years as an adjuvant therapy for patients with low response to IVF. Although clinical trials have shown that DHEA does not increase the number of eggs obtained in low-response patients, it can improve the implantation rate and sustained pregnancy rate, suggesting that DHEA can improve oocyte and embryo quality. (iii) Growth hormone: The addition of growth hormone to IVF ovulation may improve pregnancy and live birth rates in low-response patients, mainly by improving oocyte quality. Growth hormone can increase the number of functional mitochondria in oocytes, improve the expression of FSH, LH and GH receptors in granulosa cells during ovarian aging, weaken the effect of BMP, improve follicle selection and maturation, and reduce oocyte turnover. Chinese medicine: Chinese medicine has a deep knowledge and many methods for “egg nourishment”, which is also recognized by Western medicine, and is often used clinically to treat ovulation disorders and abnormal egg development. The key words “egg quality” are also more commonly used in TCM literature. TCM considers kidney deficiency and blood stasis as the basic pathogenesis of ovarian abnormalities, therefore, kidney tonification therapy is mostly used during the controlled superovulation phase, and the spleen is strengthened on the basis of kidney tonification. According to the dialectical viewpoint, follicular development abnormalities are subdivided into different types, and appropriate drugs are given according to the different subtypes. Some studies have shown that the combination of two to tenkat in a superovulatory regimen can significantly reduce FSH dosage, increase ovarian responsiveness, improve egg quality and increase pregnancy rate. The mechanism may be related to improving ovarian responsiveness, increasing estrogen levels, and coordinating the hypothalamic-pituitary-ovarian axis. In addition, acupuncture, electro-acupuncture, and ear acupuncture are also useful in improving egg quality and assisting in increasing the success rate of IVF. Here is a reminder that you should always go to a regular medical place to see a TCM practitioner. The other: some beauty salons will launch “ovarian maintenance” and other projects, from the information collected it seems that the so-called “ovarian” maintenance are mainly essential oils, drug massage, hormonal drugs, red light, hot compresses, physical therapy, etc. Massage is very difficult to press to the ovaries, essential oils, drug absorption is unimaginable, The actual fact is that you can’t imagine that the hormonal drugs must be used with caution, the red light, hot compresses, physical therapy, or go to the hospital is the most reliable. So, we must be careful. The last thing I want to tell you is that improving the quality of your oocytes is like improving the condition of your skin, you can’t rush it, you have to be patient, it takes an average of 85 days for the follicles to develop into mature follicles, that’s why there is the saying “one day with eggs, three months with eggs”. If you can carefully adjust and change your lifestyle according to the above mentioned three months, and use some medication under the guidance of your doctor, you can improve your ovarian function and egg quality.