There are many ways to describe a woman’s age: biological age, psychological age, childbearing age and ovarian age. Ovarian age basically reflects reproductive age, but they do not always coincide exactly with biological age. As early as 1957, a study on the reproductive dynamics of women who did not use contraception for religious reasons found that women’s ability to conceive declined slowly from age 25, accelerated after age 35, and became almost zero at age 50. or more. The most common theory to explain this phenomenon is that as we age, the quantity and quality of oocytes in the ovarian reserve gradually decreases, which in turn leads to the failure of fertility. Case 1: Ms. Zhang, 41 years old, a civil servant in the public security system, still felt that her economic base was not stable enough after her marriage at the age of 36, and after several years of hard work, she now has a house, a car and savings, and intends to complete her fertility plan this year. The results of the endocrine examination indicated that the ovaries had begun to fail. It looks like her plans to have children in this life are in jeopardy. Case 2: Ms. Luo, 38 years old, a personnel director of a foreign company, had quit her job for half a year to prepare for pregnancy and came for medical checkup with the mentality that there was no harm anyway because she was eligible for the free preconception checkup policy in Jing’an District. Her medical history suggested that her cycle had been delayed by 5-7 days in the last 2 months. The endocrine results showed that the pituitary hormone level was close to the upper limit, while the ovarian hormone level was posted at the lower limit, suggesting a significant decrease in ovarian responsiveness, and no mature follicles could be found in the ultrasound follow-up of that month. After a combination of outpatient Chinese and Western medical management, and even the use of my home grown hormone, one follicle was finally stimulated after 4 months. Fortunately, this one egg has allowed her to be pregnant for 5 months now. If it had been any later, I think I would have given up the treatment. Case 3: Ms. Rong, 32 years old, employee of a logistics company, preconception clinic history: menstrual cycle of 30-60 days, amenorrhea for more than half a year, no menstruation without medication. The endocrine measurement showed that the pituitary follicle stimulating hormone had exceeded three times the upper limit of normal, suggesting premature ovarian failure. There was nothing more she could do as a doctor. Shanghai’s modern urban women have significantly increased their level of advanced education and their ability to participate in social activities, which has resulted in less social space and an unprecedented demand for money and material goods. The phenomenon of “leftover men and women” has become a social problem today. However, as the incidence of infertility continues to rise and the number of older women with first-time mothers and birth defects increases, more and more family planning workers have begun to actively join the ranks of those who advocate marriage and childbearing at the right age, which has also led to a great deal of concern among reproductive medicine and eugenics practitioners about the endocrine changes in reproduction in older women. Prerequisites Egg reserve and maturation The development of female reproductive cells begins in the embryonic period. At birth, all female germ cells become primary oocytes, approximately 2 million in number, through the first meiotic division. During the following 12 years of infancy and adolescence, the number of primary oocytes decreases further to only about 300,000 at the onset of puberty. After puberty, only about 500 follicles are able to successfully complete a second meiosis to become fertilized eggs. This shows that the egg is a non-regenerative cell that requires adequate reserve during fetal life and reasonable reduction before puberty, and that after puberty, multiple follicles are recruited during each menstrual cycle, yet only one follicle matures, ovulates, and completes the final maturation of the egg. Therefore, the assessment of egg quality inevitably needs to involve the number of follicles. Urgent attention needs to be paid to changes in the number of eggs Changes in the number of eggs and age It is now well established that the number of follicles tends to decline gradually with age, with a more pronounced decline when a woman is older than 35 years of age, and an even more accelerated decline after 40 years of age, with only 2500-4000 primordial follicles remaining in each ovary as she approaches 50 years of age. It is generally accepted that reproductive function declines when the number of follicles is 250,000, and amenorrhea occurs when there are less than 1000. The average age of menopause in women is 51-52 years old, but it can also occur between 40 and 60 years old, marking the depletion of the follicular pool. In addition, recent studies have also concluded that the biological age of the woman is not important and that there is a significant correlation between the decline in follicle count and chromosomal abnormalities in the eggs, the rate of which determines the reproductive and menopausal age of the woman. Changes in egg quality and age One statistic of more than 100,000 IVF cycles found that the live birth rate was 43.2% for women under 35 years of age, dropping to 15.1% between 41 and 42 years of age, and dropping further to 5.9% over 42 years of age. In contrast, the pregnancy and delivery rates of older women who received egg donations were not lower. In addition, in the 1960s it was found that more than 50% of spontaneously aborted fetuses were chromosomally abnormal and were associated only with advanced maternal age. Genetic examination of oocytes has also revealed that the eggs of older women are unable to maintain the stable function of younger women, leading to an increased frequency of chromosomal non-segregation, which is the significance of the current prevalence of Down’s syndrome screening in prenatal diagnosis. This all points to the existence of egg quality problems in older women. Vigilance Prevention of premature ovarian failure Every woman is born with ovarian function. However, there are many diseases or factors that can affect the function of the ovaries. In addition to gynecological diseases such as ovarian cysts, fibroids, endometriosis, pelvic inflammatory disease, and pelvic and abdominal surgery, common factors include genetics, age at menarche, fertility status, use of birth control pills, nutrition, smoking, alcohol, exercise, and psychological stress. However, there is no good indicator for determining the “age of ovaries” of an individual, which is often based on understanding the physiological age of women, relying on the basal values of pituitary FSH hormone, ovarian E2 hormone, as well as ultrasound sinus follicle count and basal AMH level. The choice of treatment plan is based on a combination of indicators such as pituitary FSH hormone, ovarian E2 hormone basal values, and ultrasound sinus follicle count and basal AMH level. The fact that many women are nearing menopause and want their doctors to delay the onset of menopause through medication, as well as the so-called ovarian maintenance that many beauty salons offer today, such as oil massage of the ovaries, are not based on science and are unrealistic. The so-called Nobel Prize in medicine and the efficacy of Chinese medicine in advertising are nothing more than the concept of the pharmacological effects of Viagra and the use of our Chinese sentiment for traditional Chinese medicine. Reasonable exercise with traditional massage, acupuncture and herbal medicine can only improve the local blood circulation in the pelvis, and at most can only promote the development of the follicles that have been recruited in the ovaries in the current month, which is not likely to have an effect on delaying the aging of the ovaries. The secret to true youthfulness lies in good lifestyle habits, a reasonable diet, reconciling and maintaining a good psychological state, and insisting on proper physical exercise.