Fig. 4

The influence of ovarian reserve caused by internal and external factors. A The internal factors including changes of contents in follicle fluid, vaginal microflora alteration, and autoimmune diseases. In follicular fluids, the concentration of proteins, fatty acids, and amino acids, the decreased choline/phosphocholine and lactate, and increased lysophosphatidylcholine, glucose, and HDL are related to DOR. B The Actinobacteria, Atopobium and Gardnerella are increased in vagina of patients with DOR while Bifidobacterium is decreased. C Some autoimmune diseases can lead to DOR by regulating the level of related hormones. D The external factors including environmental pollution, psychological problems, and taking contraception. Living conditions such as persistent organic pollutants, polluted air, and heat stress can affect ovarian reserve by disturbing follicular development, inducing ovarian fibrosis, enhancing GCs apoptosis, and up-regulating inflammatory factors expression. E Psychological factors are potential influence of ovarian reserve. F Taking contraception can reduce the serum level of AMH, FSH, LH, and E2, and AFC.