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Diminished Ovarian Reserve – what this means for you

Diminished Ovarian Reserve – what this means for you

Receiving a diagnosis of diminished ovarian reserve (or low ovarian reserve) can be devastating. You will undoubtedly have concerns as to what this means for you and ultimately whether or not you’ll be able to conceive. But what does this diagnosis really mean and what can you do about it?

What is Ovarian Reserve?

Ovarian reserve refers to the number and the quality of eggs a woman has in her ovaries. If you have a diagnosis of diminished or low reserve, this means that you either have a few eggs remaining or that the ones you have are of poor quality.

It is a well-known fact that we as women have a ‘biological clock’. It is also well reported that your fertility starts to decline in your mid 30’s. However no woman is the same and for some women their biological clock may start ticking earlier than others. When we are born, we are born with all the eggs we will ever have and these reduce naturally over time. For example, at birth a woman will have 1-2 million eggs, by the time she reaches puberty this will be reduced to 400-500,000. By the time a woman reaches the menopause she’ll have lass then 1000 eggs remaining!

Some women are fertile well in to their 40’s, while others may find that their fertility has declined in their 30’s and tragically for a small percentage of women, this can happen in their 20’s.

What causes diminished ovarian reserve?

The actual cause of low ovarian reserve is not fully understood, however common causes are:

 

  • Age >35
  • Smoking – ages your ovaries by 10 years
  • Genetic abnormalities
  • Auto immune disorder
  • Chemotherapy or radiation
  • Surgery to remove part or all of the ovary

However, the majority of cases of diminished ovarian reserve are due to an unknown cause.

How to get a diagnosis

Diagnosing diminished ovarian reserve is rather controversial. It is better to consider a range of tests and their results rather than just one in isolation.

Follicle Stimulating Hormone (FSH)

An FSH blood test is measured on Day 3 of the cycle. A high FSH is strongly predictive of low reserve and predicts a poor IVF success rate.

Antral Follicle Count (AFC)

An ultrasound scan of the ovaries can be used to determine the number of follicles in the ovaries. Several studies have shown this test to be more accurate than FSH testing.

 

Antral Follicle Count Significance
< 4 Poor reserve
4–7 Low count, high dosage of FSH required
8–12 Slightly reduced reserve
> 12 Normal

 

Anti-mullerian Hormone (AMH)

An AMH blood test looks for declining levels of the anti-mullerian hormone and is best used in con-junction with the AFC scan.

 

Age Median AMH Level (pmol/l) 
25 24
30 17.5
35 10
40 5
45 2.5

 

Treatment

IVF: Assisted conception is possible with diminished ovarian reserve, although with variable success rates. Treatments for diminished ovarian reserve differ to traditional IVF and it is worth discussing these options with your clinics. Some clinics recommend the use of natural or mild IVF cycles.

EGG DONATION: Although the decision to move on to treatment with donor eggs is often a difficult one, it is important that you are aware from the outset that this is an available option and that it may offer the most realistic chance of pregnancy in those with a low ovarian reserve.

Donors are invariably <35 years old and the age of the recipient has minimal impact on outcome. There are many factors that need to be taken into consideration prior to embarking on egg donation and it is recommended that you receive either counselling or coaching to help in decision making and moving forward with this process.

Alternative Medicine:  Traditional Chinese Medicine and Homeopathy have been suggested as possible remedies for ovarian reserve issues. However, there is limited evidence to support their use in treating diminished ovarian reserve. Acupuncture and Yoga have also been suggested to positively affect blood flow to the uterus and potentially improve outcome. Again, there is no research to support their use however they are recommend as relaxation techniques and to improve quality of life if they are something you feel you would benefit from.

If you have any questions, in relation to the above. Feel free to get in touch.

 

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