The changing social fabric has changed the role of women. Depending on various personal, financial and social parameters, the decision of childbearing gets postponed. However, as the ovaries age, their reproductive potential comes down.
What is Ovarian Reserve?
Ovarian reserve can be described as, the total number of eggs available in both the ovaries of a woman at any given time.
Every woman is born with a certain number of eggs and with every menstrual cycle, a certain amount of these eggs is lost. For some women, this loss of egg reserve may be steady and slow with significantly low levels only after 40 years. But, for some, it may be rapid.
Unfortunately, ovarian ageing is 6 times faster in Indian women as compared to their Caucasian counterparts.
What could be the causes of Diminished Ovarian reserve?
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Most commonly DOR is idiopathic i.e., there may not be any obvious cause
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Autoimmune disorders
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History of past surgery involving ovaries
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Endometriosis
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History of irradiation or chemotherapy
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Genetic abnormalities like fragile X syndrome
What are the symptoms?
Quite unfortunately, there may not be any significant symptoms other than a slight shortening of the menstrual cycle.
How to diagnose DOR?
As a component of routine fertility tests, your fertility experts may ask for certain blood tests and ultrasonography to detect the current status of ovarian reserve.
The blood tests that are commonly done are:
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Follicular stimulating hormone (FSH),
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Luteinising hormone (LH) and
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Anti-Mullerian hormone (AMH).
A low AMH is usually the most significant determinant of decreased egg reserve.
In ultrasonography,
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Antral Follicle Count (AFC) is assessed which determines the number of follicles at the beginning of a menstrual cycle.
Can you conceive naturally with a diminished ovarian reserve?
The fecundability i.e ability to conceive naturally in a single cycle for a young newlywed couple is around 15 to 25 per cent. However, for a woman with diminished reserve, it may be reduced up to 5 %. But, the chances to conceive are never zero.
What is the treatment for DOR?
Diminished ovarian reserve is an urgent situation if not an emergency. The window of opportunity to conceive is narrow for these women. The mode of treatment here depends mainly on age and AMH levels.
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A young woman in her early 20s with a recent marriage and an AMH value close to 1ng/ml may benefit from quick trials of timed intercourse / Intrauterine inseminations (IUIs). If conception doesn’t occur with these trials, a swift decision for IVF without much wait can give a good outcome.
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A woman in her 20s with a low AMH who is not yet ready to start a family can undergo egg freezing or embryo freezing.
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For a woman in her late 30s with a low AMH, the best option would be an early treatment with IVF and cryopreservation of the eggs. Here, it’s important to note that the quality of the eggs has started deteriorating.
Depending on the severity of the condition, she may require either a simple IVF or embryo pooling cycles (wherein continuous IVF cycles are carried out till an adequate number of embryos are obtained for a successful transfer.)
In a situation where the egg reserve is really poor or the quality of eggs has worsened significantly, Donor IVF may be advised wherein, a suitable egg donor provides eggs which are then mixed with the husband’s sperms, embryos are formed and these embryos are transferred to the patient’s uterus.
Consultant - IVF & Reproductive Medicine
Manipal Hospital, Whitefield, Bangalore
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