Diminished Ovarian Reserve—What Does It Mean for Your Fertility?
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Understanding Diminished Ovarian Reserve (DOR)
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What Causes a reduction in Women’s Eggs?
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Symptoms of DOR
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How DOR is Diagnosed? Fertility Tests for DOR
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Fertility Treatments to work around DOR
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Understanding Diminished Ovarian Reserve (DOR)
Have you heard of the biological clock? While it is not one of our favorite topics, it is a real thing for women. As women age, the ability to reproduce naturally declines due to the lower egg count and decreased egg quality.
How many eggs does a female have?
Women are born with a limited number of oocytes (eggs). The count of those eggs never increases but only decreases. By the time of puberty, on average, a female has approximately 3 -4 lakh eggs. With each menstrual cycle, a woman loses about 1000 immature eggs. About 25,00 at age 37.
The rate at which this ovarian reserve declines rapidly at around age 32 and diminishes even faster after age 37.
What is Diminished Ovarian Reserve (DOR)?
Ovarian reserve refers to the reproductive potential of a woman which is predicted based on the number of eggs a female has in her ovaries and the quality of those eggs. And Diminished Ovarian Reserve (DOR) is the loss of normal female reproductive potential due to a lower count/quality of the remaining eggs. In simple words, DOR means a female has fewer eggs than expected for her age.
The production of eggs is essential for fertilization in turn for female fertility. diminished Ovarian Reserve with either less number of eggs or poor egg quality makes conception difficult.
Deterioration of egg reserve varies from woman to woman, younger women usually experience this less frequently. Evaluation of ovarian reserve is a crucial marker in understanding issues with conceiving.
There are no exact determining factors to define DOR, and evaluating what is the average number of eggs for a female is difficult. This is mainly due to individual differences. Measuring ovarian reserve is primarily done by observing hormone levels
What Causes a reduction in Women’s Eggs?
As women age, they will experience some level of natural diminished ovarian reserve. But there are also a wide range of other medical and lifestyle factors that could accelerate or cause an early DOR. And they include:
- Endometriosis
- Autoimmune disorders
- Smoking
- Genetic abnormalities
- Aggressive treatments (such as chemotherapy, radiation therapy)
- Ovarian surgery
- Pelvic infections
- Tubal disease
- Mumps
- Genital tuberculosis
- Idiopathic (no apparent cause)
- Being born with a fewer number of eggs
- Decline in eggs at a faster rate than normal with respect to a woman’s age
- Experiencing cumulative damage of oocytes over time.
It is even possible to have poor ovarian reserves at an early age & have none of the above risk factors.
Symptoms of DOR
The diminished ovarian reserve could be a difficult condition to accurately diagnose. Sometimes, it can be hard to detect because the symptoms are not necessarily noticeable. One of the major signs of diminished ovarian reserve is difficulty in conceiving, which is a typical symptom that makes women seek fertility treatment.
In some cases, there might be no physical symptoms, but some other symptoms that might hint at the possibility:
- Irregular/missed periods
- Heavy menstrual flow
- Shorter than average menstrual cycles
- Repeated miscarriages
If you have been trying to conceive for a while but have not succeeded, poor ovarian reserve could be one of the culprits and would likely be one of the first markers a fertility specialist will test for.
How DOR is Diagnosed? Fertility Tests for DOR
Diminished ovarian reserve is diagnosed using ORT-ovarian reserve testing, which is also known as day-3 testing. It mainly consists of blood tests and ultrasounds performed on the 3rd day of a woman’s menstrual cycle. Measuring reproductive hormones is one of the methods to identify diminished egg supply. Another is transvaginal ultrasound, which aids to count the ovaries’ antral follicles. It is important for women to know that a test showing even considerable DOR doesn’t mean she can’t get pregnant naturally. The following are some of the determining tests performed to predict the ovarian reserve of a woman:
Antral Follicle Count (AFC):
A follicle is a group of cells that contains an egg. Mature follicles are surrounded by fluid which can be shown in transvaginal ultrasound. As a part of fertility evaluation, the fertility specialists measure the number of follicles present in her ovaries during her menstrual cycle. And more number of follicles indicates that an ovary has an appropriate number of eggs. If the follicle count of both ovaries falls below 10 then it qualifies as a diminished ovarian reserve.
Follicle Stimulating Hormone (FSH) and Estradiol Testing
FSH is involved in egg production, blood tests are conducted to evaluate the FSH levels of a woman during the second or third day of her menstrual cycle. If the FSH levels are high compared with the women without diminished ovarian reserve, it signals that the woman has lower chances of conception. In this particular case, using ovulation induction with IVF can increase the likelihood of getting pregnant. Often estradiol (estrogen) and FSH levels are evaluated at the same time.
Anti-mullerian Hormone (AMH)
When follicles emerge to form egg storage in the ovary, they release AMH. Higher AMH levels indicate a higher number of follicles coming out of storage. AMH testing is accurate means of predicting the egg reserve that can even grow during IVF. Low AMH levels are indications of diminished ovarian reserve.
Fertility Treatments to work around DOR
Diminished ovarian reserve cannot be slowed down or prevented. But women with diminished/poor ovarian reserve could still get pregnant through various assisted reproductive technologies. They include the following:
DOR & IVF—IVF (In Vitro Fertilization) could be the effective ART treatment option for women who are diagnosed with poor ovarian reserve. During the IVF cycle, medications are given to women to elevate hormone levels that in turn stimulate the ovaries to produce and develop more eggs than normal. Later the eggs are collected and inseminated in the IVF lab. Once an embryo develops, it will be transferred into the intended woman’s uterus.
ICSI—Women with poor ovarian reserve also consider ICSI as a treatment option. In this procedure, a single and most viable sperm is isolated in the lab and injected directly into the egg to encourage fertilization. ICSI is very helpful in women having issues with their egg quantity and quality.
Using Donor Eggs —Donor eggs in conjunction with IVF, a woman with DOR can attain pregnancy. her partner’s sperm could fertilize eggs and the formed embryo could be implanted in her uterus.
Superovulation-–it is an enhanced form of ovulation induction, where medications are given to stimulate hormones and cause to ovulate more eggs, which can be used in a fresh IVF or cryopreserved for future IVF usage.
Fertility Preservation—women who suspect to have ovarian reserve issues, could preserve their fertility by freezing their eggs. It can also be tried as soon as a poor ovarian reserve is diagnosed.
Fertility issues related to diminished Ovarian Reserve can be successfully treated at MotherToBe Fertility Center in Hyderabad. Our legacy of expert care and renowned fertility specialists’ expertise has resulted in more than 9500 successful IVF cycles. Using the most advanced tools and ART techniques, we have been providing renewed hope for childless couples to achieve their dreams of building a family.
Discuss all your fertility treatment options with renowned fertility doctors to make the right decision for you and your family.