Poor ovarian reserve and IVF

Women who plan to get pregnant or have faced some difficulties with fertility usually refer to reproductive clinics to ask for advice on their fertility potential and recommendations for fertility treatments. Many women over 30-40 are diagnosed with something called “diminished ovarian reserve”, and they may mistakenly believe that it is a synonym to infertility. But it isn’t. What does this diagnosis mean? How does it impact the IVF success rate? Is it even possible to have IVF with low ovarian reserve?

Diminished ovarian reserve: what is it and what causes it

The low quantity of eggs in ovaries is called diminished ovarian reserve (DOR). The reduced ovaries’ egg supply is also associated with the changes in their quality, i.e. their viability, and in how well the ovaries will respond to the stimulation, performed as a part of ARTs such as IVF. In most of the cases, the causes of DOR in women are unknown but they are linked to some health issues such as genetic abnormalities, hormonal disorders, endometriosis, thyroid disorders, exposure to chemotherapy, and pelvic irradiations, as well as some lifestyle behaviours, like stress, smoking, and unhealthy nutrition, etc.

Ovarian reserves diminish over time in all women, the extent to which they do in each woman is unique. But most of the scientists agree that a steep decline in fertility starts in 13 years before menopause. Even though this pattern is pretty clear, two women of the same age may have completely different ovarian reserves and chances of getting pregnant. The problem researchers face in this aspect is that the biological ageing of the ovaries can occur independently of chronological age, so even young women may face the depletion of ovaries’ reserve. 

Despite all that, the poor ovarian reserve doesn’t necessarily mean the inability to conceive, it means that the chances are reduced, and it is necessary to improve them with some treatment or lifestyle changes. 

Unfortunately, it’s impossible to establish the number of eggs in ovaries accurately; all the existing technologies give rather approximate information. However, several tests nowadays offer the possibility to estimate the remaining pool of viable eggs, including antral follicle count (AFC), Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and clomiphene citrate challenge test (CCCT). The question about which of them works better for diagnostics is still controversial, but it is clear that the woman’s age affects the quality and quantity of her eggs. Some clinics recommend to take at least two different tests to obtain more accurate and exhaustive information and find out how many viable eggs still remain. 

Why would a woman want to test her ovarian reserve?

The reasons include the following:

• to predict how many years of fertility she has left;
• to determine her fertility status at this very point of time;
• to predict how well her body will respond to ovarian stimulation prior to IVF.

Low ovarian reserve and IVF success rates

One of the key elements of an IVF cycle is the retrieval of eggs from a woman after the ovarian stimulation. Since DOR is associated with the decline in response to such type of stimulation, and for this reason, the number of eggs ready for collection may be low.  If the number of eggs that may be collected is over 10, the prospects for the IVF are really good, if the number is lower than 5, the procedure may be problematic.

The number of eggs that may be retrieved is crucial because, in the IVF procedure, the doctor selects the best eggs for fertilization, and the obtained embryos are tested for deviations. The fewer embryos may be obtained, the higher are the chances that they may present some disorders or chromosomal abnormalities.

Implantation issues are also pretty common among the women who were diagnosed with low ovarian reserves. Such patients may also face some problems with bearing the child, for example, an increased risk of miscarriage after the IVF procedure with their own eggs.

Poor ovarian reserve treatment

The bad news is that there is no treatment for low ovarian reserve because it is a part of a natural ageing process. But there are some options you may use to solve this issue.

DHEA

The ovarian reserve does not rely only on the age of the eggs themselves, another important factor is the quality of the ovarian environment in which those eggs mature. The physician-prescribed dehydroepian-drosterone (DHEA) is used to improve that environment. DHEA is a powerful hormonal supplement that increases androgen levels in women with diminished ovarian reserve. 

Usually after undergoing such treatment and improving the ovarian environment, both the quantity and quality of woman’s eggs improves dramatically. This technology sufficiently increases the chances of pregnancy even for the women who are close to the depletion of their ovaries.

Donor eggs

The use of donor oocytes for IVF is another option for women to overcome their fertility difficulties. Reproductive clinics ensure the quality of eggs collected from a donor, fertilize them through IVF, select the best healthy embryos and implant them to the patient’s uterus or surrogate mother’s uterus. This procedure shows higher birth rates than the IVF using the eggs of a woman with low ovarian reserves. Doctors usually recommend this procedure after several IVF cycles fail.

You should understand that even if you are diagnosed with “diminished ovarian reserve”, it doesn’t necessarily mean that you are unable to get pregnant. This condition doesn’t imply that you are infertile; however, it does mean that you may face some difficulties with conceiving. Every case of this condition is unique and the treatment plan should be based on test and examination results.

 If you want to find out more about your ovarian reserve or if you are diagnosed with poor ovarian reserve, you may schedule a consultation with a fertility expert to get the help and support you need. By using professional doctor’s advice, you ensure that the obtained information about low ovarian reserve and IVF procedure and treatment services are of the highest possible quality and of reasonable price.