What is a Diminished Ovarian Reserve?
The total quantity of healthy eggs in a woman’s ovaries at any one moment is referred to as her ovarian reserve. The number of eggs a woman has at birth is limited and will eventually decrease.
Diminished ovarian reserve occurs when this decline happens more rapidly than usual, leading to a reduced number of eggs and often poorer egg quality. This condition can affect women of all ages but is more common as women approach their mid-30s and beyond.
What are the Causes of Diminished Ovarian Reserve?
While aging is the most common cause of diminished ovarian reserve, several other factors can contribute to this condition. These include:
1. Genetic Factors: Genetic abnormalities, such as Fragile X syndrome can affect ovarian function.
2. Medical Treatments: Chemotherapy and radiation therapy for cancer can damage the ovaries and reduce the number of viable eggs.
3. Surgical Procedures: Surgeries involving the ovaries, such as the removal of ovarian cysts, can impact the ovarian reserve.
4. Lifestyle Factors: Smoking and exposure to environmental toxins can accelerate the decline in ovarian reserve.
5. Autoimmune Disorders: Conditions where the body’s immune system attacks its tissues can affect ovarian function.
6. Infections: Pelvic infections and diseases like mumps can cause ovarian damage.
Diminished ovarian reserve can be difficult to anticipate and treat since, in certain circumstances, there may be no known cause.
What is the Average Egg Count by Age?
The number of eggs in a woman’s ovarian reserve changes throughout her life. Understanding these numbers can provide insight into fertility potential:
- At Birth: A baby girl is born with 1 to 2 million oocytes (immature eggs).
- At Puberty: By the time she reaches puberty, the number of oocytes decreases to about 300,000 to 500,000.
- In Her 20s and Early 30s: The egg reserve continues to decline gradually but remains sufficient for most women to conceive.
- Around Age 37: a number of oocytes drops significantly to roughly 25,000.
- At Menopause: By the average age of menopause, around 51, only about 1,000 oocytes remain.
Recognizing the Symptoms
Diminished ovarian reserve often presents with subtle or no symptoms. However, some women may notice signs that can indicate a problem. These include:
1. Difficulty Conceiving: One of the most common indicators is the inability to get pregnant after several months of trying.
2. Menstrual Irregularities: Changes in the menstrual cycle, such as shorter cycles or missed periods, can be a symptom.
3. Heavy Menstrual Flow: Some women may experience unusually heavy menstrual bleeding.
4. Miscarriages: Repeated miscarriages can sometimes be linked with poor egg quality associated with diminished ovarian reserve.
Given the subtle nature of these symptoms, many women may not realize they have diminished ovarian reserve until they face difficulties in conceiving.
Diagnosing Diminished Ovarian Reserve
Early diagnosis of diminished ovarian reserve is crucial for effective management and treatment. If a woman is having trouble conceiving, especially if she has irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, or a history of cancer treatment, she should seek medical advice promptly.
If a woman under 35 has been trying to get pregnant for a year without success, she should see a doctor. For those over 35, medical advice should be after six months of attempting. If a woman over the age of 40 wants to get pregnant, she should see a doctor right away.
The diagnosis of diminished ovarian reserve typically involves several tests:
1. Blood Tests: Levels of follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) are measured. High FSH and low AMH levels are indicative of diminished ovarian reserve.
2. Vaginal Ultrasound: This test measures ovarian volume and counts the number of small follicles in the ovaries, known as the antral follicle count (AFC).
3. Clomiphene Citrate Challenge Test: This less common test involves taking fertility medication and monitoring body responses.
These tests help healthcare providers estimate the remaining number of eggs and assess the likelihood of responding to fertility treatments.
What are the Treatment Options Available?
Although diminished ovarian reserve can make conception more challenging, several treatment options are available to help women achieve pregnancy. The choice of treatment depends on individual circumstances, including the urgency to conceive, financial considerations, and the desire for a genetically related child.
Supplements
Dehydroepiandrosterone (DHEA) supplements are at times used to improve ovarian function. Studies have shown that DHEA may increase the success rates of in vitro fertilization (IVF) and spontaneous pregnancies.
Egg Freezing
For women diagnosed with diminished ovarian reserve at an early stage, freezing healthy eggs for future use is an option. It involves hormone stimulation to produce multiple eggs, which are further retrieved and frozen.
In Vitro Fertilization (IVF)
IVF can be performed using the woman’s own eggs or donor eggs. In cases where egg quality or quantity is significantly compromised, donor eggs may be recommended. The eggs are fertilized with sperm in a laboratory, and the resulting embryos are transferred to the uterus.
Donor Eggs
Retrieving donor eggs, fertilizing them with sperm, and implanting the resulting embryos into the woman’s uterus are the steps involved in using donor eggs. When alternative therapies seem unlikely to work, this approach is considered.
The Importance of Early Diagnosis and Intervention
Early diagnosis and intervention are critical in managing diminished ovarian reserve effectively. The sooner the condition is identified, the better the chances of successful treatment and conception. Women who suspect they might have issues with their ovarian reserve should not hesitate to seek medical advice.
The Bottom Line
Diminished ovarian reserve is a leading cause of female infertility, affecting the number and quality of eggs in the ovaries. While the condition poses challenges to conception, various treatments, including supplements, egg freezing, IVF, and the use of donor eggs, offer hope to many women.
Understanding the causes, recognizing the symptoms, and seeking early diagnosis are essential steps in managing this condition and improving the chances of achieving a successful pregnancy. If you suspect you might have diminished ovarian reserve or are facing difficulties in conceiving, consult a doctor to explore your options and develop a tailored treatment plan.
FAQs
1. Can a woman with diminished ovarian reserve get pregnant?
Yes, a woman with a diminished ovarian reserve can still get pregnant, although it may be more challenging. Fertility treatments, such as IVF, can improve the chances of conception.
2. How to fix diminished ovarian reserve?
Diminishing ovarian reserve cannot be reversed, but treatments like fertility medications, egg freezing, and using donor eggs can help manage the condition and improve the chances of pregnancy.
3. What is the best IVF treatment for low ovarian reserve?
The best IVF treatment for low ovarian reserve often includes using higher doses of fertility medications and, in some cases, considering donor eggs to increase the likelihood of a successful pregnancy.
4. Does PCOS cause diminished ovarian reserve?
No, polycystic ovary syndrome (PCOS) does not cause diminished ovarian reserve. Women with PCOS typically have a higher number of antral follicles.
5. How can I increase my ovarian reserve?
Ovarian reserve cannot be increased. However, maintaining a healthy lifestyle, avoiding smoking, and managing stress can support reproductive health and egg quality.
