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Struggling with Poor Ovarian Reserve ! Know all About it!

By Medical Expert Team

Jan 22 , 2019 | 4 min read

Poor ovarian reserve or diminished ovarian reserve is one of the leading causes of infertility in women worldwide. Understanding the condition, timely diagnosing it, and active management are essential for women to achieve fertility and reduce the need for egg donation.

Poor ovarian reserve can affect women of all ages and races. However, robust fertility treatments have allowed women with poor ovarian reserve to conceive and carry the child to term.


What is Ovarian Reserve?

The ovarian reserve of a woman refers to the estimated number of eggs or oocytes that she has in her ovaries. The ovarian reserve is a good indicator of a woman's fertility.

At birth, most baby girls have about 1 to 2 million eggs. By the time the girl undergoes puberty, this number declines to about 250000 to 500000. When the woman gets to the age of about 37, she is expected to have about 25000 eggs, which falls to about 1000 during menopause. This fall in the ovarian reserve corresponds to the decline in maternal fertility with age.


What is a Poor Ovarian reserve?

The expected or normal count of eggs or oocytes in a woman is estimated by age. When this count declines in a woman prematurely, it is often referred to as poor ovarian reserve.

Poor ovarian reserve or diminished ovarian reserve is the medical condition in which a woman may have a lower reproductive potential due to a reduced count or quality of eggs.

This diminished ovarian reserve, vis-a-vis her age, causes a woman to lose her normal reproductive potential. In addition, the impairment in the development of the oocytes also poses challenges in conceiving, even with assisted reproductive techniques.


What causes Poor Ovarian Reserve?

The ovarian reserve of a woman naturally diminishes with an increase in age. However, the rate of such a decline varies from woman to woman. Some women maintain a high ovarian reserve and fertility through their 40s, while some may show a decline in their ovarian reserve even in their 20s. While an increase in age is one cause of poor ovarian reserve, doctors believe genetic and environmental factors cannot be discounted.


Some other causes for poor ovarian reserve include –

  1. Genetic factors such as Fragile X and Turner's syndrome

  2. Exposure to radiation (including radiotherapy for cancer treatment)

  3. Surgery affecting the ovaries

  4. Damage to ovaries due to trauma, torsion, or infection

  5. Smoking

In some cases, a poor ovarian reserve may be idiopathic, meaning it could occur for no discernible reason.


Why is Testing for Ovarian Reserve Important?

A woman's ovarian reserve is directly linked to her fertility potential. This makes it very important to assess the ovarian reserves of women who face difficulty in natural conception or those who wish to delay childbearing. Such an assessment can help in timely intervention and fertility treatment.


Symptoms of diminished ovarian reserve

Poor ovarian reserve is not accompanied by any noticeable symptoms. Women whose ovarian reserves are diminished may experience the following -

  1. Delayed or absent menstrual periods

  2. Heavy periods, shorter cycles

  3. Difficulty in getting pregnant

  4. Spontaneous loss of a pregnancy/miscarriage


Women with poor ovarian reserves may face difficulty in conceiving naturally. Therefore, doctors may opt to assess ovarian reserves at the start of fertility treatments.

Women with poor ovarian reserves may also face lower success rates with fertility treatments. This could lead doctors to assess ovarian reserves later, leading to a diagnosis.


Does Poor Ovarian Reserve Lead to Difficulty in Pregnancy?

Poor ovarian reserve causes reduced chances of pregnancy both naturally and following fertility treatment. Every woman is born with a fixed number of eggs. As this number diminishes, the chances of pregnancy also diminish.

The goal of assessing and testing ovarian reserves is to encourage women with diminished ovarian reserves to pursue aggressive treatment to achieve pregnancy. It also helps women with diminished ovarian reserves to plan early pregnancy.


How is Ovarian Reserve Estimated?

Your doctor may recommend an assessment of your ovarian reserves in the following cases if you have a history of irregular periods, endometriosis, cancer treatment, or recurrent miscarriages.


If your doctor suspects that you may have poor ovarian reserves, he/she may recommend the following tests -

  1. Serum FSH and LH - Testing the follicle-stimulating hormone (FSH) and Luteinizing Hormone (LH) on the second or third day of your menstrual cycle indicates your egg reserves.

  2. Serum AMH – The Anti-Müllerian hormone is a test of your ovarian reserve. The AMH is a hormone secreted by the ovarian follicles. High levels indicate adequate ovarian reserve.

  3. Antral Follicle Count- Antral follicles are small follicles present in the ovary. The doctor may recommend a transvaginal ultrasound (TVS) to obtain a count of the number of antral follicles. This gives a good estimate of your ovarian reserve.


Treatment to improve the poor ovarian reserve

It is possible for women with poor ovarian reserves to get pregnant. However, early diagnosis and treatment will considerably increase the chances of pregnancy.

Since the number of eggs a woman has been fixed, no treatment can increase or improve the ovarian reserve.

One of the common treatments administered to women with diminished ovarian reserve is administering dehydroepiandrosterone (DHEA). DHEA is a mild androgen that improves fertility. Studies indicate that women on DHEA supplements are more likely to conceive naturally.

Doctors may recommend lifestyle changes such as quitting cigarette smoking in some cases.


Expert's Tips to Maintain Egg Count with Quality

Most fertility experts agree that maintaining a healthy lifestyle improves the quality of eggs and helps slow down diminishing ovarian reserves. Your fertility doctor at Max Hospital may recommend the following -

  1. Quit cigarette smoking

  2. Manage stress through yoga, meditation, exercise

  3. Eat a healthy diet

  4. Maintain optimal BMI

  5. Consult a doctor and take supplements as recommended

  6. Manage comorbidities through medication


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