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Low Ovarian Reserve : What Next?

For many couples, infertility is a struggle with age being a primary hindrance.  With increasing age, low ovarian reserve becomes a major concern.  This biological clock has a major impact.

Let’s understand a few terminologies before we proceed further.

“Ovarian reserve” is the term often used to describe the ability of a female to have a baby. As age increases, the ovaries produce fewer eggs, their quality often goes down, and the eggs have more abnormalities, their capability to get fertilized decreases. This simply means, older women have lower pregnancy rates and higher chances of miscarriage, especially those above 35.

The ability to have a baby decreases as age progresses, but the exact age when a woman can no longer conceive varies within a group. In certain situations, it happens too early as compared to others. About one-third of the couples often face difficulty getting pregnant when the female is 35 years of age or older. There are many tests available that show a woman’s fertility potential, also known as ovarian reserve. Ovarian reserve refers to the reproductive potential left within a woman’s ovaries concerning the number and quality of eggs.

There are factors other than ageing alone that also cause diminished ovarian reserve.

What is low egg or ovarian reserve then?

Females are born with all the eggs they can have in a lifetime. During puberty, only 3 million eggs are in reserve in the ovaries. As women age, egg quantity and quality decrease. That is the reason pregnancy is often delayed.

There are other medical reasons too that can cause low ovarian reserve.

– Endometriosis (the lining of the uterus is outside & responds to hormonal changes and can cause scarring)

– Problems & disease of the fallopian tube

– Previous Ovarian surgery

– PID (Pelvic Inflammatory disease)

    – Early Menopause, 

    – Mumps 

    – smoking 

– Chemo & Radiation therapy

Women with a low ovarian reserve can still enjoy motherhood with the help of assisted reproductive technologies like IVF. Early diagnosis and treatment is the key to avoiding mental trauma and financial cost related to pregnancy.

How do I find out about my egg reserve?

A typical sign is an inability to conceive despite an active sex life for a year, without contraceptives. This applies to women below 35. For those above 35 the waiting period is 6 months only.

Other signs may be,

Amenorrhea (absence of one or more periods, not due to pregnancy)

Menstrual Cycles (shorter than 21 days)

Heavy Periods

Miscarriage

If you have any of these symptoms and cannot conceive, it is time to talk to a fertility specialist.

Can a low egg reserve be confirmed?

Yes, through a simple blood test (AMH) corelated with a transvaginal ultrasound.

On or about the third day of your menstrual cycle, through the blood sample, the hormone levels of FSH/estradiol and the anti-Müllerian hormone (AMH) levels will be measured. These hormones are necessary for regular ovulation.

Higher FSH and lower AMH than normal signal low egg reserves. AMH confirms the number of eggs in the body. On getting these reports along with a transvaginal ultrasound, the doctor will draw up a personalized plan for diagnosis and treatment.

How successful is IVF with low ovarian reserve?

For those women with borderline egg reserves, conventional IVF is the answer. The earlier you start, the better the success rates of IVF.

IVF with donor eggs is the right treatment for women with very low egg reserves. Healthy donor eggs increase the chances of a successful pregnancy.

How to address the concern of low ovarian reserve?

1. Science has a solution for low egg reserve as you are the only one suffering from this.

2. Have or adopt a healthy lifestyle.

3. Maintain a healthy BMI and body weight.

4. Take medication or supplements under the doctor’s guidance.

5. Don’t delay treatment or diagnosis.

6. Do make an informed decision to get the treatment from the right doctor first and then the clinic.

How to improve low ovarian reserve?

If you are at high risk of having a low ovarian reserve, freezing your eggs before your egg count declines further can work.

Egg freezing involves using hormones to stimulate the ovaries to produce as many eggs as possible. Then mature eggs are harvested under general anaesthesia and frozen for subsequent IVF treatment. 

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