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Ovarian reserve is a term that is used to define the number of eggs and the quality of eggs that a woman has. Diminished ovarian reserve indicates a decrease in the quantity/quality of oocytes (female reproductive germ cells). If a woman has a low ovarian reserve or poor ovarian reserve, it can potentially lead to infertility. Doctors recommend ovarian reserve testing if a woman is trying to conceive a baby and has not been able to achieve pregnancy even after trying for a year. In this article, Dr. Banker and his team will discuss in detail the causes and treatments for diminished ovarian reserve.
 
What are normal ovarian reserves?
 
As mentioned earlier, the diminished ovarian reserve can be a factor for infertility in women. It affects women who are in the reproductive age group. It is often seen in women in their thirties but it can affect women below the age of 30 as well. A woman with a healthy reproductive system should have 300,000 eggs. A newborn female baby has about 1-2 million oocytes. During puberty/reproductive age she will have about 300,000 eggs out of which only 400-450 will go through ovulation. The rest of the eggs will degenerate. As women age, there is a noticeable decline in the quality and number of eggs. By the time she reaches menopause, she has only 1000 eggs.
 
What is considered a diminished ovarian reserve?
 
If it is found through ovarian reserve testing that she has fewer eggs (number and quality) as during her reproductive age, then it is considered as a poor ovarian reserve. Hence, women who are in their mid to late thirties can find it more challenging to conceive a baby due to a limited number of eggs. There is a decline in the quality of eggs oocytes as a woman starts to age. However, it is important to remember that this condition can occur to any woman irrespective of her age and can cause pregnancy loss as well.
 

Due to an alarming lack of awareness about diminished ovarian reserve, women have limited access to treatments regarding the same. Therapeutic interventions in these women can only be done if they do not let it advance to a critical stage. Many women are negligent towards their reproductive health until they are actively trying to conceive. Women with poor ovarian reserves undergo treatments of IVF and expect lower oocyte yield and lower pregnancy rates.
 
According to a study conducted by a city-lab in Mumbai, out of the 29,621 women in the reproductive age group of 20-40 had low Anti-Mullerian levels, as an indication of low ovarian reserves. “Over 54% of women aged 30-35 who underwent the test had extremely low or low levels, indicating fertility problems. Over 38% aged 26-30 reported extremely low or low levels of AMH,” said the release. The results of the study show the magnitude of the issue, especially concerning Indian women.
Another study published in a well-reputed journal shows that Indian ovaries age 6 years earlier than Spanish women. This can be due to our ethnicity or genetics. Hence, our ovarian reserve falls faster than in the western parts of the world.
 
Diagnosis:
 
Diminished ovarian reserve is characterized by lower pregnancy rates and higher pregnancy loss. Irregular menstrual cycles, very short menstrual cycles can be an indicator of poor ovarian reserve. However, one must keep in mind that a woman’s menstrual cycle can fluctuate due to various other reasons and hence cannot be the sole criterion in determining diminished ovarian reserve. Ovarian reserve testing is useful to evaluate the oocytes. Ovarian reserve testing also helps forecast the response to ovarian stimulation.
 
As mentioned above, the diminished ovarian reserve has been associated with increasing age and declining oocyte yield. However, a low ovarian reserve may occur in younger women as well, and hence, the inability to conceive/unexplained fertility can be considered as an indicator. Antral follicle count (AFC) done through transvaginal ultrasound and anti-mullerian hormone (AMH) testing are the most reliable indicators of diminished ovarian reserve. These two factors can give us a screenshot of the ovarian reserve at that point in time and are vital to planning customized ovarian stimulation protocols. The AFC and AMH indicators help in determining an accurate prediction of the ovaries responding to stimulation. Doctors may use both or either of these indicators as they are considered to be interchangeable. However, these tests cannot forecast the rate at which the ovarian reserve will fall.
 
There are various technological advancements to test for infertility. The Anti-Mullerian Hormone blood testing is one such good tool to assess the fertility of a woman. The AMH level is least affected by a woman’s menstrual cycle and therefore a blood test can be done anytime. A very simple method in ovarian reserve testing is to do an ultrasound and count the number of Antral Follicles or AFC.
 
When should you consider ovarian reserve testing :
 
Mayo Clinic states that it is important to get fertility testing if you have not been able to conceive even after trying for a year, or earlier if your age is more than 35 or have other underlying conditions like cancer, endometriosis, etc. A history of painful periods or irregular periods, miscarriages, cancer treatment, endometriosis, pelvic inflammatory diseases, etc requires ovarian reserve testing to be done. It is recommended to get a test done at the earliest to better your chances of achieving pregnancy and successful treatment.
 
Age is also a very important factor; if you are in your early thirties and have not been able to achieve pregnancy, visit a doctor. If you are above the age of 35, then you can visit a doctor after 6 months. If you are more than 40 years old, it is best to get ovarian reserve testing done immediately.
 
What are the symptoms of diminished ovarian reserve?
 
To notice poor ovarian reserve is quite tricky and is not self-diagnosable as there are not many noticeable symptoms. It is possible to experience the following symptoms:

     

  • Not being able to achieve pregnancy
  • Missed periods or delayed periods
  • Periods arriving earlier than 28 days, or shorter menstrual cycles
  • Very heavy periods
  • Miscarriages

 
It is possible to experience more than one or neither of these symptoms. Since it varies from person to person, it is required to visit a doctor if you’re having trouble in achieving pregnancy. A 20-year-old and a 40-year-old woman might ovulate approximately the same number of times each year, but their ovarian reserve can be grossly different. So, it is important to not take regular periods as a sign of a good reserve.
 
Treatment of diminished ovarian reserve:
 
Once it is found that a woman has a low ovarian reserve, it must be noted that there is no treatment or medication to increase the number of eggs. Usually, the next step is to reserve the eggs. If you are concerned about achieving pregnancy when you are indicating poor ovarian reserve, then do not worry, as it is still possible. Dr. Manish Banker, Ahmedabad, says that It is even possible to get pregnant with your eggs after undergoing treatment. Once again, your chances increase if you visit the doctor for an early diagnosis. If the person opts to visit the doctor for an early diagnosis, she can freeze her eggs and thaw them at the time of conceiving. Using proper stimulation protocols in IVF, one can have a chance of having a pregnancy with their own eggs. Elderly women can also opt for advanced genetic testing like PGT-A on their embryos so that they have a better chance of conceiving. Another treatment would be to use donor eggs to achieve pregnancy. Donor treatments involve IVF, where the egg is taken from a registered donor, and embryos are formed using male sperms and these embryos will be implanted in the woman’s uterus. The treatment completely depends on the intensity of the patient’s situation and her plans and so it is important to talk to your doctor about all available options and their implications on you and your body.
 
If you are not looking to conceive anytime soon, then here some ways to increase your ovarian reserve:
 

  • Have a healthy diet
  • Maintain a normal BMI
  • Avoid smoking (Smoking plays a large role in diminished ovarian reserve)
  • Exercise regularly
  • Avoid stress
  • Freeze your eggs

 
Conclusion:
 
To conclude, diminished ovarian reserve is usually found in women who are above the age of 30. However, it is possible for younger women to have a poor ovarian reserve as well. While there are many symptoms like irregular periods, heavy periods, infertility, etc, it is important to get ovarian reserve testing done at the earliest possible. Seeking professional help can only give you a deeper and accurate understanding of your situation. Blood tests and Ultrasounds are important to determine the AFC and AMH levels in your body which help doctors formulate a treatment plan for you. Treatments for diminished ovarian reserve would be IVF treatments, advanced genetic testing on embryos, donor egg treatments, etc. If you would like to read more such useful blogs on infertility by Dr. Manish Banker and the team, then you can visit our website.
 
 

For more information on infertility causes and treatments by Dr Banker Ahmedabad:
 

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