Overview of Diminished Ovarian Reserve and Treatment at PRC in Dubai
Diminished ovarian reserve (DOR) is a condition where the ovary loses normal reproductive potential, which will compromise fertility. DOR can occur from injury or disease, but it is most often the result of normal aging. Around 20% of women diagnosed with infertility have DOR.
What is the ovarian reserve?
A woman is born with all the eggs she will produce during her lifetime. The ovarian reserve is the number and quality of eggs in a woman’s ovaries, which is approximately 2 million. Women with a diminished reserve either have poor egg quality or have few eggs remaining. Many women have a good ovarian reserve into their early 40s, whereas others lose fertility in the 20s or early 30s. By the time puberty occurs, a woman has already lost three-fourths of the eggs she had at birth. By the late 30s, this number has declined significantly.
What is a menstrual cycle?
A menstrual cycle involves a growing follicle within one of the ovaries. The follicle is composed of an egg cell and the supportive and nourishing substances around it. The pituitary gland of the brain releases follicle-stimulating hormone (FSH), which causes the follicles to grow. A follicle becomes dominant and releases estrogen, which causes the uterine lining to thicken. After a follicle ruptures, an egg cell is released during ovulation (after a surge of the hormone luteinizing hormone or LH). The egg is then fertilized somewhere within the fallopian tube.
What are common causes of diminished ovarian reserve?
By the age of 45, few women remain fertile. However, success rates for fertility improve using in vitro fertilization (IVF) and egg donation. Certain things contribute to the diminished ovarian reserve. The common causes include:
- Age of 35 years and older
- Cancer treatments using chemotherapy and radiation
- Genetic abnormalities, such as X chromosome abnormalities
- Surgical removal of a portion or all of an ovary
What signs and symptoms are associated with DOR?
There are no outright symptoms and signs associated with diminished ovarian reserve, other than shortening of the menstrual cycle (going from 30 days to 24 days). Once menopause occurs, women show symptoms and signs of low estrogen, which include vaginal dryness, hot flashes, missed or absent menstrual periods, and trouble sleeping.
How is the ovarian reserve assessed?
To diagnose diminished ovarian reserve, the fertility specialist will perform a thorough physical examination and take blood samples. Testing is done on the second or third day of the menstrual cycle to measure estradiol and follicle-stimulating hormone levels. Fluctuations in normal baseline values of these two hormones indicates a decline in the ovarian reserve. Another blood test that checks fertility is the anti-Mullerian hormone (AMH), which reflects the actual number of eggs in the woman’s body. In addition, the doctor will conduct ultrasounds to visualize the number of follicles on the ovaries.
How is DOR treated?
At present, there are no treatments for slowing down or preventing ovary aging. After DOR is diagnosed, a woman can cryopreserve (freeze) eggs or embryos for later use. With ovarian failure, or when ovaries do not respond to ovarian stimulating drugs, donor eggs are recommended by the fertility specialist. Women with DOR can use eggs donated from younger women to conceive long after menopause occurs. Part of the treatment for infertility is injectable gonadotropin (FSH). The response of the ovaries following FSH for stimulation is predictive of egg quantity. In vitro fertilization is a treatment option for women who have poor egg quality, as well as few viable eggs. A natural IVF cycle is used for women who produce 2-3 follicles, and it does not require ovarian stimulation. With natural IVF, the success rate is only 5%. However, with regular IVF, the success rate is 10%.