What is Poor Ovarian Reserve and What Does It Mean for Fertility?

With more and more women leaving it for later to have babies. Some do so to follow a carrier or due to delay in finding a suitable partner to settle down to raise a family. Whatever the reason, more and more couples are having problems in conceiving a baby at later ages.

How Poor Ovarian Reserve Matters?

• Poor ovarian reserve leads to decrease in reproductive potential, which leads to infertility.
• Poor ovarian reserve leads usually to menopause, but the changes vary from woman to woman.
• No treatment can improve ovarian reserve, but women can take the help of assisted reproductive technology to get a baby.
• A woman’s ovarian reserve means the quality and quantity of her eggs, is reduced, ovarian reserve means those factors are decreasing.

Factors Affecting Ovarian Reserve

• Age (<=40 years)
• Genetic factors (Family History)
• Pollution
• Use of contraceptives
• Medical treatments
• Injuries

Tests for Ovarian Reserve

There are several tests to determine ovarian reserve:

• Blood AMH (Anti Mullerian Hormone); (0.5-1.1 mg/ml).
• Antral follicle count and ovarian volume (5-7 follicles).
• Disruption of the menstrual cycle.
• Day 3 levels of FSH/LH & E2 are good indicators of the poor ovarian.
• But the real test is by stimulating the ovaries and sees how many eggs we get.

Causes of Low Ovarian Reserve

Age –

A female is born with fixed number of eggs at the time of birth. The number of eggs begins to go down from the time a female becomes pubertal and several eggs are lost during each cycle, till the ovary is exhausted by 45 years of age. The menopause sets in. As the age increases the quantity and quality of eggs goes down and it becomes difficult to conceive. In some cases the changes may occur much earlier than normal.

Symptoms –

• Shortening of the menstrual cycle
• Signs of low estrogen (hot flushes)
• Vaginal dryness

Poor Ovarian Reserve and IVF Treatment

Poor ovarian reserve is an important limiting factor for the success of any treatment of infertility. Evaluating ovarian reserve and individualizing the therapeutic strategies are very important for optimizing the success rate. Majority or women with POR need to undergo IVF to achieve pregnancy. However, pregnancy rate remain low.

Last Resort:

However, if there are three or more failed IVF cycles, egg donation is recommended.

What to Expect?

It’s very crucial for a woman with known diminished ovarian reserve to be aware that her stimulation results may not be as robust as women who are younger or have normal ovarian reserve. Also, as ovarian reserve diminishes, there are higher chances that quality of eggs may be reduced as well, adding to the difficulty in conceiving and increasing the risk of unfavorable pregnancy outcomes. Remaining realistic about success rates is the safest approach.