Diminished Ovarian Reserve: What You Need to Know

Diminished Ovarian Reserve: What You Need to Know

Did you know that if you are a woman who was born with ovaries, you entered this world with all the eggs you’ll ever have? Unlike men, who make new sperm every day, your ovaries cannot make any new eggs during your lifetime. The number of eggs you have is at its highest right after birth and will slowly decline throughout your life until you reach menopause. This is a natural occurrence that happens to every woman. 

But what happens if the number of eggs you have starts to go down sooner than expected? This is called diminished ovarian reserve (DOR). According to the Center for Human Reproduction, about 10 percent of women may experience DOR. 

Many women with DOR may have trouble getting and staying pregnant. However, there are treatments available, and an early diagnosis is important for success. Let’s take a closer look at our ovaries and dive deeper into the causes and treatments of diminished ovarian reserve. 

Read More: The Role of Genes and Family History in Fertility

What is Ovarian Reserve?

Ovarian reserve refers to the number and quality of eggs you have in your ovaries. It’s a natural process for your egg reserve to decline as you get older. The American College of Obstetrics and Gynecology states that a good egg reserve is usually around the following numbers depending on your age:

  • 300,000 – 500,000 at puberty
  • 25,000 by age 37
  • 1000 by age 51

It’s impossible to know the exact number of eggs you have because ovarian reserve testing is done using hormone levels and not by counting eggs. Your healthcare provider can order blood tests to determine your hormone levels and what they mean for your ovarian reserve.

Read More: An Essential Guide to Improving Your Natural Fertility

What is diminished ovarian reserve?

Diminished ovarian reserve is when you have fewer eggs than other women your age. It can also mean that the eggs you have left are of lower quality. Fertility naturally declines as we age, but in some women, this can happen sooner than expected. 

What causes diminished ovarian reserve?

Getting older is usually the number one cause of DOR. Every woman will age differently, which can affect your ability to get pregnant. Some other causes of DOR include:

  • Smoking
  • Cancer treatments
  • Genetic abnormalities
  • Endometriosis
  • Ovarian surgeries
  • Only having one ovary
  • Pelvic infections

In some cases, there is no cause of diminished ovarian reserve.

Symptoms of diminished ovarian reserve.

There are usually no symptoms of diminished ovarian reserve. The only way you may find out you have a low ovarian reserve is if you have a hard time getting pregnant and your healthcare provider orders test to be done. Some women may start to notice changes in their menstrual cycle. Other symptoms may include:

  • Hot flashes
  • Vaginal dryness
  • Miscarriages
  • Shorter than average menstrual cycle

It’s important to talk to your healthcare provider if you are having trouble conceiving because of the lack of symptoms for DOR. ACOG recommends seeing a provider If you are over the age of 35 and have been trying to get pregnant for 6 months or more unsuccessfully. 

How can I test for low ovarian reserve?

You can test for low or diminished ovarian reserve by using blood tests that check for specific hormone levels. The eggs in your ovaries are immature eggs. They need certain hormones in order to mature into an egg that can be released during ovulation and potentially fertilized. Follicle-stimulating hormone (FSH) and estradiol are two hormones that work together to mature an egg. Antimüllerian hormone (AMH) is another important hormone that is used to determine ovarian reserve. 

Can I get pregnant with diminished ovarian reserve?

Yes, you can get pregnant with diminished ovarian reserve, but it may take more effort and interventions to make it happen. While getting pregnant is still possible, you’ll need to adjust your expectations. Your chances of conceiving are lower but remember, it only takes one egg to get pregnant. Only you and your healthcare provider can decide which options are right for you. Decisions like how many children you’d like to have, finances, and having a child that’s biologically related to you will factor into your treatment options. 

What is the treatment for low ovarian reserve?

Currently, no treatments can slow down or prevent diminished ovarian reserve. Quitting smoking, if you are, and early detection are the best ways to get ahead of the clock and maintain good quality eggs. For anyone who’d like to get pregnant with DOR, there’re a few options available depending on your wants and needs.

In-vitro fertilization (IVF) – If you’re ready to get pregnant but haven’t been able to, one option is IVF therapy. During IVF, your ovaries are stimulated with hormones to over-produce mature eggs. The mature eggs are then collected, fertilized to create an embryo, and placed back into your uterus, where it will hopefully implant and become a viable pregnancy. Treatment with IVF can get expensive, especially if multiple cycles are needed. Check with your insurance provider to discuss how many cycles of IVF may be covered. 

It’s also been recommended that some women with DOR who are going through IVF treatment take a supplement called DHEA. Studies have suggested that pregnancy rates increased in women who took DHEA before starting IVF.

Freezing your eggs/embryos – Another option you have is to freeze your eggs for future use in IVF treatment. Mature eggs are collected through ovary stimulation and then frozen until you need them. Some women may also decide to have the eggs fertilized into embryos and then frozen. 

Using donor eggs – If ovary stimulation is not working or not an option for you, you may decide to use a donor egg for IVF. This is a very personal decision since the baby will not be biologically related to you. However, you will get to experience being pregnant and giving birth. 

Folate – Folate alone won’t increase your egg count, but it has been shown to help maintain the quality of eggs you have left. Prenatal vitamins all contain folic acid and should be started before you try to get pregnant. 

Does low ovarian reserve mean early menopause?

There’s no clear answer on when you’ll go through menopause, with or without a low ovarian reserve. The number of eggs you have does decrease and becomes zero around menopause. Since every woman is different, we don’t know how fast that number will drop for each person. 

Being diagnosed with a diminished ovarian reserve can be very discouraging, especially if your dream is to have a child. Just remember that there are options available to help you reach your pregnancy goals. Having a child is a very personal decision that only you, your partner, and your healthcare provider can make. Talk to your healthcare provider if you have any concerns about the diminished ovarian reserve. The earlier you seek help, the higher your chances of having a successful pregnancy. 

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