What is Diminished Ovarian Reserve?
Having fewer or low in quality eggs in the ovaries than in other females of the same age is known as diminished ovarian syndrome.(1) A person with the diminished ovarian syndrome may find it difficult to conceive, but it may not be impossible.
A female is born with all their eggs, the number of which decreases with age. Those with diminished ovarian reserve experience a decrease in the egg count earlier. Normally a female reaches peak fertility in her late teens till about the late twenties. By the age of 30, it starts declining. According to the American Society for Reproductive Medicine, females start losing their ovarian reserve before they become infertile and stop menstruating.(2)
Depending on the severity, in vitro fertilization or donor eggs may be recommended by the doctors. Other assistive reproductive technologies such as egg freezing or ovarian superovulation may also be recommended. Superovulation involves giving drugs to stimulate the ovaries to produce more eggs.
Females with a diminished ovarian reserve may find getting pregnant difficult. They may have fewer and lower-quality eggs. However, pregnancy requires only one egg, therefore it might not be completely impossible.
Other factors that may affect female fertility are:
- Body weight
- Sexual activity
- Previous pregnancy
- Ovulatory problems
- Tubal blockage
- Medication use
- Hormonal abnormality
- Uterine abnormalities
- Medical conditions including thyroid problems, vitamin D and polycystic ovarian disease
Causes of Diminished Ovarian Reserve
The diminished ovarian reserve has no causes. However, the condition can be linked with a person’s genes or medical treatments.
The causes include:
- Genetic variants
- Smoking tobacco
- Ovarian surgery
- Aggressive medical treatment including radiation therapy for cancer
Symptoms of Diminished Ovarian Reserve
A female with a diminished ovarian reserve may not have any symptom until they start trying for pregnancy. They find it difficult to conceive.
The symptoms experienced may include a shortening of the menstrual cycle from 28-25 days. An ovarian reserve test is carried out to determine the number of eggs. The diagnostic testing includes a transvaginal ultrasound to check the number of small resting follicles. Hormone level testing is also done, it includes testing the following hormones:
- Follicle stimulating hormone (FSH): It is an indicator of fertility and response to ovarian stimulation.
- Estradiol: It is a form of estrogen and also an indicator of fertility.
- Anti-Mullerian hormone: It indicates the fertility potential and is an indicator number of eggs a person is left with.
Treatments for Fertility
Increasing the number of eggs is not possible with any treatment but there surely are chances of an increase in the chances of pregnancy. The plan of treatment depends on age, when a pregnancy is needed, and how many children they want to have.
The various options for fertility include:
- Fertility Preservation: This option involves IVF for stimulation of egg growth, retrieving and freezing them.
- Ovarian Superovulation: In this option medication either injectable or oral is used to induce the growth of multiple eggs. During this procedure, ovulation is triggered and sperms are delivered by intrauterine insemination, a procedure in which the sperms are placed in the uterine cavity using a thin and flexible catheter.
- IVF with Donor Eggs: Females with an extremely low ovarian reserve may not be able to produce their own eggs. They can use the donor eggs and combine them with sperm to create an embryo.
Various vitamins and minerals can be helpful in supporting pregnancy. It is important to start taking prenatal vitamins 1-3 months before conceiving, to prepare the body for pregnancy.(3) Folic acid intake is necessary to prevent neural tube defects.
Docosahexaenoic acid (DHEA) plays a role in supporting the baby’s development. Vitamin D can benefits fertility and pregnancy and coenzyme Q10 is an antioxidant that may help with egg quality.(4)
The diminished ovarian syndrome is a condition in which there is a lower number of eggs. Various reproductive technologies and supplements can be helpful in making a person conceive.