Diminishing Ovarian Reserve (DOR) rarely manifests in symptoms beyond an irregular menstrual cycle and shortening. Most women are diagnosed with DOR after blood tests measure FSH, estrogen and anti-Mullerian hormone levels such as AMH.
DOR occurs when a woman experiences either low egg counts or quality, most commonly as she ages; it can also be caused by genetic defects, aggressive medical treatments or physical injuries.
Ovarian Function
Ovarian reserve decreases with age, beginning in late 20s and continuing through menopause. This decline can be observed both in regular natural cycles as well as those taking fertility drugs to induce or stimulate ovulation induction or stimulation. Unfortunately, women experiencing diminished ovarian reserve typically show no symptoms; thus being diagnosed by transvaginal ultrasound testing and hormone analysis of FSH, Estradiol, and anti-Mullerian hormone levels.
Young women typically possess an oocyte pool containing over 8 million potential oocytes; over time this number gradually declines until it reaches approximately 2 million; of these approximately 400 will rise to the stage of ovulation while any others either perish during menopause or through atresia as part of apoptosis (cell death).
Anti-Mullerian hormone, or AMH, is one of the most popular ovarian reserve tests. AMH acts as a precursor for FSH during follicular phase development; therefore a low AMH level indicates reduced oocyte count. Unlike early-follicular phase FSH which rises with treatment-induce medication; instead AFC testing measures total number of antral follicle oocytes which provides an alternative testing approach for AMH testing.
Even as ovarian reserve diminishes with age, biomarkers of ovarian function do not reliably predict reproductive potential among women who are trying to conceive. Prospective cohort studies of time-to-pregnancy have not demonstrated AMH markers to reliably predict ovulation or pregnancy in current cycles, or provide insights into improving response to fertility medications that induce ovulation induction medications.
Ovarian Health
Women are born with a finite number of eggs that gradually decrease as they age, dropping from seven million in an early 20-week-old fetus to one to two million by birth, then 300,000. Over time, those that remain can become damaged and fail to result in pregnancy or cause miscarriage after conception.
In order to ascertain whether a woman’s ovarian reserve is within normal levels, her doctor will conduct several diagnostic tests such as transvaginal ultrasound and hormone analyses of FSH, estradiol and anti-Mullerian hormone. These can help your doctor evaluate your reserve as well as suggest appropriate treatments.
Not everyone believes that regular periods indicate healthy ovarian function; young women can still have low ovarian reserves due to genetics or lifestyle factors like environmental toxins that impact ovarian health and reduce reserves. Delaying childbearing until later life also increases risks of DOR; however if detected early there are several effective low ovarian reserve treatments which can increase chances of conception such as using donated eggs or IVF with one’s own healthy eggs.
Ovarian Stimulation
Ovarian stimulation is a treatment used to increase the number of eggs released during ovulation. It may be performed before artificial insemination or IVF to increase chances of successful conception. Ovulation is a natural process in which fertilized eggs are implanted into fallopian tubes by sperm sperm; however, many women have reduced ovarian reserve which makes achieving successful conception more challenging.
Diminished Ovarian Reserve (DOR) can be detected through blood tests and ultrasound imaging. In essence, DOR indicates that you possess fewer eggs than is typical for women your age, as well as lower quality eggs than most others your age. DOR may result from natural aging but can also be caused by genetic anomalies, aggressive medical treatments (radiation for cancer or surgery), and physical trauma to the ovaries.
To evaluate your ovarian reserve, we can measure blood levels of anti-mullerian hormone (AMH), estradiol and follicle stimulating hormone (FSH). Furthermore, an antral follicle count should be performed on day 2 or 3 of menstruation using transvaginal ultrasound and the number of visible small follicles on your ovaries can also help determine your reserve; an antral follicle count below 12 may indicate DOR which could result in poor responses to IVF stimulation stimulation.
Ovarian Reserve
Women are born with about 2 million potential eggs. Over time, their supply is gradually depleted through damage caused by natural processes called apoptosis – this causes their quality to diminish as their follicles shrink, making it harder for fertilized eggs to implant and lead to pregnancies. They lose approximately 100 eggs every day until menopause takes hold, meaning by 30 years old most women have shed half their potential egg supply.
Women with diminished ovarian reserve (DOR) often have regular cycles but fail to ovulate on an annual basis, increasing the risk of infertility due to age or other factors. The good news is that through ovarian stimulation treatment it is possible to enhance egg quality.
Ovarian reserve tests have been developed to assess a woman’s ovarian health. These include blood and ultrasound markers such as anti-mullerian hormone (AMH). Studies have demonstrated its predictive capability when used on quantitative outcomes such as oocyte yield; however it’s less effective at predicting qualitative ones such as being able to conceive. AMH levels also can vary considerably cycle to cycle; many doctors find antral Follicle Count (AFC) to be more reliable because it yields faster results that is less variable between cycles.
