What to Know About Your Ovarian Reserve  

pregnant couple with their son

Your ovarian reserve is an important assessment of your fertility potential. Your ovarian reserve looks at the potential eggs that remain in your ovaries at any given time.

“Women are born with all the eggs they will ever have, around 1 to 2 million, and as a woman ages the number of eggs in her ovaries declines,” shares Eduardo Hariton, M.D., M.B.A., a fertility specialist at Reproductive Science Center of the San Francisco Bay Area (RSC). “By the time a woman reaches menopause, as few as a couple hundred may remain. A woman’s egg count naturally diminishes with age, however, diminished ovarian reserve can occur at any age due to genetics, medical treatments, environmental factors, or prior surgeries.”

How is ovarian reserve tested?

The first step in checking for diminished ovarian reserve involves a blood test. This test is typically done on the third day of a woman’s menstrual cycle and measures certain hormones related to reproduction. These hormones include follicle stimulating hormone (FSH), estradiol (a hormone from the ovaries), and anti-Müllerian hormone (AMH), which is linked to fertility.

If FSH levels are high, and/or AMH levels are low, it could indicate a reduced ovarian reserve. It’s important to note that AMH can be tested at any point in the menstrual cycle and even while using birth control, although in the latter case, the levels may be lower because of the contraceptive’s hormonal effects.

What causes diminished ovarian reserve?

Diminished ovarian reserve is caused by women being born with fewer eggs than is normal, losing eggs more rapidly than other women her age, or experiencing more damage to eggs than normal. Even with every best effort made to prepare for conceiving naturally, some women and couples find they just can’t get pregnant. If the woman is in her mid- to late-thirties or older, there’s a strong chance the reason could be diminished ovarian reserve.

DOR is the result of a biological process that occurs in women as they age. Females are born with approximately 1-2 million eggs – all the eggs she’ll ever have. By the time they reach puberty, the quantity falls to between 300,000 to 400,000.

“During each menstrual cycle, several follicles, which house the eggs in the ovaries, start to develop, but ultimately usually only one follicle grows and leads to the release of an egg,” shares Dr. Hariton. “All the other eggs in that cycle die during a natural process called atresia. In fact, the majority of a woman’s eggs eventually disintegrate. This process occurs whether a woman is cycling regularly, takes oral contraceptive pills, becomes pregnant, or gives birth.”

Other risk factors for DOR include smoking, previous ovarian surgery, family history, and environmental conditions.

The number and health of a woman’s eggs are crucial when trying to get pregnant. As a woman gets older, her eggs are more likely to have genetic problems, which can result in embryos with an abnormal number of chromosomes. These embryos are less likely to develop properly and can lead to difficulties in getting pregnant or miscarriages, whether they are trying to conceive on their own or with fertility treatments.

Fertility treatment options for diminished ovarian reserve

By the time a woman has been officially diagnosed with diminished ovarian reserve, her options for achieving successful conception naturally are also likely diminished. Thankfully, there are treatment options through our fertility clinic. 

  • Ovarian stimulation with high-dose hormones: If a woman’s test results suggest that she still has sufficient ovarian reserve, a fertility specialist may recommend medications to stimulate ovulation using FSH and luteinizing hormone (LH) to produce eggs in larger quantities than normal. This option is suitable for intrauterine insemination (IUI) or IVF treatments, though the latter is typically more effective.
  • Egg donation and IVF: If a woman’s egg reserve is severely limited or she does not respond well to ovarian stimulation, she may still be a good candidate for donor eggs and in vitro fertilization (IVF). In this process, donor eggs are fertilized using sperm from the intended mother’s partner (or donated sperm) in the embryology laboratory. The resulting embryo(s) are then implanted in the woman’s uterus with the hopes of achieving a pregnancy.

For more information, please call your Progyny Patient Care Advocate (PCA) or visit RSC’s website.

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