Diminished Ovarian Reserve

Over the past few decades, postponement of childbearing until the mid-30s or 40s has been commonly seen because of women wanting to pursue higher education and a successful career. As a result of this, there has been a marked increase in the number of women with infertility who seek various treatment options to conceive.

What is Diminished Ovarian Reserve?

Diminished Ovarian Reserve (DOR), or poor ovarian reserve, is when a woman has low number of eggs in her ovaries and/or the existing eggs do not develop properly.As a woman ages, there is a natural and normal reduction in the number of eggs left in the ovaries. This is because eggs that are present in the ovaries cannot multiply. They continuously decrease in number from birth all the way through till menopause. Ovarian reserve may begin to decrease at age 30 or even earlier and decreases rapidly after age 40.

What are the consequences of DOR?

As the number of eggs in the ovary decrease, it becomes harder for the ovary to produce and release a healthy egg. As such the menstrual cycles become shorter and eventually stop. In this situation, women with DOR may have problems getting pregnant. Even if they do get pregnant, there may be high chances of miscarriage (pregnancy loss) or abnormalities in the foetus.Also, they may not respond optimally to fertility treatment.

What are the causes of DOR?

A woman is born with a fixed number of eggs. As the woman ages, the quantity as well as the quality of the eggs diminish and, therefore,her natural fertility potential diminishes.The following factors may accelerate the ovarian ageing process:

  • Smoking
  • High body weight
  • Endometriosis of ovary (presence of part of the uterine lining inside the ovary)
  • Surgical removal of part or all of an ovary·
  • Chemotherapy
  • Tumour in the ovary
  • Genetic problems

However, apart from women over 40, DOR can affect younger women as well.

What are the symptoms of DOR?

Most women exhibit no signs or symptoms of DOR, except for changes,perhaps, in the menstrual cycle, e.g., shortening of the menstrual cycle. It’s only when a woman is trying to conceive that she may realize that there is a problem and she will consult the gynaecologisst.

How is DOR diagnosed?

The following tests will be required to be done for testing the ovarian reserve

  • History of the woman - to understand if she has conceived before or not
  • Blood tests - to check for hormonal levels, e.g., AMH and FSH levels on day 3 of menstrual periods, on empty stomach
  • Ultrasonography - to check and monitor the number of follicles in the ovary

What are the treatment options for DOR?

Once a woman is diagnosed with DOR, it is advisable for her to attempt conception. In case she wants to delay pregnancy, she may undergo IVF* and freeze her eggs or embryos for future use. There are no medicines to increase the number of eggs in the ovaries; however the woman may be given medicines to help use the existing eggs efficiently. In case this fails, they can be taken from a donor.

*IVF - eggs and sperms are taken from the couple and are fertilized in a dish in a laboratory to produce an embryo. This embryo is then placed into the uterus.

How can DOR be prevented?

There is no way to avoid ovarian ageing, though lifestyle changes such as stopping alcohol consumption, not smoking, exercising regularly, having a balanced and nutritional diet may help. It is also important to know that postponing pregnancy may lead to complications such as difficulty in getting pregnant, high risk of miscarriage, and a high risk of abnormalities in the baby. Hence, it is important to take informed decisions related to fertility preservation.

For further queries, kindly consult your Doctor. .

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