Ovarian reserve can be defined as the quality and the quantity of the oocytes (eggs) in the ovaries. Diminished Ovarian Reserve (DOR) is defined as reduced capacity of the ovaries to produce oocytes (eggs). The oocytes produced by a woman with DOR are usually of poorer quality as compared to those produced by females with good ovarian reserve. Couples who are unable to conceive and plan to consult a fertility clinic must be tested for the female partner’s ovarian reserve. IVF clinics in Chandigarh conduct this test when a patient initially comes for a consultation.
Age of the female is the one of the most important factors in determining the quality and quantity of oocytes produced in an IVF cycle. This directly affects the chances of pregnancy. As a woman grows older, her ovarian reserve and her ability to conceive decrease both in natural cycle and assisted reproductive techniques cycle.
Decline in the ovarian reserve may put a woman at risk of poor performance in assisted reproductive techniques like IUI, IVF (test-tube baby). The most severe form of Diminished Ovarian Reserve (DOR) is represented by Premature Ovarian Failure (POF – Early Menopause) in young females.
Nowadays, with the increase in success rates of cancer treatment in children and in young women, the incidence of POF is rapidly rising. Age is considered to be the main cause of reduced ovarian reserve in a woman over 40 years of age, but as it is known, a premature reduction of ovarian reserve can also occur in young age. POF can occur spontaneously which is primary POF, or can be secondary to the consequence of chemotherapy, radiation, or surgery. Primary POF is because of unknown reasons in about 90% of cases.
RISK FACTORS & CAUSES OF EARLY MENOPAUSE/ POF
- Cigarette smoking
- Hypothyroidism (Increased TSH)
- Diabetes Mellitus
- Rheumatoid Arthritis
- Ovarian Surgeries
- Infections like Herpes and Mumps
HOW TO DIAGNOSE DIMINISHED OVARIAN RESERVE (DOR)
Most of the women with DOR have normal menstruation at the time of diagnosis. However, some may experience decreased menstrual flow or delayed cycles. Ultimately, DOR may result into early menopause or POF. Such patients may present with symptoms of flushing and sweats, depressive mood, and vaginal dryness.
Ovarian Reserve may be diagnosed based on:-
- Absence of periods for more than 3 months
- High levels of Follicle Stimulating Hormone (FSH)
- Low estrogen levels
- Low AMH level
- Low Antral Follicle Count (immature eggs count in ovary) through Ultrasound
The assessment of ovarian reserve has an important role in the management of patients with infertility. Clinically, the patient’s age and menstrual cycle pattern give a fair idea about the patient’s ovarian reserve.
CAN PATIENTS WITH DIMINISHED OVARIAN RESERVE CONCEIVE?
The only method of achieving pregnancy in DOR patients is by means of assisted reproductive techniques like – Artificial Insemination (IUI), In Vitro Fertilization (IVF), and In Vitro Fertilization with Donor Eggs. Women with severely DOR or POF benefit best by donor oocyte program.
To conclude, it is always wise to predict the patients likely to have a compromised ovarian reserve and provide proper counseling about the available options. A heartwarming emotional support by the treating doctor at Test Tube Baby clinics in Chandigarh provides miraculous psychological benefit to the patients.