Low Ovarian Reserve

Low Ovarian Reserve is a condition in which the ovary loses its normal reproductive potential, compromising fertility. Each woman is born with their lifetime egg supply. This supply continually decreases with age, trauma, and through monthly ovulation. During a woman’s reproductive life she will ovulate approximately 300-400 eggs. Theoretically, the best quality eggs will be ovulated first. 

The single most consistent variable affecting ovarian reserve is the woman’s age. In some cases like borning with genetically unbalanced eggs, some younger women can also have Low Ovarian Reserve. Although age is a factor there are some other reasons that cause diminished ovarian reserve such as environmental, genetic, and health-based. Known causes of Low Ovarian Reserve are; smoking, endometriosis, previous ovarian surgery, exposure to toxic chemicals, taking chemotherapy or radiation. 


Diminished Ovarian Reserve Diagnosis

Low Ovarian Reserve which is also known as “Diminished ovarian reserve” or “Poor Ovarian Reserve ” is a fact that reduces the chance of normal fertility. It’s also an important parameter for the success of IVF. 

Low Ovarian Reserve is a subnormal follicular response. Therefore there will be less number of eggs retrieved after ovarian stimulation during IVF. In order to identify if the individual has a low ovarian reserve or not, there are several clinical markers to be done before starting the IVF procedure. 

Before starting on an IVF treatment it’s a must to identify if the individual has enough ovarian reserve.  There are several clinical markers used to identify “poor responder”. 


How is Low Ovarian Reserve Diagnosed?

The most commonly used clinical markers are; Anti-Müllerian hormone testing (AMH), basal Follicle Stimulating Hormone (FSH), and ultrasound. 

Both AMH and FSH are blood tests that give the results of the remaining egg supply. Although FHS is the most known blood testing,  Anti-Müllerian hormone testing (AMH) is accepted as a novel method allowing much more analytical performances on measuring the size of the pool of growing follicles in women. The size of the pool of growing follicles reflects the size of the remaining egg supply – or “ovarian reserve”.

As every individual is unique, AMH levels may vary significantly in women of the same chronological age. The AMH test can be done on any day of a woman’s cycle. The purpose of monitoring the AMH level is to individualize the IVF protocols based on the women’s AMH level. 

FSH is another marker performed as a blood test. The purpose of FSH is to stimulate the ovaries. If the FSH level is high that means there are few eggs available. According to the test the individual’s FSH levels have to be in the normal range for the success of IVF treatment. FSH tests are drawn on the second or third day of the menstrual cycle. Test results may change due to what time blood is actually taken so FSH is not the only parameter to say that the individual has a low ovarian reserve and she is a poor responder. 

In addition to the FSH test, ultrasound is used to count small (antral) follicles in the ovaries. Ultrasound screening is also a promising approach. By monitoring the ovarian volume and antral follicle count clinicians can determine the chance of the individual’s fertility. 


Low Ovarian Reserve Symptoms

The low ovarian reserve doesn’t actually present any noticeable symptoms in most people. Difficulties in conceiving, numerous miscarriages, irregular menstrual cycles, or absent menstruation are the common signs that the individual may experience. 


Is IVF Successful With Low Ovarian Reserve?

If you are diagnosed with a diminished ovarian reserve, don’t despair. It only takes one egg to result in a successful pregnancy. 

In vitro fertilization (IVF) treatment is an excellent option for borderline or low ovarian reserve. Even if the individual has a very low ovarian reserve she may still be able to get pregnant by taking the right treatment. 


Low Ovarian Reserve IVF Protocol 

There are several types of IVF protocols for low ovarian reserve women. To choose the right protocol it’s important to see the hormone levels of the couple and learn about the couple’s fertility background in detail. As general, IVF protocols for low ovarian reserve are;  

  • Controlled ovarian hyperstimulation is the basis of any in vitro fertilization (IVF) procedure. There are multiple COH protocols used in IVF or poor, normal, and hyper-responders. 
  • Another IVF protocol for low ovarian reserve women is to utilize higher gonadotropin dosages.
  • IVF protocols for low ovarian reserve may prefer the application of “Recombinant FSH” (r FSH). 
  • Generally used another protocol to improve follicular recruitment in women is to start taking FSH. This procedure may be planned for the ones who are having a poor ovarian response in their past. 
  • IVF protocols for low ovarian reserve may contain the usage of LH. LH will let the individual get a favorable result on the quality of the oocyte. 
  • In some IVF protocols for low ovarian reserve, according to the needs, the usage of gonadotropins supplementing it with growth hormone (GH) or growth hormone with releasing hormone (GH-RH) may be planned. 
  • Using lower doses of GnRH agonists in tandem with higher doses of gonadotropins is another IVF protocol for low ovarian reserve.