Diagnosis And Treatment Of Diminished Ovarian Reserve
Diminished ovarian reserve or DOR refers to the process leading to the reduced ability of your body to produce eggs. Both the number and the quality of the eggs that you have decreased in diminished ovarian reserve. Aging is one of the most common reasons for DOR, but some other factors, including genetic defects, surgeries, or radiation, can contribute as well.
Your ovarian reserve indicates your ability to produce healthy eggs that the sperm can fertilize. So, in a way, it refers to the number of eggs that are left in your ovaries that are viable and can potentially lead to a pregnancy.
In contrast to men, women are born with all the eggs that they will make throughout their lives. As you age, this number keeps declining constantly. Let’s take a look at some numbers that will help you understand it a bit better-
• The number of eggs that a normal woman is born with 1 – 2 million
• Eggs left in ovaries by the time you reach puberty 400,000
• By your 30’s number of viable eggs remaining in your ovaries 27,000
• On the onset of menopause, the number of eggs remaining-about 1000 You might have heard women talk about how their ‘biological clock is ticking away, and they are not entirely wrong.
There is a truth to it; as you age, the number and quality of your eggs can diminish, and so can the chances of you getting pregnant. If you are looking to get pregnant later in your life, it is something to consider.
What is diminished ovarian reserve?
The number of viable eggs in your ovaries keeps on decreasing as you age. That said, some women can deplete their ovarian reserves earlier or later than other women. However, while diagnosing for diminished ovarian reserve, the number of eggs n your ovaries is compared to the national averages of women your age. If you have fewer eggs than the average for women of your age, you will be diagnosed with diminished ovarian reserve.
Although every woman is different when it comes to the number of eggs in the ovaries, it is safe to assume that you have around 2,000,000 eggs at the start of your life. By the time you enter the age of puberty, this number has already been reduced to about 400,000. By the time you are in your 30’s the number of eggs in your ovaries sees a further decline, with only about 27,000 eggs remaining.
You keep losing eggs through your fertile ages into menopause. Most women are left with less than 1000 eggs in their ovaries when they enter the menopause phase of their life.
Numbers from the Center of Human Reproduction suggest that as many as 10% of women are diagnosed with diminished ovarian reserve before reaching 40 years of age.
If you are diagnosed with diminished ovarian reserve, there is no need to lose hope; there are plenty of treatment options available for you. In the following sections of this post, we will try to take a comprehensive look at some of the treatment options available for women diagnosed with a diminished ovarian reserve and see some of the success stories.
What causes DOR?
Let’s make one thing clear; every woman will lose eggs as she ages. However, some women tend to lose eggs faster than others and risk being diagnosed with diminished ovarian reserve. Apart from aging, other causes can lead to a diagnosis of diminished ovarian reserve. Some of them are –
- Smoking The harmful chemicals present in cigarette smoke can cause an increase in the pace with your body’s destroyed eggs. The fertility problems faced by any woman who smokes are directly related to the number of cigarettes she smokes in a day.
- Genetic factors Certain genetic factors such as Fragile X syndrome has been shown to increase the risk of a diminished ovarian reserve diagnosis.
- Pelvic infections Pelvic inflammatory disease is a medical condition that can arise due to untreated pelvic infections. Several studies have shown a distinct link between pelvic inflammatory disease and diminished ovarian reserve.
- Autoimmune disease The hallmark of autoimmune diseases is an overactive immune system that can even attack the cells of your own body. If this attacks your ovaries, you can start losing eggs faster, leading to the diagnosis of diminished ovarian reserve.
- Chemotherapy and radiation treatment of cancer, such as radiation therapy and chemotherapy, can destroy rapidly dividing cells of the body, including ovarian follicles. Consequently, women undergoing these treatments might find it difficult to get pregnant.
- Endometriosis whether superficial or in the form of Endometriomas (Also called chocolate cysts) has the potential to decrease your ovarian reserve.
- Pelvic surgery If pelvic surgery requires the excision of a large portion of your ovarian tissue, then you stand to lose a chunk of your viable cells leading to diminished ovarian reserve.
- Idiopathic Not all cases of the diminished ovarian reserve have a defined cause. Such cases are called an idiopathic diminished ovarian reserve.
There are new causes of diminished ovarian reserve that are constantly being discovered. Much research is going on in this area, providing further insight into the condition and its causes. Scientists are hopeful of finding better treatment strategies for diminished ovarian reserve soon.
What are the symptoms of diminished ovarian reserve?
Diminished ovarian reserve is notoriously difficult to diagnose. In most cases, there is a lack of obvious physical symptoms that indicate the diminishing of the ovarian reserves. However, some signs might indicate an issue with the number of eggs you have in your ovaries-
- If you are experiencing irregular periods or missing periods occasionally
- If you are experiencing an unusually heavy flow during your cycles
- If you are having difficulty getting pregnant
- If you have had repeated miscarriages over the past few years
For most women, the diagnosis of diminished ovarian reserve is a surprise as they find about it only after a diagnostic fertility test such as hormonal tests and transvaginal ultrasound.
How is DOR diagnosed?
As we saw before, due to the lack of any obvious signs or symptoms, a diminished ovarian reserve can be accurately diagnosed only after lab tests.
Two fertility hormones routinely checked during blood work are Luteinizing Hormone (LH) and Anti-Mullerian Hormone (AMH). An abnormal reading in the levels of the hormones can potentially point to a possible diminished ovarian reserve diagnosis. Women diagnosed with DOR generally have a higher level of LH and a lower level of AMH compared to women of their age with normal egg reserves.
Your doctors can estimate the number of eggs you are left with by looking at the levels of these hormones. However, it is impossible to precisely determine exactly how many eggs you have remaining in your body. The doctor can tell you your fertility potential and how you compare to women your age who have no DOR diagnosis.
What are the treatments for diminished ovarian reserve?
You can still get pregnant even if you are diagnosed with diminished ovarian reserve. Some women with DOR can even conceive naturally, but for some, fertility treatments might be needed. The best chance of getting pregnant with a diminished ovarian reserve diagnosis is early detection and a personalized treatment plan.
If you are trying to get pregnant naturally, it is crucial to keep track of your fertility window. You have fewer eggs remaining, so; you must take advantage of the ones you still have.
Planning the intercourse at the right time goes a long way in improving your overall chances of getting pregnant. Using Fertility2Family’s ovulation predictor kits and basal body thermometer can help you determine the best time to have sex to get pregnant.
That said, many women who have been diagnosed with DOR need special fertility treatments to conceive. Some of the most common treatments include-
- Fertility preservation is the top priority when DOR is diagnosed. It includes removing the viable eggs from your ovaries and freezing them later or undergoing an in-vitro fertilization procedure if you are ready.
- DHEA supplementation is known to help increase the levels of androgens in your body, thereby preserving the quality of the eggs for an IVF procedure.
- Ovarian stimulation is the procedure of injecting hormones directly into your ovaries in an hour to stimulate them in making more eggs during an IVF procedure.
- Donor eggs can also be used from a younger female
One of the most unfortunate things about the diagnosis of DOR is that there is no treatment to reverse it. Hence, women with fewer eggs of high quality will still suffer from miscarriages even with an IVF procedure.
Talk to your doctor to weigh the benefit to risk ratio of each treatment option available to you. They will be able to help you with the option that best suits your individual needs.
Can you still get pregnant with diminished ovarian reserve?
The simplest answer to this question is yes. You might require fertility treatments, but it is quite possible for most women diagnosed with diminished ovarian reserve to get pregnant. Some women might need donor eggs or adopted embryos, but most will have their biological children.
A diminished ovarian reserve diagnosis might mean that the road to your pregnancy is a difficult one, but it doesn’t mean, in the least, that you should lose hope