Ovarian Conditions
What Is Ovarian Reserve?
The ability of a woman's ovaries to produce high-quality eggs (and ultimately good-quality embryos) is known as ovarian reserve (OR). OR declines naturally as women age, but some women experience a decline of ovarian reserve sooner than others. This variability can be influenced by factors, such as genetics, lifestyle, and underlying medical conditions. Understanding a woman's ovarian reserve can be crucial for fertility planning, as it provides insight into her reproductive potential.
What Is DOR?
Diminished ovarian reserve (DOR) is one of the primary conditions contributing to infertility in women. It is characterized by a reduced number of eggs in the ovaries and/or impaired development of the existing eggs. Commonly referred to as "low egg reserve," DOR presents unique challenges for women trying to conceive. The Center for Human Reproduction has been at the forefront of research on DOR for decades, pioneering treatments that have transformed patient outcomes. Notably, CHR has led the way in the use of DHEA, a treatment now widely recognized as a critical intervention for women with diminished ovarian reserve.
What Does Low Ovarian Reserve Mean for Fertility?
Women with untreated DOR often face significant difficulties in conceiving. Additionally, when conception does occur, the likelihood of miscarriage is higher than with any other infertility diagnosis. This increased risk is due to the fact that approximately 95% of embryo quality is derived from the eggs. Poor-quality embryos are less likely to develop and implant successfully in the uterus, and even if they do, they have a higher probability of resulting in miscarriage.
How Does Diminished Ovarian Reserve Affect Natural Pregnancy?
DOR, particularly when it's severe, significantly reduces a woman's chances of conceiving naturally. With fewer eggs available, ovulation may not occur every month, further decreasing the likelihood of pregnancy. Additionally, DOR often results in both low egg quantity and quality. Many women with DOR require ovarian stimulation and androgen (DHEA) supplementation, followed by IVF to improve their chances of conceiving.
What Does Low Egg Reserve Mean for Women Under 40?
Diminished ovarian reserve is typically associated with aging, but it can also affect women under 40. About 10% of younger women experience this early decline, a condition known as premature ovarian aging (POA), a term coined by CHR researchers. These women often face challenges in conceiving, even with fertility treatments, due to misdiagnosis. However, with accurate diagnosis and targeted treatment, many POA patients at CHR have successfully achieved pregnancy.
What Causes Poor Ovarian Reserve?
When initially diagnosed with poor ovarian reserve, many of our patients ask, “What causes low ovarian reserve?” DOR may be a part of the natural aging process; in other women, especially those with POA, it may have an autoimmune etiology. We also suspect there is a genetic component when DOR develops prematurely. With DOR, it is crucial that your fertility specialist recommend appropriate ovarian reserve testing for proper diagnosis and suggest diminished ovarian reserve treatment.
What Are the Symptoms of Diminished Ovarian Reserve?
Diminished ovarian reserve (DOR) often presents with no noticeable symptoms, leaving many women unaware of the condition. When symptoms do occur, they typically include irregular or missed periods. Difficulty conceiving and repeated miscarriages are often the only outward signs that DOR may be a factor.
How Is Diminished Ovarian Reserve Diagnosed?
Due to the lack of obvious symptoms, testing is crucial for diagnosing DOR in women struggling to conceive. The most reliable method involves blood tests measuring follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels; elevated FSH and low AMH indicate a depleted ovarian reserve. While antral follicle count (AFC) is sometimes used, it is generally less reliable than FSH and AMH testing.
What Is Premature Ovarian Aging (POA)?
Premature ovarian aging (POA) occurs when a younger woman has a lower ovarian reserve than expected for her age, leading to infertility issues. This condition is often overlooked but is a significant cause of female infertility. POA is characterized by a decline in both the number and quality of eggs at an earlier age than normal, making it difficult for affected women to conceive.
How Does Premature Ovarian Aging Differ from Early Menopause?
Dr. Gleicher explains that, unlike early menopause where the ovaries completely lose their ability to produce eggs, women with POA still have a chance to conceive. Although ovarian reserve naturally declines with age, approximately 10% of women experience this decline much earlier, a condition known as POA. With appropriate treatments, such as IVF combined with DHEA or CoQ10 supplementation and aggressive ovarian stimulation, women with POA can successfully conceive, unlike those with premature ovarian failure (POF) where egg production is lost entirely.
What Causes Premature Ovarian Aging?
The exact causes of premature ovarian aging remain largely unknown, but evidence suggests that genetic factors play a significant role, as POA often runs in families. Medical treatments like chemotherapy and radiation, as well as surgeries involving the ovaries, can also lead to POA or even premature ovarian failure (POF). Certain conditions, such as autoimmune diseases, endometriosis, and pelvic infections, are linked to an increased risk of developing POA. For these reasons, CHR physicians recommend avoiding unnecessary pelvic surgeries if family planning is a consideration.
How Does Premature Ovarian Aging Affect Female Infertility?
POA leads to diminished ovarian reserve, resulting in a poor response to ovarian stimulation during IVF cycles. This condition often produces low-quality eggs and embryos with a high rate of chromosomal abnormalities (aneuploidy). As a result, there are fewer viable embryos with a balanced set of chromosomes, leading to low pregnancy rates and a higher likelihood of miscarriage. These challenges make it significantly harder for women with POA to achieve and sustain a successful pregnancy.
What Is Premature Ovarian Failure (POF)?
Premature ovarian failure (POF), also known as primary ovarian insufficiency (POI), is a loss of ovarian function before the age of 40. POF can affect women at various ages, from their teenage years to their 30s. Women with POF are at a greater risk of a range of health issues, including osteoporosis, estrogen deficiency (hot flashes, vaginal dryness, etc.), and heart diseases. These POF-related issues can usually be managed well with hormonal replacement. However, for women with POF, fertility poses a challenge, as the loss of ovarian function means that the probability of pregnancy with their own eggs is greatly reduced.
What Causes POF?
Premature ovarian failure can be caused by several factors, including genetic conditions like Turner Syndrome and Fragile X syndrome. Autoimmunity, where the immune system mistakenly attacks the ovaries, is another potential cause. Surgical removal of ovarian tissue, such as during surgery for endometriomas, can also trigger early menopause. Additionally, chemotherapy and radiation can deplete the ovarian follicle pool, leading to POF, which is why fertility preservation is often recommended for cancer patients.
What Are the Symptoms of Premature Ovarian Failure?
Premature ovarian failure in younger women can present with symptoms similar to those of natural menopause, such as irregular periods, hot flashes, vaginal dryness, and mood swings. Other symptoms may include bladder issues, dry skin, and decreased sexual desire. Even if not trying to conceive, women experiencing these symptoms should seek medical help, as POF can have serious effects on overall health. Early intervention is crucial for managing the broader impacts of POF on the body.