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Diminished Ovarian Reserve

For some women, the cause of infertility is found to be diminished ovarian reserve.

While all women run out of eggs as they age, some women run out of eggs faster than they should. There are several potential causes for this condition, known as diminished ovarian reserve.

What causes diminished ovarian reserve?

Sometimes, diminished ovarian reserve appears to be due to genetic factors, such as a family history of early menopause. Sometimes, the cause is previous ovarian surgery for an ovarian cyst or endometriosis. Unfortunately, even with careful surgical techniques, some normal ovarian tissue, containing thousands of egg-containing follicles, will be lost during the process of surgery.

Treatments for cancer, including chemotherapy and radiation, as well as non-cancerous conditions such as lupus, can also significantly deplete a woman’s egg supply.

Most of the time, however, no cause is found. Regardless of the cause, the end result is the same: a shortened, protracted timeline for accomplishing family-building goals, sometimes associated with reduced chance for pregnancy and possibly, an earlier age at menopause.

Ways to measure ovarian reserve combine ultrasound and blood work

When your TFC physician performs an ultrasound, they can count the number of follicles that are visible in your ovaries. These small follicles are called antral follicles. The antral follicle count gives a clue as to the ovarian reserve, or “bank account” in the ovary.

In addition to the antral follicle count, bloodwork can be obtained early in your menstrual cycle to measure the hormones involved in egg development. These include follicle stimulating hormone (FSH), estrogen (E2), and anti-Mullerian hormone (AMH). Follicle stimulating hormone comes from the brain and is the hormone that makes eggs grow and mature. The lower the number of eggs left, the higher the FSH has to rise to cause eggs to grow and mature.

A normal FSH is less than 10 to 12. It is important to have an estrogen level drawn at the same time as the FSH. The estrogen level should be less than 70 to ensure that the FSH level is accurate. If the estrogen level is greater than 70, the FSH level is usually falsely low.

A high estrogen level may also be suggestive of diminished ovarian reserve because it signals that the ovary and brain have been working in advance to get the next month’s egg ready. This is another sign of the protracted fertility window.

There is nothing that can be done to improve ovarian reserve or make more eggs. Reassuringly, it is also important for patients to know that there is likely nothing in their past history that they should feel guilty about or responsible for causing. In some cases, pregnancy can still be achieved, so aggressive fertility treatment should be started immediately. However, for some women, the loss of eggs is so severe and the number of viable eggs remaining is so small, an egg donor is necessary for fertility treatment to be successful.

There are many options for treating diminished ovarian reserve. Our fertility specialists can help you get on the path to parenthood in a timely manner. Contact us to schedule an appointment to discuss diminished ovarian reserve and how we can help.