Diminished Ovarian Reserve: What should you do?
Ovarian reserve is the estimation of the ability of a woman to produce eggs. A diminished ovarian reserve means the decrease in the total number of eggs present in the ovaries of a woman. With the continued decrease in diminished ovarian reserve, higher amounts of fertility medications will be required to achieve optimal follicular development. Due to decreasing egg supply, the woman experiences menopause.
The best time to diagnose the beginning of diminished ovarian reserve through blood tests is inaccurate. However, it coincides with an increase in basal follicle stimulating hormone (FSH) level (usually measured on the 2nd or 4th day of menses) more than >9.0 MIU/ml and antimullerian hormone (AMH) level less than 2.0 ng/ml or <15 pmol/L). If the FSH level increases more than 10 MIU/ml and the AMH level reduces to below 1.0 ng/ml or <8 pmol/l), the diminished ovarian reserve becomes more evident and when the basal FSH blood level is above >15 MIU/ml and the blood AMH concentration is below 0.5 ng/ml or 5 pmol/l, then the extent of diminished ovarian reserve becomes more severe, which contributes to likelihood of a “fresh” IVF treatment cycle leading to a low possibility of having a successful pregnancy. However, in such cases, egg donor IVF or “IVF” with embryo banking is given special consideration.
What are the possible reasons behind the occurrence of Diminished Ovarian Reserve (DOR)?
- Age related “wear and tear” of the women’s ovarian reserve
- Damage to ovarian tissues due to endometriosis and ovarian tumors
- Surgical removal of ovarian reserve
- Impact on ovarian tissues because of autoimmune process
Mini IVF or Natural Cycle IVF for women with DOR?
A woman with DOR can be easily convinced that absence or reduced ovarian stimulation yields a more natural and less painful approach instead of a durable, high gonadotropin based and long pituitary down regulation method. In my opinion, this is a misconception and be compromised rather than achieving benefits from IVF outcomes. The IVF success rates, either “mini” or “natural”, for women in their early or mid-30s is less than 15% than what could be achieved through the use of standard long down regulation protocols, which has a success rate of at least 30%. A “mini” IVF cycle involves the use of clomiphene which is linked with the production of LH-induced ovarian testosterone in high content, followed by an HCG (Human Chorionic Gonadotropin) dosage. Also, low dosage stimulation promotes lesser egg availability causing reduced IVF treatment India success chances in each egg retrieval performed. According to me, “Natural” cycle IVF is in my opinion also not in the best interest of women with DOR, as nothing can be done to regulate the excessive production of LH (luteinizing hormone by the woman’s pituitary gland.
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