Diminished ovarian reserve (DOR) is a diagnosis commonly seen in the infertility world. Women actually have the greatest number of eggs (6-7 million) prior to birth! By the time a female infant is born, the peak level has decreased to 1-2 million eggs. This number continues to decrease with age; as the loss of eggs with age is a natural occurrence in women. Hence, every woman will eventually be categorized under DOR. It is very hard to predict when a woman will reach DOR, but studies have shown that there is accelerated egg loss between ages 35-37. A woman is be categorized under DOR if two of the three criteria are met:
- Anti-mullerian hormone<1.1 ng/mL or less than 5 antral follicles (eggs) seen in each ovary
- Age > 40 years old or other risk factors (such as history of chemotherapy)
- Previous poor response to IVF stimulation – less than or equal to 3 eggs retrieved with previous cycle
Furthermore, once a woman is classified as having a low egg reserve, there is currently no evidence-based treatments to increase the number of eggs. Hence, DOR can be a very challenging diagnosis for both the patient and clinician. It is important to note that although there is a slight correlation between egg number and quality; quality of eggs is ultimately a function of age. Meaning, the younger a woman is the better the quality (genetics) of her eggs.
Can IVF help women with diminished ovarian reserve?
Women with DOR tend to either take longer to respond to IVF medications or respond poorly. There is also a higher chance that women with DOR undergoing IVF will have cycle cancellation and a low egg yield. Additionally, utilizing traditional IVF protocols may require high doses of medications with a greater number of stimulation days. A woman with DOR may also require multiple IVF cycles prior to a successful outcome.
While these traditional IVF protocols can lead to successful pregnancies, recent evidence points to the use of milder IVF protocols. There are a unique set of IVF protocols that utilize a lower amount of IVF medications with the goal of retrieving 2-6 eggs per cycle. Studies have shown equal to better pregnancy rates with these protocols. The added benefit for the patient is a lower cost burden; as less medication is utilized.
If you are struggling with DOR, seek a physician who is knowledgeable on the specific options available to you as someone with this diagnosis. There is still hope for pregnancy under the care of the right physician!