Diminished Ovarian Reserve

Diminished ovarian reserve or low AMH does not mean you cannot get pregnant, either naturally or via IVF.

DOR is characterized by a low AMH or low number of eggs in the ovaries. Although AMH levels reflect the number of eggs (oocyte pool) that remain in the ovary, it does not predict whether you can conceive.

 

What is causing my ovarian reserve to decrease?

A decreasing ovarian reserve is a part of the natural aging process – you did not do anything that caused DOR.


In some women especially when DOR develops prematurely, there may be a genetic component. If your mother or siblings had menopause before age 45, these can be random events, but can also be passed on through families.
You may have an autoimmune etiology.


Smoking is highly associated with diminished ovarian reserve.
Previous ovarian surgery, endometriosis or chemotherapy can significantly decrease your ovarian reserve.

Can I get pregnant with DOR?

You can get pregnant with DOR or ‘low AMH’; we had countless patients that are proof of that.

Age is a huge factor that affects your fertility prognosis. Numerous studies have shown that young women with low AMH level have a fairly good chance of getting pregnant naturally or via IVF. If you are > 38 years old, you may need a fertility specialist that is experienced in treating women with DOR to help you achieve the best chance of success. Think Fertility has special expertise in treating women with DOR, born out of our year-long experience on the condition.

Why is Mild-IVF the best treatment for DOR?

Regardless of your age, if you can achieve a healthy egg and embryo, your chances of getting pregnant after the embryo transfer is the same as other women who have normal ovarian reserve. The challenging issue is how to get that healthy egg and embryo. Conventional IVF strategy includes using high dose injectable medication that was not designed for, and is not an ideal strategy for women who have DOR. The rationale for conventional IVF is based on the assumption that women will respond well to the IVF medications and subsequently procedure more eggs that can result in higher chance of pregnancy.


Unfortunately, women with DOR do not have many eggs in the ovarian pool to work with. Oftentimes they do not respond to IVF medication well and do not grow many eggs despite using high dose IVF medications. Many of these women are recommended by their doctors to cancel the IVF treatment and use donor eggs.


Mild IVF was developed with the observation that many women with DOR respond better to the hormones (gonadotropin) that are produced by their body. By using oral medication without or with much lower dose injectable IVF medication, women with DOR can mobilize their body hormone production and achieve 4-8 good quality eggs in each IVF cycle. The retrieved eggs are ones with the highest potential and can provide the best chance of success. The less injections and medication use, as well as the subsequent less invasive treatment dramatically lower the physical, mental, and financial burden to the women, make IVF cycle much more affordable and tolerable. With a limited number of eggs, you need experienced fertility specialists and a state-of-art IVF laboratory to provide you the maximal chance of success. Think Fertility has expertise and a team dedicated to treating women with DOR. Call us and let us help you.

What can I do to improve my ovarian reserve?

There are no magic pills that can reverse ovarian aging. However, there are many things you can do to keep your body and your eggs as healthy as possible.


Maintain a healthy body weight. Other than a woman’s age, weight is the 2nd most important factor to predict fertility outcome. A Mediterranean-style diet: plenty of fruits, vegetables, bread and other grains; olive oil as a primary fat source; dairy products, eggs, fish and poultry in low to moderate amounts.


Moderate regular exercise such as brisk walking, gardening or dancing 30 minutes on most and preferably all days of the week.
Supplements: NAD+ (Nicotinamide Mononucleotide); CoQ10 600mg daily; VitD 200mg daily (depends on your serum vitD level), DHEA Avoid smoking.