Struggling to conceive, and not sure why? The low ovarian reserve could be impacting your chances. Low ovarian reserve means the capacity of the ovary to produce eggs has gone down. Essentially, your ‘ovarian reserve’ is your current egg supply, and it is closely related to your potential to reproduce. In general, the more eggs you have left, the better your chances of conception. So, if you have a low ovarian reserve, it may impact your chances of conceiving.
Women are born with a fixed number of oocytes (eggs) inside their ovaries. It’s generally accepted that as a woman ages, this supply gradually decreases over time until menopause occurs. But yes, certain factors can accelerate this decrease, including underlying genetics, environmental factors, and medical issues such as endometriosis and more.
What are the causes?
A woman’s age is critical and inversely proportional to ovarian egg reserve – the older you get, the lower ovarian reserve you have. But this problem can also affect young women, as it occurs in cases of premature ovarian failure. Other possible causes include medical or surgical treatments, chemotherapy, environmental pollution, unhealthy lifestyle habits, and diseases such as endometriosis.
A low ovarian reserve result may indicate the following:
- It is better not to delay starting a family
- Depending on the age and other health factors further assisted fertility methods have to be considered
- If already undergoing treatment may call for a change in the dosage of medication
What is AMH?
Blood tests are used to check levels of hormones called AMH (Anti-Mullerian Hormone), which is produced by the follicles in the ovaries, and FSH (Follicle Stimulating Hormone), which stimulates the follicles to grow. There are several baseline tests used to determine the issue:
- Follicle-stimulating hormone (FSH)
- Estradiol (E2)
- Inhibin B
- Anti-mullerian hormone (AMH)
- Antral follicle count (AFC)
These tests reveal how well you would respond to follicular stimulation, based on which our specialists can customize your treatment protocols. It is important to identify these women early on so that they can make decisions on when to start having a family and when to access assisted reproductive technology if required. Anti-mullerian Hormone (AMH) seems a superior predictor of ovarian response compared to other markers. AMH can be drawn at any time in the menstrual cycle and is not affected by hormonal therapy, including oral contraceptives. Normal AMH levels range between 3 and 35, and FSH, between 2 and 8.9. An antral follicle count – an ultrasound scan of the ovaries to see how many follicles are growing in each one – signifies the number of eggs.
What is considered a low ovarian reserve?
In general, a count equal to or less than 4 oocytes per ovary, or 7 in total (the sum of both ovaries) and low levels of the hormone AMH are indicators of low ovarian reserve. A woman’s ovarian reserve usually depletes as she grows older. This is why specialists strongly advise against postponing having a baby. If a woman is found to have a very low ovarian reserve, the only effective therapy is to bring forth the plans to start a family. If a woman has a low ovarian reserve and has not conceived within six months of trying, we suggest a referral to see our Fertility Specialist for an early investigation.
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A variety of measures is used to estimate a woman’s ovarian reserve. It is important to understand that ovarian reserve testing is not perfect: no test results should be interpreted to mean that an individual will or will not be able to have a baby using her own eggs. That said, test results help to predict success rates with different treatments and may inform medical decisions. It is essential for this test to be ordered by the gynecologist/ fertility specialists who are trained to interpret the results and explain them in detail. The good news is that women with a low ovarian reserve still might be able to get pregnant. If you’ve been trying to get pregnant for a while with no success, it’s best to reach out to a fertility expert to figure out your best fertility treatment options. After all, our goal is the same as yours – to help you have a healthy baby.
