Knowledge | Diminished Ovarian Reserve: Causes and Management of Declining Female Fertility
Diminished ovarian reserve (DOR) means that the ovaries produce fewer eggs and that these eggs have lower reproductive potential. This directly affects fertility and makes pregnancy more difficult. An estimated 10%–30% of infertility patients have DOR.
1. Symptoms and Causes of Diminished Ovarian Reserve
A female has about 6 million eggs in the ovaries at birth, but only several hundred thousand remain by puberty. Research shows that fertility begins to decline around age 25 and falls further between 25 and 40, mainly because egg quantity and quality decrease with age.
Other potential causes of DOR include:
Ovarian surgery, such as surgery for endometriosis
Smoking
Genetic abnormalities
Invasive medical treatment such as radiation therapy for cancer
In some cases, DOR has no apparent cause.
Symptoms of Diminished Ovarian Reserve
As egg production and quality decline, menstrual cycles may become shorter with age and further loss of ovarian reserve. Eventually, as menopause approaches, pregnancy will no longer be possible.
2. Ovarian Reserve Testing
Ovarian reserve testing is the only way to diagnose DOR. It usually includes blood tests and ultrasound to assess the number of eggs in the ovaries. Although important for diagnosis, these tests cannot accurately predict whether pregnancy will occur.
Blood tests: The most common approach measures certain hormone levels. Estradiol and follicle-stimulating hormone (FSH) are usually measured on day three of the menstrual cycle. Anti-Müllerian hormone (AMH) is associated with egg quantity but cannot directly predict fertility.
Women with higher day-three hormone levels generally have lower pregnancy rates with hormone treatment or in vitro fertilization (IVF) than women of the same age with normal levels.
Ultrasound: A doctor may recommend transvaginal ultrasound at the start of the menstrual cycle. It counts small ovarian follicles measuring 2–10 millimeters to estimate the available egg supply.
3. Treatment for Diminished Ovarian Reserve
No known treatment can slow ovarian aging or loss of function. However, common treatments may improve the chance of conception.
Egg preservation: After DOR is diagnosed, a doctor may recommend retrieving and freezing eggs for future use. Success is more likely at a younger age.
Donor eggs and IVF: During IVF, high-dose hormones may be used to stimulate the ovaries. If this is unsuccessful, donor eggs may be recommended. These are usually donated by women in their 20s. Donor eggs can substantially improve pregnancy rates for women with DOR.
Knowledge | Diminished Ovarian Reserve: Causes and Management of Declining Female Fertility
Knowledge | Diminished Ovarian Reserve: Causes and Management of Declining Female Fertility
Diminished ovarian reserve (DOR) means that the ovaries produce fewer eggs and that these eggs have lower reproductive potential. This directly affects fertility and makes pregnancy more difficult. An estimated 10%–30% of infertility patients have DOR.
1. Symptoms and Causes of Diminished Ovarian Reserve
A female has about 6 million eggs in the ovaries at birth, but only several hundred thousand remain by puberty. Research shows that fertility begins to decline around age 25 and falls further between 25 and 40, mainly because egg quantity and quality decrease with age.
Other potential causes of DOR include:
Ovarian surgery, such as surgery for endometriosis
Smoking
Genetic abnormalities
Invasive medical treatment such as radiation therapy for cancer
In some cases, DOR has no apparent cause.
Symptoms of Diminished Ovarian Reserve
As egg production and quality decline, menstrual cycles may become shorter with age and further loss of ovarian reserve. Eventually, as menopause approaches, pregnancy will no longer be possible.
2. Ovarian Reserve Testing
Ovarian reserve testing is the only way to diagnose DOR. It usually includes blood tests and ultrasound to assess the number of eggs in the ovaries. Although important for diagnosis, these tests cannot accurately predict whether pregnancy will occur.
Blood tests: The most common approach measures certain hormone levels. Estradiol and follicle-stimulating hormone (FSH) are usually measured on day three of the menstrual cycle. Anti-Müllerian hormone (AMH) is associated with egg quantity but cannot directly predict fertility.
Women with higher day-three hormone levels generally have lower pregnancy rates with hormone treatment or in vitro fertilization (IVF) than women of the same age with normal levels.
Ultrasound: A doctor may recommend transvaginal ultrasound at the start of the menstrual cycle. It counts small ovarian follicles measuring 2–10 millimeters to estimate the available egg supply.
3. Treatment for Diminished Ovarian Reserve
No known treatment can slow ovarian aging or loss of function. However, common treatments may improve the chance of conception.
Egg preservation: After DOR is diagnosed, a doctor may recommend retrieving and freezing eggs for future use. Success is more likely at a younger age.
Donor eggs and IVF: During IVF, high-dose hormones may be used to stimulate the ovaries. If this is unsuccessful, donor eggs may be recommended. These are usually donated by women in their 20s. Donor eggs can substantially improve pregnancy rates for women with DOR.
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