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Measuring the quantity and quality of eggs is one of the most challenging aspects of fertility care. While many patients and couples are often given the diagnosis of “egg factor” or “advanced age” or “decreased ovarian reserve”, the actual diagnosis can be hard to make and even harder to understand.
Patients often ask me:
- What do these terms mean?
- Are there any eggs left for me to use?
- If I have low or decreased ovarian reserve, can I still get pregnant? And…
- What can be done to improve the odds?
What is ovarian reserve?
Ovarian reserve is not a simple number or value measured in isolation that seals the fate of a woman’s fertility. Instead, ovarian reserve is the doctor’s estimate of the quantity and quality of eggs inside a woman’s ovaries. We can estimate this using ultrasound (to count the number of ovarian follicles/eggs available that may grow in a given month) and blood tests (anti-mullerian hormone, or AMH; a hormone produced by these follicles/eggs) in combination with an understanding of the patient’s medical and reproductive history. It is critical to understand that these measures of ovarian reserve will decrease naturally as women age. In my practice, I prefer to describe ovarian reserve as “above normal”, “normal”, and “decreased” for the age of the patient.
What can be done to help women with decreased ovarian reserve?
Women with a diagnosis of decreased ovarian reserve can and do get pregnant. However, they often require prompt and aggressive treatment. Depending on a women’s age and history, and array of treatments ranging from simple oral medications to daily injections to in-vitro fertilization (IVF) can increase the odds of pregnancy in a given month. In addition, women who receive the diagnosis of decreased ovarian reserve that do not currently want children can be given the option to freeze eggs or embryos to preserve the possibility of future pregnancy.
What can be done to improve ovarian reserve?
In our current understanding, women have their entire pool (“reserve”) of eggs at the time of birth. (Actually, when the women is a fetus at five months!) As women age, this pool decreases in number and quality. Unfortunately, very little can be done to improve the ovarian reserve. However, with infertility treatments, we can increase the number of eggs produced in a given cycle and increase the proximity of the eggs that are produced to sperm; both of which can increase the chances of pregnancy in a given month.