Diminished Ovarian Reserve

Diminished Ovarian Reserve (DOR) is a medical term used to indicate when a woman's natural supply of eggs has significantly declined. The decrease in the number of available eggs is a normal and expected process that occurs in women as they age and approach menopause.

There is a good deal of variation in the ovarian reserve of women of the same age and the rate of loss varies from woman to woman, as well. In fact, the rate of loss increases in most women around age 37, so the decrease in ovarian reserve from the age of 37 to 40 is usually much more rapid than the decrease from age 27 to 30, for example.

In some women, the rapid phase of decline in ovarian reserve occurs earlier than expected and, in today’s world, fertility doctors recognize that this is a common reason for women to find themselves seeking the help of a specialist to find out why they are experiencing problems getting pregnant. In extreme instances, some women may rapidly lose their egg supply and become menopausal even as teenagers! When a woman runs out of eggs (menopause) before age 40, the condition is known as premature ovarian failure (POF).

At some point in every woman’s life, if she has a normal life span, ovarian reserve will diminish and finally disappear, an inexorable fact. This is because women are born with all the eggs they will ever have and the finite supply simply declines and deteriorates as time goes by, whether or not a woman is trying to conceive, using oral contraceptives, ovulating or not, or pregnant.

Diminished Ovarian Reserve has a significant impact on a woman’s ability to conceive, as it becomes less likely for her to mature and release healthy eggs in any given menstrual cycle. The diagnosis of DOR is based on blood tests and ultrasound examination of the ovaries (high basal FSH, low AMH and/or low antral follicle count). The degree a woman’s ovarian reserve is diminished, and, most importantly her chronologic age, factor into her prognosis regarding her ability to ever conceive using her own (autologous) eggs (oocytes).

Patients finding their ovarian reserve is diminished are often quite upset when they are rightfully told that their chances of conceiving a biological child are very low or virtually nil. It is often devastating to learn the truth - that most common treatments, including powerful, aggressive, high tech treatments, such as IVF, will not be successful. To be honest, a woman’s quickest, most efficient, route to achieving a successful pregnancy, when diagnosed with DOR, is to try IVF using donor eggs right away. And, at FIRST, our fees for such services are among, if not the lowest, in the community.

Our belief at FIRST IVF, however, is to support every woman’s desire to conceive a child with her own eggs, even if she has been diagnosed with DOR. Rather than refuse treatment, or very much discourage women who would like to find out if they are at all capable of conceiving with their own eggs, we now offer a relatively low cost, lower tech treatment, for DOR that is gaining worldwide popularity: Ministim or Natural Cycle IVF, which may be as, or even more, effective for some cases!

Here, at FIRST IVF, we no longer utilize, or encourage, aggressive, costly treatment of DOR patients with conventional IVF, which distinguishes us from most South Florida fertility clinics. Unlike the vast majority of fertility treatment centers, where very high doses of expensive gonadotropins, such as Gonal-F, Follistim, Menopur, etc., are prescribed to try to overcome the ovaries' poor response, we take an opposite approach, because women with DOR already have high, endogenous levels of FSH (the active hormone in these medications). Using high doses of gonadotropins will only push FSH levels higher. When FSH levels are very high, all the follicular FSH receptors of the ovary become saturated so that the end result is that no follicles at all can develop. Unfortunately, after spending thousands of dollars, many DOR patients treated with conventional IVF simply end up as a statistic among the number of cycles cancelled by their clinic because of poor response.

At FIRST IVF, for DOR patients, we prefer to focus on the woman’s natural cycle and create a customized treatment plan with the individual patient in mind. With information from several key factors such as basal FSH and Estradiol levels, and an antral follicle count, we may recommend a Natural Cycle IVF or Minimal Stimulation IVF protocol.

For example, in some patients with DOR, with FSH levels between 12-20 and several antral follicles, we may consider using Minimal Stimulation IVF. Often these patients respond well to Femara (Letrozole) or Clomiphene Citrate (Clomid), both anti-estrogen medications, combined with low dose gonadotropin injections. For patients with FSH levels between 20-30, we may consider trying Natural Cycle IVF; we can then monitor follicular development, and when the follicle appears ready to ovulate, schedule an in-office egg retrieval. For women with extremely high FSH levels, follicles, if at all present, most often will not grow because of very high ambient levels of FSH. In these patients, we may use medication to lower the FSH level to foster follicular development, which usually means a course of daily Estradiol tablets and/or birth control pills.

As with any of the various personalized treatment approaches we might recommend, we strive for success when treating our patients with DOR and believe every woman should be given a chance to conceive with her own eggs, should she desire to do so. To learn more about our treatment protocols and options at FIRST IVF, please call our center at 954-217-3456.

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