Ovarian reserve decline
The number of eggs in our ovaries declines gradually with age, from 1-2 million at birth to just around 1000 when we reach menopause. There is huge individual variability in how our ovarian reserve declines and in some women it can happen much earlier than expected, leading to low ovarian reserve.
The rate at which our egg numbers decline is mainly determined by our genetics, however there are environmental factors which can also affect it. Some women who have chemo or radiotherapy, or who have had surgery to their ovaries, can have a much earlier loss of the ovarian follicles. Smoking is also associated with low ovarian reserve and medical conditions such as endometriosis and auto-immune disease. Unfortunately for most women, the early loss of eggs has been genetically determined, and was not something that could have been prevented.
Ovarian reserve testing
It is possible to have testing of your ovarian reserve, usually with the hormone AMH and an ultrasound to assess antral follicle count. In conjunction with doing these investigations we always recommend having a consultation to discuss your medical history and the implications of these tests.
It is important to note that the most important factor which determines whether a person conceives naturally or through IVF is their age and that AMH or AFC are not good at predicting how quickly a woman falls pregnant naturally. Women who are young with low ovarian reserve still have a good chance of conceiving as the egg quality remains good, even if egg numbers are relatively low.
Fertility treatment with low ovarian reserve
If you have been diagnosed with low ovarian reserve we can provide support and advice about your fertility options.
Ovarian reserve tests are helpful in predicting how people will respond to ovarian stimulation for fertility treatment. If you have low ovarian reserve the ovaries may not respond well to stimulation with only a few eggs produced.
We provide specialised treatment protocols for women with low ovarian reserve having IVF. This will be a tailored approach depending on your individual history but may include pre-treatment with androgens such as testosterone, and specialised stimulation protocols including the option of mild IVF.