What Is Diminished Ovarian Reserve?

Of the three most important factors playing a role in human fertility (egg quality, sperm quality, and the function of Fallopian tubes), egg quality is the most important for the probability of pregnancy. The quality of eggs within the ovaries, rather than the receptivity of the uterus, determines female fertility potential.

The egg quality factor refers to the frequency of genetically and biologically "perfect" eggs present within the ovaries. This frequency begins to decrease at the age of approximately 32, and by the age of 40, a vast majority of high-quality eggs have already disappeared from the ovaries. This results in diminished ovarian reserve. For some women, diminished ovarian reserve can begin at a much younger age.

Diminished ovarian reserve occurs when there is only a small proportion of high-quality eggs left within the ovaries.

At Bay IVF, we utilize a combination of transvaginal ultrasound examination of the ovaries and an assessment of reproductive hormone levels: Ovarian Reserve Assay (ORA) to estimate the "biological age" of your ovaries. The results of these tests will determine the most appropriate treatment for you.

Ultrasound of your ovaries will establish the number of antral follicles (seen as small dark circles) within the ovaries. Their number is related to the quality of the eggs. Ideally, there should be 8 to 12 antral follicles per ovary.

ORA consists of the measurement of Follicle Stimulating Hormone (FSH), estradiol (estrogen, E2), and Anti-Mullerian Hormone (AMH) blood levels. It can assess the likelihood that normal quality eggs can be produced.

FSH stimulates the ovaries to produce eggs. If the ovaries cannot produce normal quality eggs, the FSH level is increased. Estradiol production by the ovaries influences FSH secretion and is also related to egg quality. AMH level reflects the quality of eggs, and its result is used to optimize ovarian stimulation.

Most patients with a diminished ovarian reserve will require In Vitro Fertilization, Donor Egg IVF, or Frozen Donor Egg IVF to conceive successfully.

To optimize your fertility potential, it is very important that you adhere as closely as possible to the reproductive health recommendations.