DOR – Diminished Ovarian Reserve
Ovarian reserve refers to a woman’s ability to conceive and deliver a live birth. Perhaps the strongest predictor of ovarian reserve is a woman’s age. A woman is born with a finite number of eggs, typically one to two million. By the time puberty is reached the number of eggs is reduced to approximately 400,000. From puberty (around age 12) to menopause (around age 51) there is a progressive depletion of egg number and quality in the ovaries, and therefore a decrease in ovarian reserve and reproductive potential.
In addition to advancing age, a woman’s medical/surgical and family history may suggest other factors which can negatively impact on her ovarian reserve. Such factors may be genetic, autoimmune, exposure to certain chemotherapeutic agents/radiation treatment, pelvic infection, ovarian surgery, severe endometriosis, smoking, and unexplained etiologies.
At the California Center for Reproductive Health, a routine part of the infertility evaluation includes comprehensive testing for ovarian reserve in order to determine a treatment course and to predict the likelihood of pregnancy with any specific treatment protocol. Multiple tests are available including cycle day 3 hormonal (FSH, estradiol, inhibin, AMH) and transvaginal ultrasound evaluations (antral follicle count, ovarian volume testing), as well as dynamic tests such as the clomiphene citrate challenge test. Ovarian reserve may also be determined by the outcome of ovarian hyperstimulation with gonadotropin hormones.
Unfortunately, to date, no “magic potion” solution to reduced ovarian reserve has been found. However, emerging recent data on the use of various over-the-counter and prescribed supplements (DHEA, CoQ10, Isositol, Melatonin, L-Arginine, transdermal testosterone…) suggest that ovarian reserve, in some patients diagnosed with diminished ovarian capacity, may actually improve).
Women diagnosed with diminished ovarian reserve have hope! Reduced reproductive potential does not necessarily mean absent reproductive potential! The California Center for Reproductive Health provides women with diminished ovarian reserve with safe, practical, yet aggressive customized treatments aimed at achieving a healthy pregnancy using their own eggs.
FAQ
Reproductive endocrinology and Infertility is a sub-specialty of Obstetrics and Gynecology. In addition to managing medical and surgical treatment of disorders of the female reproductive tract, reproductive endocrinologist and infertility (REI) specialists undergo additional years of training to provide fertility treatments using assisted reproductive technology (ART) such as in vitro fertilization.
Reproductive endocrinologists receive board certification by the American Board of Obstetrics and Gynecology in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.
In general, patients should consider consulting with an REI specialist after one year of trying unsuccessfully to achieve pregnancy. The chance of conceiving every month is around 20%, therefore after a full year of trying approximately 15% of couples will still not have achieved a pregnancy.
However, if a woman is over the age of 35 it would be reasonable to see a fertility specialist earlier, typically after 6 months of trying.
Other candidates to seek earlier treatment are women who have irregular menses, endometriosis, fibroids, polycystic ovary syndrome (PCOS), women who have had 2 or more miscarriages, or problems with the fallopian tubes (prior ectopic pregnancy).
Approximately 1/3 of the time cause for infertility is a female factor, 1/3 of the time a male factor, and the remaining 1/3 a couples’ factor.
At CCRH, we emphasize the importance of establishing a correct diagnosis. Both partners undergo a comprehensive evaluation including a medical history and physical exam.
Furthremore, the woman’s ovarian reserve is assessed with a pelvic ultrasound and a hormonal profile. A hysterosalpingogram (HSG) will confirm fallopian tube patency and the uterine cavity is free of intracavitary lesions. A semen analysis is also obtained to evaluate for concentration, motility, and morphology of the sperm.
Additional work up is then individualized to direct the best possible treatment option for each couple.
In vitro fertilization (IVF) is the process that involves fertilization of an egg outside of a woman’s body.
The process starts with fertility drugs prescribed to help stimulate egg development. In your natural cycle, your body is only able to grow one dominant egg, but with stimulation medication we can recruit multiple eggs to continue to grow. After about 8-10 days of stimulation, the eggs are surgically retrieved and then fertilized with sperm in a specialized laboratory. Fertilized eggs are then cultured under a strictly controlled environment within specialized incubators in the IVF laboratory for 3-5 days while they develop as embryos. Finally, embryos (or an embryo) are transferred into the uterine cavity for implantation.
Before deciding if IVF is the right choice, it’s important to sit down with an REI specialist to discuss available treatment options. For some people, other methods such as fertility drugs, intrauterine insemination (IUI) may be the best first choice treatment. At CCRH, we believe each individual couple is unique and not everyone needs IVF.
While not painful, the fertility medications may some side effects including headaches, hot flashes, mood swings, and bloating. The injection sites may also bruise.
Unfortunately, no. Many people think once they start IVF it’s a matter of time that they will be pregnant and have a baby. But according to national statistics per the Society of Assisted Reproduction (SART), on average 40% of assisted reproduction cycles achieve live births in women under age 35. The chances of success then continue to decrease with advancing age.
At CCRH, we employ only evidence-based interventions to ensure patient safety and optimal outcome. While we cannot guarantee a baby, we guarantee that you will receive the best, most advanced, personalized care to help you maximize your chance of a baby.
The average IVF success rate (success measured in live birth rate) using one’s own eggs begins to drop around age 35 and then rapidly after age 40. This is due to the decline in egg quantity and egg quality as a woman ages.
Our clinic’s success rate consistently beats the national average year after year.
Individual insurance plans often do not have any coverage for infertility treatments. If you have a group plan, you can call members services to see if they have coverage for infertility (including consultation/workup and IVF).
After your consultation with our REI specialist, one of our dedicated account managers with sit with you to go over the cost of treatment.