I remember a young woman, let’s call her Sarah, sitting across from me in the clinic. Her voice was quiet, her hands clasped tightly in her lap. “They said my egg count is low,” she began, the words tumbling out. “Does this mean… does this mean I can’t have a baby?” Her eyes, filled with a mix of hope and fear, are something I see often when we start talking about fertility. It’s a heavy conversation, and if you’re reading this, you might be feeling some of those same emotions. Let’s talk about what Diminished Ovarian Reserve really means.
What is Diminished Ovarian Reserve, Really?
So, what are we talking about here? Diminished Ovarian Reserve (sometimes called low egg count or low ovarian reserve) simply means that your ovaries have fewer eggs than we might expect for someone your age. Think of your eggs as the crucial starting blocks for a pregnancy, along with sperm, of course.
Now, it’s completely natural for your egg count to go down as you get older. We’re all born with all the eggs we’ll ever have – quite amazing, isn’t it? But for some, this decline happens a bit sooner or faster than for others. Having Diminished Ovarian Reserve can make getting pregnant trickier, but here’s the key thing I want you to hear: it doesn’t automatically mean you can’t get pregnant. It just means the path might be different, and we might need to look at fertility support.
How Many Eggs Are We Talking About?
It’s natural to wonder about numbers. Age is the biggest factor here, and generally, we see a more noticeable drop in egg numbers after 35. These are just averages, mind you, and everyone is different:
- At birth: Around 1 to 2 million eggs. (Wow!)
- At puberty: About 300,000 to 400,000 eggs.
- Around age 40: Roughly 25,000 eggs.
- By menopause: Fewer than 1,000 eggs.
Only specific tests, which we’ll get to, can give us an estimate of your personal situation.
Can I Still Get Pregnant with a Lower Egg Count?
Yes, absolutely. It might sound counterintuitive, but you only need one healthy egg to achieve a pregnancy. While a lower ovarian reserve can reduce the odds, it’s not the only piece of the puzzle. The quality of your eggs, the quality of sperm, and how well your uterus and fallopian tubes are working – these all play huge roles.
What Might You Notice? Signs and Causes
Often, the main “symptom” of Diminished Ovarian Reserve is simply not conceiving after several months, or even years, of trying. Some women might notice their menstrual cycles getting consistently shorter. That’s a little clue.
If it’s part of something called primary ovarian insufficiency (where the ovaries stop working as they should much earlier than usual), you might experience things that feel a bit like early menopause:
- Hot flashes (that sudden wave of heat)
- Irregular periods or periods stopping
- Vaginal dryness
What’s Behind Diminished Ovarian Reserve?
Ageing is the most common reason, as we’ve discussed. But sometimes, there isn’t a clear cause. Other times, specific things can contribute:
- Genetic conditions, particularly those affecting the X chromosome.
- Medical treatments like radiation or chemotherapy for cancer. These can be tough on the ovaries.
- Previous surgery on your ovaries.
- The loss of one or both ovaries through surgery.
- Certain autoimmune conditions, where the body’s immune system mistakenly attacks its own tissues.
A quick note: I get asked this a lot – can stress cause this? The answer is no, stress itself doesn’t directly cause Diminished Ovarian Reserve. According to experts like the American Society of Reproductive Medicine, lifestyle factors like smoking and using tobacco are known to be linked with a decrease in ovarian reserve.
How Do We Figure This Out? Diagnosis and Tests
To get a clearer picture, we use something called ovarian reserve testing. This helps us estimate the number of eggs you might have left. It’s important to understand that these tests can’t tell you exactly how many fertile years you have left, or if you’ll definitely get pregnant. What they can do is help us see if you might respond less well to ovarian stimulation medications used in treatments like IVF (in vitro fertilization), or if your chances of getting pregnant without treatment might be lower.
A “positive” screen for Diminished Ovarian Reserve doesn’t mean you can’t conceive naturally. These tests aren’t great at predicting natural conception.
Here’s what ovarian reserve testing usually involves:
- Blood tests: We look at hormone levels, specifically:
- Anti-Müllerian Hormone (AMH): This hormone is produced by small follicles in your ovaries (where eggs develop). Lower levels can suggest fewer eggs.
- Follicle-Stimulating Hormone (FSH) and Estradiol: FSH helps your eggs mature. High FSH levels, especially early in your cycle, can indicate your ovaries are working harder, which can be a sign of lower reserve. Estradiol is another key hormone we check alongside FSH.
- Vaginal ultrasound: This lets us take a look at your ovaries. We can measure their size (ovarian volume) and count the number of small, visible follicles. This is called an antral follicle count (AFC).
- A clomiphene citrate challenge test is less common these days. It involves taking an oral fertility medication and then checking your hormone response.
Generally, women with Diminished Ovarian Reserve tend to have higher FSH levels, lower AMH levels, and a lower AFC compared to others their age. Again, these tests primarily predict how you might respond to fertility medications.
What Can We Do? Management and Treatment Options
Here’s the honest truth: we can’t reverse Diminished Ovarian Reserve or make your body produce more eggs. Once we suspect a low ovarian reserve, we’ll sit down and talk about a plan tailored to you – your hopes for pregnancy, how soon you’d like to conceive, how many children you envision, your financial considerations, and how important it is for you to have a child genetically related to you. It’s a lot to think about, I know.
Treatment options might include:
Using Your Own Eggs
- Egg Freezing (Oocyte Cryopreservation): If we identify a high risk for low ovarian reserve, freezing your eggs can be a way to preserve your fertility for the future. This involves taking hormone medications to stimulate your ovaries to produce multiple eggs. These mature eggs are then collected and frozen. Later, they can be thawed, fertilized, and used in IVF.
- Embryo Creation and Freezing: Sometimes, we might suggest fertilizing the collected eggs with your partner’s sperm or donor sperm to create embryos, which are then frozen for future use or transferred to your uterus.
- IVF with your own eggs: Even with a lower reserve, IVF might still be an option.
Using Donor Eggs
If the quantity or quality of your eggs is a significant concern, using donor eggs might be discussed. In this scenario, an egg from a donor is fertilized (usually with your partner’s sperm, unless donor sperm is also used), and the resulting embryo is transferred to your uterus. Your baby wouldn’t share your genes but could share your partner’s.
Another option is embryo donation, where you use an embryo created from donor eggs and donor sperm.
A Quick Word on Folic Acid
You might have heard about folic acid. Prenatal vitamins, which contain folic acid, are really important for maintaining the quality of your eggs. If you’re thinking about pregnancy, I’ll always recommend starting a prenatal vitamin, ideally at least three months before you start trying. Diet, exercise, and a healthy lifestyle can also positively impact egg quality. But, these things don’t change the number of eggs you have.
What’s the Outlook?
When it comes to IVF, success rates can vary. It depends on why the ovarian reserve is low, how many eggs are retrieved, and how your body responds to the medications. The exact success rates for IVF with Diminished Ovarian Reserve are hard to pin down with one number because so many factors are at play. We do know that, just like with natural pregnancy, IVF success tends to decline with age, and this includes women with lower ovarian reserve. If tests show a low reserve, you might be less likely to have a big response to stimulation medications, but IVF could still be your best path. This is something to discuss in detail with a fertility specialist. They’re the experts in navigating these specific challenges.
Can I Prevent This?
Mostly, no. The causes of Diminished Ovarian Reserve are often out of our control. However, focusing on a healthy lifestyle – maintaining a healthy weight and definitely avoiding tobacco products like cigarettes – can help preserve the quality of the eggs you do have.
Is Menopause Around the Corner?
It’s tough to say exactly when menopause will start for any individual. A low ovarian reserve is an indicator that your egg quantity is decreasing, which is a natural part of the journey towards menopause. But it doesn’t give us a precise timeline.
Take-Home Message: Navigating Diminished Ovarian Reserve
This can feel overwhelming, I truly get it. If you’re facing concerns about Diminished Ovarian Reserve, here are the key things to hold onto:
- It means fewer eggs, not no hope: You can still get pregnant.
- Age is a factor, but not the only one: Genetics and medical history also play a role.
- Symptoms aren’t always obvious: Often, difficulty conceiving is the first sign.
- Testing gives us clues: AMH, FSH, and AFC help estimate your reserve and predict response to treatment.
- Treatment is personalized: Options range from egg freezing to IVF with your own or donor eggs.
- Focus on egg quality too: A healthy lifestyle and prenatal vitamins are important.
- Talk to us: We’re here to guide you through the options and support you.
You’re not alone in this. There are many paths to building a family, and we’ll explore them together.