Poor Ovarian Reserve

Poor Ovarian Reserve

The goal of any stimulation regimen for IVF is several good quality eggs and a healthy uterine environment. Ovarian reserve is a theoretical concept. As a practical matter, it refers to the ease at which an individual’s ovaries can be successfully stimulated with fertility drugs. The single most consistent variable affecting ovarian reserve is the woman’s age. This is because a woman is born with all the eggs she will ever have. In most women a majority of the eggs are genetically normal or balanced. However, there will be some that are genetically abnormal or unbalanced. It appears that the best eggs are ovulated first. The older a woman is, the fewer genetically balanced eggs she has left to respond to fertility drugs. This age relationship holds true even in the fertile population. In older women fewer normal embryos are available for implantation into the uterus.

Causes of poor ovarian reserve

The main causes of diminished ovarian reserve are:

  • Cigarette smoking.
  • Genetic abnormalities (Fragile X and other X chromosome abnormalities).
  • Aggressive treatments (radiation for cancer).
  • Ovarian surgery, such as for endometriosis.
  • Idiopathic (this means that there is no apparent cause).

Fertility treatments for women with Poor Ovarian Reserve

No treatments can slow ovarian aging and truly prevent diminished ovarian reserve. However, women with DOR who still want to conceive have options through assisted reproductive technologies.

When a woman is diagnosed with diminished ovarian reserve, she can take an immediate step and try fertility preservation. Fertility preservation involves retrieving a woman’s eggs from her ovaries and freezing them for later use. The best time for women to freeze eggs is when they are young and their ovarian reserve is better.

Women can also use ovarian superovulation, which is an exaggerated form of ovulation induction. This treatment uses injectable hormones to induce the woman to ovulate multiple eggs. The eggs are then collected for cryopreservation or for use in a fresh IVF cycle to create an embryo and implant it in the woman’s womb.

Donor eggs in conjunction with IVF are often the best option for women with a low ovarian reserve, especially if their remaining eggs are of low quality. A woman can achieve pregnancy using the donor eggs fertilized by her partner’s sperm and having the resulting embryo implanted in her uterus. Although the resulting child will not have the birth mother’s genes, the recipient mother gets to carry a pregnancy to term and give birth.

The presence of mitotically active OSCs (ovarian stem cells) in human ovarian cortex are capable to ensure oocyte turnover during the women lifespan. The application of these cells to infertility field will cover different and unrelated conditions ranging from the endocrine defective ovarian reserve to the iatrogenic infertility in oncologic patients, as well as the utilization of OSCs only for restore the woman endocrine physiology in postmenopausal age.