This is part 2 of our IVF-FAQs and talks about a major hurdle for women doing IVF - poor ovarian reserve.
When a clinic advertises that they have a 40-50% success rate per IVF cycle, it doesn’t mean this applies for every woman who undergoes IVF in that particular clinic. Even though it is hard to predict whether a woman will conceive in a particular IVF cycle or not, it is possible to calculate her chances of success , using certain parameters.
To a large extent, the chances of achieving success depend on your ovarian reserve. If you have a decent number of usable eggs left in your ovary, you are more likely to find success. Your ovarian reserve depends mostly on your age , but there are women who suffer from poor ovarian reserve at a young age as well .
How do you test your reserve ?
1. Anti-müllerian hormone levels (AMH) in blood, measured on any day of your menstrual cycle. AMH is produced by the antral follicles which are present in your ovary. Read more at www.drmalpani.com/amh.htm
2. FSH and e2 levels in blood, measured on day 3 of your menstrual cycle
3. Antral Follicle Count (AFC) – scanning your ovaries using a vaginal ultrasound probe on day 1-5 of your menstrual cycle will allow your doctor to count the follicles which are between 2-6 mm is size. These follicles are called as antral follicles. The higher your antral follicle count, the better your ovarian reserve, because these are follicles which will grow when you are superovulated. Read more at www.drmalpani.com/afc.htm
What is poor ovarian reserve ?
Poor ovarian reserve or diminished ovarian reserve ( DOR) or oopause is a condition where the amount of eggs which have the potential to give rise to a healthy baby decline. Most women develop poor ovarian reserve 6 to 8 years before reaching menopause. As women age, their ovarian reserve declines too. But there are some women who develop diminished ovarian reserve much earlier in their reproductive period and their ovarian age does not match their calendar age . In 90% of cases there is no explanation (idiopathic) why such premature ovarian aging happens. But there are a few explanations for premature ovarian aging . These include
• Mutation in genes which codes for proteins that are involved in reproductive function
• Autoimmune disorders
• Certain viral infections
• Chemotherapy or radiation exposure during cancer treatment
• Surgery on the ovaries to remove cyst , or to remove endometriosis implants
How does poor ovarian reserve compromise IVF success ?
• Women with poor ovarian reserve have fewer antral follicles in their ovaries. Antral follicles are the ones which grow in response to ovarian stimulation. This is why they produce fewer eggs when their ovaries are stimulated with gonodotropins (FSH and LH), which reduces their chances of IVF success .
• Older women with poor ovarian reserve have poorer egg quality too. Older eggs are more prone to genetic errors , like aneuploidy. Embryos formed from these eggs either fail to implant or fail to achieve a healthy pregnancy.
How will I know whether I have poor ovarian reserve ?
There are three important tests which are routinely used in the field of ART for predicting a woman’s ovarian reserve
• Measuring Anti-Müllerian Hormone levels (AMH) in blood
• Measuring FSH levels in blood
• Counting antral follicles (AFC count) present in your ovaries using vaginal ultrasound
These are very simple tests to perform and the information they provide is pretty accurate.
I am diagnosed with poor ovarian reserve , will I be able to have my own genetic child ?
Women with poor ovarian reserve have a poor prognosis with IVF treatment. However, younger women who are diagnosed with poor ovarian reserve have a better chance of success than their older counterparts. This is because these younger women still produce some eggs which are of good genetic quality. This means they produce fewer eggs , but the quality of their eggs is comparable to women of their age. This improves their chances of achieving a pregnancy and carrying a baby to term is high too.
If you are diagnosed with poor ovarian reserve, it is wise to try one IVF cycle by stimulating your own ovaries , before deciding what to do. Remember, the final proof of your ovarian reserve status depends on how well you respond to ovarian stimulation during IVF. There are women who have very good AMH levels, and yet they respond poorly to ovarian stimulation - and vice versa. Theoretically, as long as you produce eggs, you have a chance of achieving a pregnancy. During your IVF cycle, if your doctor finds that even with maximal stimulation, you are unable to produce a decent amount of eggs ; and if those eggs give rise to very poor quality embryos, you may want to consider the option of using donor eggs. This is a decision only you can make !
You should explore the option of Mini-IVF as well.
is an excerpt from our forthcoming, book, The Expert Patient's Guide to
IVF. This being authored by our expert patient, Manju and me.