Fertility advice: Low Ovarian Reserve



What is low ovarian reserve?
A woman is said to have “low ovarian reserve” if her ovaries function in a way consistent with older women. If you have been told you have diminished or low ovarian reserve, there are some different possibilities
Is your present age and your ovary's age the same? There is a strong correlation , but it is not always true for every woman hence the condition- low ovarian reserve.

What can identify you as someone likely to have low ovarian reserve?
Age: In general, female fertility declines almost insignificantly up to age 30. Then from 30-35, it declines significantly but not rapidly. It’s not until age 35-40 that fertility takes a rapid decline. So if you are over 35, having diminished ovarian reserve is actually quite normal or expected.
Blood Tests: Blood tests can also give a clue as to how somebody’s ovaries are expected to function. The two most famous of these tests are FSH and AMH. If you are under 35, but your AMH or FSH are bad, then there is a high possibility that your ovaries perform like those of someone who is older than you really are.
Ovarian Volume & appearance: The size of a woman’s ovaries has a general correlation with age. A young teenager is expected to have fairly large ovaries, that are thought to be full of a reserve supply of eggs. The ovaries of a 45 year-old are usually much smaller and have been depleted of many of the eggs that were once there. Besides the size, it is helpful to look at the “texture” of the ovaries on ultrasound; are there many antral follicles (these are units/cells that have the potential to grow to become eggs)? or whether there are large areas of inactive “dead” ovarian tissue?
Ovary Performance: Performance refers to your ability to grow eggs of good quality. I find this to be the most important factor. There have been patients encountered in the past who were older, had poor blood tests and poor ovarian volume / appearance, but when they were given fertility enhancing drugs, they grew a number and quality of eggs that were surprisingly good, eventually resulting in a healthy baby.
How is this important to you if you want to get pregnant?
It is certainly better for your odds of getting pregnant if you are younger, have better lab values and better ovarian ultrasound findings, however, you can still find many stories of women who were thought too old to have a baby, thought to have too high a FSH or too low an AMH to have a baby, or who had ovaries too small or too devoid of antral follicles to have a baby, but who in the end wound up having a healthy baby. The take-away message is that estimates of ovarian aging are just that — estimates, so stay positive and keep trying .

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