Diminished Ovarian Reserve (DOR)

What is a Diminished Ovarian Reserve?

Diminished Ovarian Reserve refers to the reduced quantity and quality of eggs in a woman's ovaries, affecting her ability to conceive and bear children. This condition is a significant concern for women attempting to get pregnant, particularly those over the age of 35.

Who can get a Diminished Ovarian Reserve?

Diminished Ovarian Reserve is primarily observed in women who are approaching or are in their late 30s and 40s, as ovarian function naturally declines with age. However, it can also occur in younger women due to various medical conditions or treatments.

What are the Types of Diminished Ovarian Reserve?

Diminished Ovarian Reserve can be categorized into three types:

1. Primary DOR: Occurs due to natural ageing and is associated with reduced egg quantity and quality.

2. Secondary DOR: Results from medical interventions such as surgery, chemotherapy, or radiation that impact ovarian function.

3. Occult DOR: Presents with normal menstrual cycles but diminished ovarian function, often diagnosed during fertility testing.

What are the Causes of Diminished Ovarian Reserve?

Several factors can contribute to Diminished Ovarian Reserve:

• Age: Aging is a primary cause, as the number and quality of eggs decline with advancing age.
   
• Genetic Factors: Some individuals may have a genetic predisposition to early ovarian ageing.
   
• Medical Treatments: Chemotherapy, radiation, or ovarian surgery can damage the ovaries and reduce their functioning.
   
• Autoimmune Disorders: Certain autoimmune conditions can adversely affect ovarian function.
   

• Smoking and Substance Abuse: These can accelerate the decline in ovarian reserve.

• Environmental Factors: Exposure to certain environmental toxins may contribute to DOR.

What are the Symptoms of Diminished Ovarian Reserve?

Diminished Ovarian Reserve may not manifest noticeable symptoms early on. However, as the condition progresses, some signs may become evident:

• Irregular menstrual cycles
   

• Difficulty in getting pregnant

• Reduced or absent premenstrual symptoms

• Lowered response to fertility treatments like in vitro fertilization (IVF)

Does Diminished Ovarian Reserve Affect Fertility?

Diminished Ovarian Reserve significantly affects fertility. The diminished quantity and quality of eggs reduce the likelihood of successful fertilization and implantation, making it harder to conceive. Additionally, it can increase the risk of miscarriages and chromosomal abnormalities in embryos.

How is Diminished Ovarian Reserve Diagnosed?

Diagnosing Diminished Ovarian Reserve involves several tests and evaluations:

• Hormone Testing: Blood tests for follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) levels.

• Antral Follicle Count: An ultrasound to count the number of small follicles in the ovaries, indicating ovarian reserve.

• Ovarian Reserve Assessment: Evaluating menstrual cycle regularity and levels of inhibin B, a hormone produced by developing ovarian follicles.

How is Diminished Ovarian Reserve Treated?

While Diminished Ovarian Reserve is challenging to treat, various approaches can help improve fertility or assist in conception:

• In Vitro Fertilization (IVF): Stimulating the ovaries with fertility drugs to retrieve multiple eggs for fertilization and implantation.

• Egg Donation: Using eggs from a healthy, young donor in an IVF cycle to increase the chance of successful conception.

• Pre-implantation Genetic Testing: Screen embryos for chromosomal abnormalities before implantation to improve the chances of a healthy pregnancy.

• Ovarian Rejuvenation Techniques: Experimental procedures aiming to enhance ovarian function, although their efficacy and safety are still being researched.

Conclusion

Diminished Ovarian Reserve can be a distressing challenge for women desiring to have children. Understanding the causes, symptoms, diagnosis, and available treatments is crucial in managing this condition and exploring viable options for conception. Seeking guidance from fertility specialists and considering various treatment alternatives can offer hope and support in the journey to parenthood.