Diminished ovarian reserve also known as DOR is when a woman's ovaries loose their reproductive potential. As women our fertility is linked to our age and as we get older the percentage of infertility increases and the chances of a life birth decreases. Women are now having children later in life due to focusing on careers and education. They are also marrying or finding a partner later in life which means that we see many more women trying to conceive with DOR.
Whilst in general the birth rate is falling, in the ages of 35-39 and 40-45 the birth is actually on the increase. Getting older does not mean a woman won't be able to conceive but it could take longer and the chances are lower. The older we are when we begin our fertility journey the lower our ovarian reserve is likely to be. This means we may not respond as well and many women may need treatment such as IVF and higher dosages of fertility medication in an IVF treatment cycle.
It is important to be aware that DOR can also occur in younger women, fertility is individual to all women. Risk factors for DOR include previous ovarian or pelvic surgery, smoking, a family history of POI or chemotherapy. Sometimes a specific reason cannot be found. Blood tests such as an anti-Mullerian hormone blood test (AMH) can be done to check a woman's ovarian reserve, however it is important to note that this test is not a predictor of a possible conception. There are a number of other different tests that can be also useful to diagnose diminished ovarian reserve, these include an FSH blood test and a pelvic ultrasound to assess the antra follicle count (AFC) Other factors which could be an indicator of DOR include an IVF cycle where less than 4 eggs were collected and a diagnosis of primary ovarian insufficiency.
Some supplements such as DHEA, COQ10 and Melatonin have been used alongside fertility treatment and could show promise, however it is important to note that more research and studies are needed before we know if they could benefit and we could offer it to all women presenting with DOR. DHEA is not currently licenced in the UK and Melatonin is only available in specific cases with a prescription. Possible treatments can include IVF using higher dosages of stimulation medications. Mild IVF where small dosages of stimulation medication are used in a natural cycle can also be a treatment option, usually only 1-2 eggs are collected during each cycle.
It is important to note that while chances are lower, a pregnancy is still possible, whilst working as a fertility nurse, I have seen patients where 1 follicle is scanned, 1 egg collected, 1 embryo replaced and 1 baby born, however this is unusual and chances may be lower.
Oocyte donation may also be a possible treatment option, often with high success rates. However this is an individual choice and supportive counselling is recommended prior to starting treatment with egg donation.
For patients it can be hard to receive a diagnosis of diminished ovarian reserve, it is important to ensure support is available for patients such as counselling and support groups. DOR remains a challenge for clinicians as there is no specific treatment plan or protocol, treatment remains individual. I ran an egg donation programme for over 5 years DOR is one of my specialist areas of interest and I supported many patients who received a diagnosis of DOR. Here at Conceivable Fertility Support. I offer bespoke consultations to support and advice you on treatment options.