Diminished ovarian reserve (fewer eggs available to conceive a healthy baby) is a natural part of the aging process – one of the reasons age is such an important factor when trying to conceive. However age isn’t the only reason women experience diminished ovarian reserve, which is why ORT (ovarian reserve testing) is a routine part of the initial infertility testing protocol.
Genetics and lifestyle play a role in ovarian reserve
The average woman is born with millions of eggs, but only about 300 to 400 of these will be released by the ovaries in her lifetime, and not all of them are viable to conceive a baby. Some women are born with fewer eggs, or their egg quality is compromised due to other factors.
Here are some of the most common reasons younger women may find they have diminished ovarian reserve:
Genetic factors play a role in a woman’s ovarian reserves. So, women who have mothers or sisters with low ovarian reserve are more likely to experience it as well.
Smoking cigarettes is the enemy of fertility, affecting women’s fertility health in almost every way. This includes over-stimulation and acceleration of follicular depletion (causing early menopause) – and smoking also compromises egg quality.
On average, women begin perimenopause in their early- to mid-forties, and will experience full menopause (the cessation of periods for 12-consecutive months) around 51-years old.
Some women, the result of genetics, certain medical conditions and treatments, and/or lifestyle choices start going through menopause (called premature menopause) as early as their 20s or early 30s.
There are two conditions in particular that can make an outwardly healthy woman experience diminished ovarian reserve – often in the form of eggs that have chromosomal defects: fragile X and other X-chromosome factors. In some cases, this means only 50% or less of all of the woman’s eggs are viable at all.
Certain medications and more aggressive forms of medical treatment, chemotherapy and radiation being the most notorious of these, compromise egg numbers and quality; this the reason we promote fertility preservation for women who have a cancer diagnosis.
If you have a medical diagnosis and/or a treatment recommendation that compromises your fallopian tubes and eggs, freezing your eggs and storing them allows you to use IVF down the road.
Sometimes, the surgery required to treat an ovarian issue – like endometriosis – can wind up negatively impacting the ovaries, the follicles and/or the eggs. If you’re scheduling an ovarian surgery and want to have children, make sure you vet the prospective surgeon, ensuring s/he has an exceptional track record.
If you have existing or potential infertility factors, you may even want to schedule the surgery with a fertility specialist who spends his/her life handling ovaries with the utmost care and respect for your future fertility chances.
A more extreme body mass index (BMI) in either direction (too thin or too overweight) negatively affects fertility. As a result, being obese can negatively impact fertility rates. While obesity doesn’t directly affect women’s ovarian reserves, research has linked obesity and lower AMH levels in older women.
So, while healthy weight management should always be a priority when trying to conceive, overweight and obese women should prioritize achieving a healthy BMI from 35-years and upwards.
Sometimes, we test and test, and evaluate and research…and we simply can’t find the reason for a woman’s diminished ovarian reserve. In this case, it’s called idiopathic DOR – and all we can do is move forward to find the best solution. In-vitro fertilization is the most successful fertility treatment for patients with DOR when timing intercourse and IUI aren’t effective.
Suspect diminished ovarian reserves are playing a role in your inability to get pregnant? Schedule a consultation with the Reproductive Resource Center.