Low ovarian reserve vs Primary ovarian insufficiency 

As terms related to low ovarian reserve, POI (primary ovarian insufficiency) is one such concept that is often confused with DOR. 

But, there are some major differences: 

1. POI leads to postmenopausal FSH levels (>40mIU/mL)and sometimes, months without a period, which does not happen in the case of DOR. 
2. POI also occurs most frequently in women <40 years of age. Sometimes this is the case with DOR as well, but most times affected women are above 35 years of age.

What causes low ovarian reserve?

While there’s no exact reason, here are some researched causes:

1. Genetic abnormalities (such as fragile X syndrome and any other genetic mutations such as BRCA1, etc.)
2. Chemotherapy/Radiotherapy
3. Smoking cigarettes or vaping
4. Chronic psychological stress
5. Ovarian surgery
6. Unexplained causes 

How do I identify poor ovarian reserve?

Low ovarian reserve doesn’t really have prominent symptoms, but these are some ways it can be diagnosed clinically:

1. Shortened menstrual cycles
2. Reduced inhibin B levels
3. Lower Antral follicle count 
4. Reduced Anti Mullerian hormone levels (<1ng/mL)
5. Higher FSH levels during early follicular phase (>10 mIU/mL)
6. Higher basal FSH:LH ratio
7. High basal estradiol and normal FSH levels

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Growing follicles produce inhibin B and AMH, and they help suppress FSH levels and recruit the number of “follicles for the month”. Ideally, they are supposed to decline with age. However, in low ovarian reserve, these markers decline earlier, leading to an increase in FSH levels. 

Additionally, low ovarian reserve leads to lesser number of primordial and early antral follicles (essentially, 🥚 eggs in the baby phase, which is exactly what AFC when done at the start of your menstrual cycle, measures). When there’s a decrease in those, the AFC levels decrease as well. 

Poor ovarian reserve is also the major cause of poor ovarian response, where the ovaries show a lower response to fertility medication. 

Can you freeze your eggs if you have a low ovarian reserve?

Yes, you can freeze your eggs, even if you have a low ovarian reserve. The main idea behind this is to retrieve as many mature eggs as possible and freeze them, so you can use them later on.

Given that a low ovarian reserve usually means AMH levels <1ng/ml (or <331 pmol/L), the number of eggs you retrieve in one cycle might be less. But with modified protocols and egg pooling, you will be able to freeze the desired number of eggs. 

And hey, let’s not forget that egg quality plays an equal role here too 👋 

How does low ovarian reserve affect egg freezing?

Freezing your eggs is actually one of the recommended options you have with low ovarian reserve. However, your healthcare provider will alter your treatment protocol and propose some modifications such as:

1. Multiple cycles: With low ovarian reserve may need to undergo multiple egg freezing cycles within a 28-day “cycle” or time frame to obtain the required number of eggs. This is because a lower AMH means that fewer eggs can be retrieved each cycle. This approach also helps pool more eggs to freeze in an attempt to improve success rates. The number of cycles can depend on factors such as age, any underlying medical conditions and the levels of AMH and AFC.
2. Customised protocols: The dosage of medications may be tailored and protocols such as agonist, antagonist, high-dose gonadotropins, or adjuvants etc, might be used to maximise the number of eggs retrieved while ensuring safety. 

Does low ovarian reserve mean low egg quality?

The ovarian reserve does include the quality as well as the quantity of eggs, but a low ovarian reserve does not mean low egg quality. 

Studies on patients with low ovarian reserve consistently show that maternal age is the major factor dictating egg quality, regardless of the ovarian reserve. 

And since low ovarian reserve is usually seen in women above 35, the correlation with a lower egg quality is often made. 

But it’s actually the age and not the ovarian reserve that affects the egg quality. Along with age, other factors that do affect egg quality include chromosomal abnormalities, mitochondrial defects, genetic factors, etc. basically, the same factors that affect all of us, in general. 

So, here’s the verdict 👩‍⚖️: age is still the best dictator of egg quality, regardless of ovarian reserve. 

How is low ovarian reserve treated?

To treat ovarian reserve, there are some options: treatments, preserving your fertility or going for fertility procedures. Here’s a breakdown:

Preserving your fertility:

1. Egg or embryo freezing

You can go for egg freezing if you want to freeze your eggs for use later on or go for embryo freezing if you have a partner or donor sperm.

🤔 Also read: Should I go for egg or embryo freezing?

Fertility procedures: 

1. In vitro maturation

This is a procedure where immature eggs are collected and their maturation is completed in the lab within culture media. 

This is favourable for some patients as it reduces the stimulation dosage, helps reduce the risk of OHSS (ovarian hyperstimulation syndrome) in PCOS patients and may reduce the need for multiple cycles. 

📚 Download our free PCOS guide 

2. IVF/ICSI with donor eggs 

The option to undergo IVF/ICSI with donor eggs is also available. It is possible to do IVF with donor eggs that are not frozen and are from a fresh cycle. For frozen donor eggs, you would have to choose ICSI as the option. The semen sample can be that of your partners, or you can opt for donor sperm as well. 

Treatments:

1. Ovarian PRP

Platelet which plasma or PRP is extracted from blood samples. PRP is known to play a role in cell migration, differentiation, and tissue repair.

PRP is injected into the ovary in an attempt to “rejuvenate the ovary” and post-procedure, AMH and FSH levels are monitored every two weeks. When there is a rise in AMH levels or a decrease in FSH levels, patients may have a chat with their healthcare provider and be directed to any fertility procedure. 

Egg freezing with Low Ovarian Reserve: How Amilis can help 

It’s time, we build the conversation around fertility and take care of our own reproductive health. 

This can be as simple as reading up on it, taking a fertility test, booking a consultation or even having the required conversations on our reproductive health. 

You can even take our egg freezing quiz, or have a 1-1 with Amilis experts to decide whether it’s for you or not. 

Ultimately, early detection could help you make informed decisions on your fertility. 

At Amilis, we aim to make fertility testing in the UK affordable and accessible, partnering with Randox, and top fertility clinics in the UK for egg freezing.

So we have your back, whether you want to start out by knowing your ovarian reserve, or by consulting a healthcare provider.

You've got this ❤️