Ovarian reserve is the number and quality of eggs (oocytes) a woman has. And as the name suggests, a diminished ovarian reserve (DOR) signifies a lower number and quality of eggs. Various factors such as pollution, age, stress, smoking, endometriosis, tubal disease, and chemotherapy can take a toll on the ovaries and impact them. Women with a low ovarian reserve may experience infertility and need to opt for procedures like egg freezing.
There are many reasons behind a low ovarian reserve. Experts explain that women are born with a large number of eggs. By the time they get their periods, they have only a few eggs left. With age, the ovarian reserve diminishes.
According to Dr Nisha Pansare, fertility consultant, Nova IVF Fertility, Pune, exposure to air pollutants can decrease a woman’s ovarian reserve. “Anti-Müllerian hormone (AMH) is a marker of ovarian reserve. AMH levels tend to decrease with age. Low levels of AHM are associated with environmental pollutants. Even age and smoking tend to impact AMH levels in a negative way. Smoking impacts oocyte quality. Alcohol consumption is also related to ovulatory abnormalities. Additionally, tubal disease, endometriosis, genetic abnormalities like fragile X syndrome also disrupt the functioning of the ovaries leading to low ovarian reserve,” she said.
Sometimes, the cause can also be a combination of environmental and genetic factors.
Dr Padma Srivastava, consultant obstetrician and gynaecologist, Motherhood Hospitals, Lullanagar, Pune said, “Women who tend to undergo ovarian surgery, take chemotherapy or radiation therapy and have a pelvic infection, autoimmune disorders may also have a low ovarian reserve. Sometimes, the cause is unknown and can be a combination of environmental and genetic factors. Being overweight or underweight can lead to irregular ovulation. If you have low ovarian reserve, then you may have shorter menstrual cycles, heavy menstrual flow, irregular menstrual cycles, miscarriage, or even inability to conceive.”
Diminished ovarian reserve is diagnosed via blood tests that measure follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels. Both of these hormones play a pivotal role in menstruation and reproduction, Dr Srivastava said, adding that early diagnosis will allow one to get timely treatment with successful outcome.
If a woman is planning to delay her marriage, then she should get an AMH test done, Dr Pansare said. “Egg freezing can be a good option for women with low ovarian reserve. This will help you to plan your pregnancy later on. You can thaw those eggs, create embryos, and conceive easily. If one has a low ovarian reserve, then it is better to plan pregnancy via in vitro fertilization (IVF) as it has a good success rate,” concluded Dr Pansare.