Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on Oct 08, 2018
Treatment options for diminished ovarian reserve and advanced maternal age
"1/3 of women who have been told they need egg donation actually wind up conceiving at the CHR with their own eggs"
At CHR, we believe that using donor eggs is a last-resort treatment for women with diminished ovarian reserve (DOR). Before resorting to donor eggs, we first try all other avenues, applying our expertise and extensive knowledge about ovarian reserve to help women get pregnant with their own eggs. Due to our dedication to patient's autonomy over whether to use their own eggs or donor eggs, as well as our specialized knowledge that enable us to help patients who decide to try with their own eggs, CHR has become the go-to center for fertility patients from all over the world.
CHR meets many women who have been turned away by other IVF centers because of their desire to get pregnant only with their own eggs. This is especially true for our patients over 40. Many centers won't even consider treating women over the age of 40 with their own eggs, never mind over the age of 44.
At CHR, we specialize in helping women over 40 become pregnant with their own eggs by implementing a personalized treatment plan tailored to each woman's circumstances. Our physicians and scientists constantly update the treatment protocols based on extensive research. Our constantly evolving treatment method has been successful, and our statistics from last year reflect that success.
How DHEA Improves Fertility in Women with Low Ovarian Reserve
Dr. Norbert Gleicher, on why CHR offers such a rare program.
A Timely Diagnosis
Our treatment plan for DOR starts with a timely diagnosis. This is of particular importance for women over 40, as time isn't on their side. We make it a priority to diagnose DOR rapidly, so an effective treatment can quickly follow.
First, we assess your levels of follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH). Our approach when interpreting these levels is unique: instead of using a universal cut-off value for all patients – unfortunately a common practice in other fertility clinics – we measure these hormone values against the patient's age, as FSH and AMH levels change naturally as a woman ages. This age-specific approach allows us to pick up on subtle abnormalities in these reproductive hormones, and our physicians are able to adjust your fertility treatment accordingly.
A diagnosis of DOR is by no means the end of a woman's ability to conceive with her own eggs. With the right treatment approach, many women with DOR, even those over 40, can go on to have safe, successful pregnancies. In fact, a recent study conducted at CHR demonstrated that some women who have been told that they have a "less than 1% chance" of pregnancy with their own eggs actually have a much higher chance of pregnancy, in the 5-7% range, if they are able to produce 2-3 embryos to transfer in an IVF cycle. [Watch Dr. Gleicher explain the findings in our video gallery.]
Our Integrated Treatment Approach
Our treatment approach for DOR is an integrated plan that our world-renowned fertility experts have developed through their research and clinical experience over the past thirty years. It has three main pillars:
- An Individualized Ovarian Stimulation Protocol: Ovarian stimulation is the process that develops the eggs that will be used for fertilization. Women of different ages have different ovarian reserves (as measured by AMH/FSH values) and thus require different ovarian stimulation plans to address their specific ovarian function. We make it a priority that each patient receives the ovarian stimulation protocol best suited to her clinical circumstances, and we monitor everyone’s progress closely.
- Pre-stimulation Supplementation with DHEA: CHR's confidence in DHEA in treating DOR is based on our extensive clinical research in the area. In fact, CHR pioneered research into DHEA, which is now used in a third of the world's fertility treatment centers. Our research has shown that DHEA is extremely effective in improving the ovarian environment.\ Why is this important?
- A woman's eggs that have not yet gone through the maturation process do not age. The aging process of eggs begins only when they mature in an aged ovarian environment.
- Eggs that mature in an aged ovarian environment will lose quality.
- Poor-quality eggs are linked to increased miscarriages and lower implantation rates.
- DHEA improves the ovarian environment. Women take this supplement before ovarian stimulation, so when the time comes for eggs to mature, they mature in a healthier, revitalized, "younger" environment.
- Individualized Management: Each patient's treatment plan is individualized, taking into account past medical history and any existing medical conditions (such as autoimmune disease) that could affect fertility and need to be proactively addressed. Individualized management also includes early egg retrieval, an approach developed recently at CHR that increased pregnancy rates by two- to three-fold for women with DOR (see below).
New research on improving female fertility
In addition to our proven integrated treatment approach to help women get pregnant with their own eggs, we also continue to research other ways to help women improve their chances of getting pregnant with their own eggs.
While still in the early stages of research, supplementation with Coenzyme Q10 is emerging as a new way to help fight oxidative stress on the ovaries and therefore improve egg quality and fertility. Watch the video to learn more.
Testosterone and Female Fertility
The effect of testosterone on female fertility has been an evolving area of research at CHR in the last couple of years, as a result of our investigation of the mechanisms of DHEA’s effects on egg quality. Studies conducted at our center, as well as animal studies at other institutions, have suggested that low androgen levels are associated with diminished ovarian reserve. With DHEA supplementation (which is converted into testosterone in the body) and directly with testosterone, this low androgen state can be reversed, and the ovarian environment can be restored to its youthful, testosterone-rich state. For more information on how your testosterone levels may impact your ability to get pregnant with your own eggs, watch the video here.
Early Egg Retrieval
Early egg retrieval for women over 43, another treatment innovation at CHR, proved to be extremely beneficial, improving their pregnancy chances with IVF by as much as two-fold. Our research suggests that retrieving eggs earlier than typical, when the lead follicle is at about 16-18 mm rather than waiting until it is around 21 mm, prevents eggs from "overcooking" in the ovaries. By retrieving eggs early and maturing the immature ones in the laboratory via in vitro maturation (IVM), we have been able to increase the number of embryos available for transfer for women with diminished ovarian reserve, and subsequently improve their pregnancy chances.
Furthermore, early egg retrieval also works for younger women with premature ovarian aging (POA). When this technique is used for younger women whose ovarian reserve is abnormally low for their age, the result was even more spectacular: Their IVF pregnancy rates tripled according to a paper CHR investigators published in 2015 in a prestigious endocrinology journal. By applying these innovative techniques developed in-house, CHR's clinical team is able to offer robust, much-better-than-assumed pregnancy chances with IVF using patients' own eggs.
Schedule an Appointment or Get a Second Opinion
There are conflicting treatment approaches for women trying to get pregnant with diminished ovarian reserve. It can be difficult to figure out what you want or whether your current treatment path is right for you. To consult with a physician about what treatment plan is right for you you can either send us an email to get started, participate in our extensive second opinion program, or call (212) 994-4400 to schedule an appointment today.
Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.