Diminished Ovarian Reserve Treatment
What Is the Best Fertility Treatment for Low Ovarian Reserve?
Many women who have a diagnosis of diminished ovarian reserve (DOR, also called low ovarian reserve or low egg reserve) with high FSH and/orlow AMH are told by their reproductive endocrinologists that there is no treatment for low egg reserve, leavingand that using donor eggs asis their only option for pregnancy. At CHR, almost all of our every patients haves been told that their only chance of having a baby is through egg donation because of diminished ovarian reserve. However, about one third (33%) of our patients do get pregnant with their own eggsafter receiving appropriate thoroughly individualized treatment for diminished ovarian reserve at CHR.
Consciously focusing our treatment and research on women over 40 and younger women with premature DOR for over a decade, we have made many breakthroughs and refined our treatment approaches, as evidenced by dozens of research studies published on this topic. Furthermore, a recent analysis of our IVF outcomes in "poor-prognosis" patients has shown that the "less than 1% chance of pregnancy" often thrown around to women with high FSH or low AMH is often incorrect, and even with severe DOR, some women do have a better chance of pregnancy with their own eggs than they’ve been led to believe. For decades now, our doctors and fertility specialists have been focused on finding solutions for how to improve low ovarian reserve.
With this experience under our belt, we are convinced that many women with even very low ovarian reserve can conceive with their own eggs, if given individualized treatment that is tailored for their ovarian reserve status (and any accompanying conditions affecting fertility). Ultimately, time is the most important factor with DOR, and the sooner treatment can be started,the better her low ovarian reserve treatment options and the higher a woman's pregnancy chances.
Low Ovarian Reserve and Natural Pregnancy
When trying to start a family without the use of fertility treatment, low ovarian reserve and natural conception are at odds with each other. Low ovarian reserve usually means that a woman just does not have the supply of good-quality eggs necessary to achieve ovulation and fertilization without medical assistance. Furthermore, it’s important to remember that time is always of the essence when trying to get pregnant with low ovarian reserve. CDC and professional organizations in our field recommend that women over 35, who are at higher risk of DOR, consult a fertility specialist when they do not get pregnant after 6 months of unprotected intercourse. The timeline of 6 months if shorter than that for younger women because of the urgency with DOR.
Low Ovarian Reserve and Intrauterine Insemination (IUI)
Some IVF centers recommend intrauterine insemination (IUI) to patients with low ovarian reserve. In CHR’s opinion, IUI, a form of fertility treatment where prepared sperm is directly injected into the uterus, is not the best fertility treatment for diminished ovarian reserve.The often-cited claim that patients with DOR have “less than 1 % chance of pregnancy” with IVF that they might as well try multiple rounds of less costly IUI rather than go straight to costlier and more aggressive IVF, is highly inaccurate and goes against the published evidence in the literature; in our experience, IVF, if designed specifically for individual DOR patients, has a much higher success rate than IUI. Importantly, repeating unsuccessful IUI cycles with low ovarian reserve also leads to wasted time, which is not on the patient’s side when it comes to ovarian reserve.
At CHR, once ovarian reserve testing reveals that a patient has diminished ovarian reserve, our physicians usually recommend patients to start ovarian preparation and move onto IVF as soon as possible to ensure the best chance of pregnancy.
DOR and In Vitro Fertilization (IVF)
For most women looking to get pregnant with their own eggs after being diagnosed with DOR, IVF with ovarian stimulationovarian stimulation is the quickest and most reliable treatment option. Our IVF protocol for low ovarian reserve means that women with DOR are given different treatment plans than younger women with normal ovarian reserve: for instance, they need larger doses of fertility medications to produce a good number of good-quality eggs. As another example, at CHR, women undergoing a DOR IVF protocol are typically supplemented with DHEA before the IVF cycle starts, in order to readjust their ovarian environment to a more rejuvenated, youthful, androgen-richandrogen-rich ovarian environment that allows eggs to undergo a healthier maturation process. At CHR, our experts have shown that well-designed IVF for DOR patients can increase pregnancy chances in women who previously thought they would not be able to have a baby using their own eggs.
DHEA Supplementation for Diminished Ovarian Reserve
For over a decade now, CHR has been supplementing women with DOR with the mild androgen dehydroepiandrosterone (DHEA)dehydroepiandrosterone (DHEA) , a poor ovarian reserve treatment that is most effective when used within individualized IVF treatment protocols. DHEA supplementation was first introduced into fertility care by CHR physicians and has since spread worldwide with remarkable results. DHEA is a weak androgen (male sex hormone) that is converted into testosterone in the body. Research at CHR has shown that a good level of testosterone is necessary for the development of eggs in women’s ovaries.
DHEA improves ovarian reserve in the sense that it improves the ovaries’ ability to produce a good number of high-quality eggs.
The major benefits of DHEA for fertility include an increase in the quality and quantity of eggs and embryos, increased spontaneous pregnancy rates, increased IVF success rates, decreased miscarriage rates, and decreased risks for chromosomal abnormalities in embryos. In this sense, DHEA can help women with low egg counts improve ovarian reserve and finally get pregnant with their own eggs. There have been many women who had been advised by other fertility centers that their only chance of conception was with egg donation, but who later conceived under our care using their own eggs. For women with diminished ovarian reserve, DHEA supplementation combined with aggressive, individualized IVF protocols developed at CHR has proved a life-changing treatment option.
Finding the Best Fertility Treatment for Low Ovarian Reserve
As was said before, timing is everything when it comes to correctly diagnosing and effectively treating diminished ovarian reserve. There are conflicting treatment approaches for DOR (some of which are better-supported by evidence than others), and it can sometimes be difficult to figure out what you want or whether your current treatment path is right for you. CHR's physicians can help you at different points of your decision-making process.
We hope you will decide to start your journey on the right foot, consulting our physicians and undergoing through infertility workup, including ovarian reserve testing, but we are here to help you find the right treatment even if--or especially if--you have already experienced disappointments elsewhere. Many patients who are already receiving treatments at other fertility centers take advantage of our online second opinion consultation.
Read more about Diminished Ovarian Reserve
The ability of a woman's ovaries to produce high-quality eggs is known as ovarian reserve (OR)...
Effective treatment of DOR starts with timely diagnosis. Timely diagnosis is crucial...
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, 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.
Last Updated: June 3, 2019