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/or low AMH are told that there is no treatment other than donor eggs. At CHR, almost all of our patients have been told that their only chance of having a baby is through egg donation because of DOR. However, about one third (33%) of these patients do get pregnant with their own eggs after receiving appropriate, thoroughly individualized treatment for diminished ovarian reserve at CHR.
Focusing our research and treatment on women over 40 and younger women with premature ovarian aging (POA, an early-onset form of DOR) for over a decade, our physicians and scientists 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.
With this experience under our belt, we are convinced that many women with even very low OR can conceive with their own eggs, if given individualized treatment that is tailored to their ovarian reserve status, as well as any accompanying conditions affecting fertility. Ultimately, time is the most important factor with DOR treatment, and the sooner a patient’s treatment can be started, the better her treatment options and the higher her pregnancy chances.
Low Ovarian Reserve and Natural Pregnancy
When trying to start a family without the use of fertility treatment, DOR and natural conception are at odds with each other. DOR 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.
The 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. This 6-month timeline is shorter than the 12-month timeline recommended for women younger than 35, due to the urgency associated with treating 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 DOR. The often-cited claim that patients with DOR have “less than 1 % chance of pregnancy” with IVF anyway so 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 each DOR patient, has a much higher success rate than IUI.
Importantly, repeating unsuccessful IUI cycles with low ovarian reserve also leads to wasted time. With declining ovarian reserve, 3-6 months can make a significant difference; by the time patients move to IVF after many months of failed IUIs, they may face lower pregnancy chances even with IVF (compared to if they had started IVF straightaway). Some insurance policies also require IUIs before patients can access their IVF benefits, and this is why we find these insurance policies not in the best interest of patients.
At CHR, once ovarian reserve testing reveals that a patient has diminished ovarian reserve, our physicians usually recommend that patients 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 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, these patients need larger doses of fertility medications to produce a good number of good-quality eggs.
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 youthful, androgen-rich ovarian one. This 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) prior to the start of IVF cycles. 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.
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 improve ovarian reserve and finally get pregnant with their own eggs. For women with DOR, DHEA supplementation combined with aggressive, individualized IVF protocols developed at CHR has proved a life-changing treatment option.
Finding the Best Fertility Treatment for DOR
Timing is everything when it comes to 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 for patients to figure out who to trust or whether the current treatment path is the right one. CHR's DOR experts 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 a thorough 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. Patients who are already receiving treatments at other fertility centers can also 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 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.
Last Updated: May 5, 2020