Diminished Ovarian Reserve
Many women who have a diagnosis of DOR with high FSH and/or low AMH are told by their reproductive endocrinologists that using donor eggs is their only option for pregnancy. That, however, may not always be the case. At CHR, almost every patient has 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 eggs after 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 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 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 higher a woman's pregnancy chances.
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. We recommend that women with diminished ovarian reserve attempting IVF be given different treatment plans from younger women with normal ovarian reserve: for instance, they need larger doses of fertility medications to produce a good number of good-quality eggs. For another example, at CHR, women with DOR are typically supplemented with DHEA to readjust their ovarian environment to a more rejuvenated, youthful, androgenandrogen -rich ovarian environment that allows eggs to undergo a healthier maturation process that results in better pregnancy chances.
For nearly a decade now, CHR has been supplementing women with DOR with the mild androgen dehydroepiandrosterone (DHEA)dehydroepiandrosterone (DHEA) . DHEA supplementation was first introduced into fertility care by CHR physicians and has since spread worldwide with remarkable results. 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. There have been many women who had been advised by other fertility centers that their only chance of conception was with egg donation, who have 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.
As was said before, timing is everything when it comes to effectively diagnosing and treating diminished ovarian reserve. There are conflicting treatment approaches for DOR (some of which have more 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. Many patients who are already receiving treatments at other fertility centers also take advantage of our online second opinion consultation.
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: October 8, 2018