We often consult for women after repeatedly failed IVFs, eventually landing into something called as poor ovarian reserve or poor ovarian response. The hormone AMH levels are drastically low and their IVF specialists has scared them to hell about the prognosis and pushing for another cycle of IVF or ICSI as early as possible. Is the scenario same with you???
So what exactly is Poor Ovarian Reserve ?
- It is usually accompanied by high FSH (Follicles Stimulating Hormone) levels.
- It is a condition of low fertility characterized by:
ü Low numbers of remaining oocytes in the ovaries.
ü Possibly impaired preantral oocyte development.
- One of the most frustrating problem in IVF today is poor ovarian reserve.
- It is well known that the pregnancy rates in IVF are directly dependant upon quality and number of embryos transferred and the more number of eggs a woman grows then better embryos can be select from it.
- This is why woman with good ovarian response have much higher pregnancy rates than the woman with poor ovarian response.
Is poor ovarian reserve is common condition or not?
- No poor ovarian reserve is not common condition but can be observed after repeatedly failed IVF cycles.
What is the incidence or chances of poor ovarian reserve?
- This condition is mostly seen in only10-12% of woman who has menstrual abnormalities like amenorrhea (absence of menses).
Poor ovarian reserve affects age group of?
- Usually the ovarian function is varies with age, as age increases her ovarian response starts declining naturally. It mostly seen in age group of 30-40 yrs.
What are the causes of poor ovarian reserve?
- Mostly causes are idiopathic- no known causes.
- Poor ovarian reserve is premature decrease in number of eggs and can be caused by chromosomal anomalies s/a Turner Syndrome where there the woman does not have two X chromosome, or Gene anomalies s/a fragile x syndrome.
- About 20-28% woman experienced fragile x syndrome and 23 % experienced early menopause.
- Autoimmune disorder.
- Adrenal gland impairment.
- Iatrogenic- due to radiation, chemotherapy or surgery s/a laser surgery of the surface of ovary to treat endometriosis. Excessive laparoscopic ovarian drilling can cause premature ovarian failure
Which are the tests to be done to detect poor ovarian reserve?
- Various tests are there to measure ovarian response.
(1) The commonest test is to measure the FSH (Follicle Stimulating Hormone) levels in blood- the basal (day 3) FSH levels. A high level suggests the poor ovarian response/ reserve. And very high level (more than 20 mlU/ml- though it is varies from lab to lab) is diagnostic of ovarian follicle.
(2) CCCT (Clomiphene Citrate Challenge Test) – This test provides the earlier evidence of declining ovarian function. This is similar to the “stress test” of ovary and involves measuring the basal Day 3 FSH level and Day 10 FSH level after administering 100 mg of Clomiphene citrate from Day 5 to Day 9. If some of FSH level is more that 25, then this suggest poor ovarian function and predicts that the woman have poor ovarian response. The high FSH level in woman does not mean that she can not get pregnant it just mean that the chances of pregnancy are drooping because the egg quality is impaired.
(3) It is also useful to check your FSH: LH ratio. A normal FSH: LH ratio is 1. However, if the FSH level is much higher than the LH level, then this suggests poor ovarian reserve.
(4) Also test estradiol (E2) level on Day 3 at the time of checking FSH level. A high E2 level can artificially suppress the FSH back to normal, and giving you false results. However, a high E2 level suggests poor ovarian reserve.
(5) Another test which has been recently developed is measurement of blood level of Anti Mullerian Hormone, (AMH) which are produced by good follicles. Low levels of AMH suggest poor ovarian reserve. AMH levels do not change significantly throughout the menstrual cycle and can be measured independently on any day of menstrual cycle. AMH level may decrease with age. Healthy woman with age of 38 yrs old with normal follicular status on Day 3 of menstruation have AMH levels of 2.0- 6.8 ng/ml. High levels are found in patients with PCOD.
(6) Along with using biochemical test to assess ovarian function we can use biophysical markers too. This biophysical markers use ultrasound technology to image the ovaries and follicles. The most useful test is called as the Antral Follicle count (AFC) in which counts the number of antral follicles present in ovary on Day 3 using vaginal ultrasound scanning. Antral follicles are small follicles usually measures 2-8 mm in diameters. (The normal total antral count is between15 to 30). If count is less than 6 then prognosis is poor.
What should be the alternative treatment for a high FSH level?
- Basically there is no treatment for a high FSH level in conventional medicine. Once the ovarian reserve is depleted, the ovary cannot grow any new eggs. However, if you have a borderline high FSH levels, there are many alternative options you can explore to try to improve your ovarian reserve.
- Homeopathy basically stimulates your glands to regulate the hormone levels and strive to improve the ovarian reserve. We have seen in our patients,that AMH level improves with authentic Homeopathy treatment.