Low ovarian reserve
Today the concept of delayed parenthood is becoming quite common. With the popularity of fertility treatment women are not under the banner of having to start a family early on in their marriage. Now couples can concentrate on their careers and settling themselves financially before they begin thinking about having children and raising a family.
The ease of a planned parenthood has made life very convenient for people living in nuclear homes. The inability to conceive is no longer a major worry. Infertility is not something that robs couples of their sleep. The booming medical industry has laid an indelible imprint on the minds of the current generation that medical science has all the answers to medical problems. They no longer worry or fear about ailments and health problems.
Some women even go to the extent of starting their family planning late in their 30s and well into their 40s. Women who are older are more susceptible to suffering from problems which hinder them from getting pregnant easily. Sometimes they have to try for several years before they can conceive naturally and sometime a natural conception is not possible due to other factors. Since so much time has already progressed and age is against them, any further delay is not welcomed. The quality of female fertility decreases as a woman gets older.
The female egg which is instrumental for fertility reduces in quality with age and hence hinders conception. The quality of the female egg is very vital for pregnancy to take place. It is not just the quality of the eggs but the quantity of the female eggs which becomes a cause of concern in women older than 40 who are trying to get pregnant.
However, do not fear getting pregnant is still possible whatever age you are, but it may need some patience and corporation with the doctors. But medical science has done wonders by enabling older women to conceive and have their own children.
A woman’s fertility revolves around her ovarian reserve. Ovarian reserve represents the number of eggs that a woman has in her ovaries. Most of these eggs have the capability to be fertilised and become into a baby. Unfortunately a woman does not generate new eggs over the passage of time. A girl child is born with a certain stock of eggs, which is generally approximately 2 million. A large percentage of these eggs are lost by the time she reaches puberty.
At the onset of puberty a female begins her fertility cycle. Every menstrual cycle a woman’s ovaries will begin to mature about 5 eggs. Among these eggs, some will not mature completely, but one mature egg will be ready for fertilisation during each ovulation cycle. This process goes on till all the eggs in the ovaries are used up. After this a woman will enter menopause. A woman’s fertility years are basically between puberty to menopause.
Reduced ovarian reserve
Some women suffer from a reduced ovarian reserve. This means that the number of eggs remaining in her ovaries is limited. A woman generally enters menopause in her late 50s or early 60s once her ovarian reserve is used up. If a woman’s ovarian reserve finishes earlier then she will enter menopause earlier and this could even be in her late 40’s or early 50’s. Some women are detected with a low ovarian reserve in their late 30’s or early 40’s. This can affect their fertility in a negative manner. Early menopause means that a woman does not have good eggs left in her ovaries and will not be able to have children.
A woman with a low ovarian reserve may come into menopause earlier in her life, thus deeming her unable to have children naturally. The only option left for her at this stage is fertility treatment. IVF treatment has made it possible for women with all kinds of fertility problems to still have children.
Fertility in women over 45
Women over the age of 45 are prone to a reduced fertility. Many women over 45 suffer from two major problems with regards to their eggs. These are:
- Poor quality eggs
- Decreased ovarian reserve
The advancement of medical science has made conceiving after the age of 45 no big deal. Women in this age group don’t have to think twice about having a child, even if it is a first child. Earlier doctors believed that having a child after 45 was not possible if you had not had a child earlier, but today such issues are no longer a cause for concern. All kinds of things are possible now. With the help of in vitro fertilisation women can conceive well into their late years.
Checking ovarian reserve
There are several tests which can be used to check the ovarian reserve of a woman. Before undergoing ovarian stimulation it is advisable to first check the ovarian reserve especially for women over the age of 40. This can prepare the patient and the doctors for what they should expect. The dosage of hormone medication given to stimulate the ovaries to mature a larger number of eggs can also be altered accordingly.
Some of the methods used to get an idea about the ovarian reserve are:
- Antral follicle count test: This test involves counting the number of antral follicles that are visible. It is conducted using a transvaginal ultrasound. Doctors can get a good idea of the ovarian reserve through this test.
- AMH (Anti-Mullerian hormone) level test: A blood test is taken to check the level of the anti-mullerian hormone. This helps doctors determine the ovarian reserve levels based on the level of the hormone present in the blood. A low level of the AMH indicates that there is a low ovarian reserve.
- Day 3 FSH and Estradiol test: The FSH (Follicle Stimulating Hormone) level on the 3rd day of the menstrual cycle indicates how much of an ovarian reserve a woman may have. If the FSH levels are high then the woman has a reduced ovarian reserve.
These tests indicate the level of ovarian reserve but do not specify exactly how many eggs there are and the quality of the eggs that are present in the ovaries. Doctors take these tests to get a rough estimation of the ovarian reserve.
While it is possible to check the quantity of eggs that a woman has in her ovaries, there is no test that can ascertain the quality of the eggs. Based on the quantity of the eggs presents doctors try and determine the quality of the eggs but this is a flawed prognosis. An ovarian reserve test doesn’t say much about the quality of the eggs that remain in the ovaries.
Age is a very important factor used to determine the quality of the female egg. In fact doctors use age as the most reliable measuring stick for female egg quality. A younger woman will have better quality eggs than an older woman. As women age the quality of eggs deteriorate. Doctors make a rough estimation about the quality of the female eggs based on the age of the patient.
Poor ovarian responders
A poor responder is defined as one who responds poorly to ovarian stimulation. A woman’s ability to respond to the hormone injections administered during IVF treatment to stimulate the ovaries to mature additional eggs defines how well she responds. Generally a good responder would be able give around 6 to 12 eggs while a poor responder many result in only 1 to 6 eggs. However, even if the quantity of the eggs is poor but the quality is good there is a high chance of IVF success.
Women who have poor ovarian reserve are usually poor ovarian responders too. Hence a woman with poor ovarian reserve will need extra stimulation for maturing the eggs in her ovaries.
Conceiving at the onset of menopause
As long as a woman has eggs in her ovaries she can conceive. As women approach menopause and begins the initial symptoms, it is quite natural to get a little apprehensive about ones fertility. However, there are still some eggs in the ovaries and it is no too late to get pregnant.
The whole turmoil of entering menopause is the end of fertility for women and some women do not take too kindly to this biological change that is taking place. It leads them into depression that they are getting old. Ageing is the greatest fear of women.
With the help of special medication the ovaries can be stimulated to mature some of the eggs that are still available. These eggs are extracted and can be used for conceiving through the IVF treatment like in the following case.
Rehka found that she was experiencing the initial symptoms of menopause. She took an ovarian reserve test and was diagnosed with reduced ovarian reserve. Rekha was 44, but she and Suraj were eager to have a baby. They had been delaying their baby planning and now time was catching up to them. The premature menopause took them by surprise. They thought they still had plenty of time ahead of them.
After some research and enquiring they found that Medicover Fertility Clinic was their best bet. They immediately took an appointment and started fertility treatment with no time to lose. Rekha’s first ovarian stimulation resulted in the retrieval of only 4 eggs. The ICSI technique was used to fertilise the eggs. Fortunately all 4 eggs resulted in a successful fertilisation. Of the 4 eggs 3 of them made it to the blastocyst stage. The fertility consultant recommended the transfer of two embryos to Rekha’s womb. The remaining one embryo was frozen for future use. The first cycle was not successful and Rekha did not conceive. However, Rekha’s fertility levels had improved by the next ovulation cycle with the medication she was taking. The one remaining embryo was transferred during the next ovulation cycle. This time the procedure was successful and Rekhagot pregnant much to their delight.
Fertility consultant at Medicover says, “It’s not often that we get a patient who is on the brink of menopause. However this case was an interesting challenge since the patient had never been pregnant earlier or tried IVF prior to coming to us. We had no background on her fertility conditions from other medical treatment. As long as the uterus is receptive a woman can conceive even if she has crossed menopause.”
Conceiving after menopause
There are cases of women who have conceived after they have entered menopause. Essentially what is required for conception is an egg that is of a good quality. Women who have had their eggs frozen have prepared for this delayed conception. However sometimes it is even possible to still extract some eggs from the ovaries that have been left behind and forgotten after they enter menopause. But these are arare cases and one shouldn’t count on it.
Hormone injections are given to prepare the body especially the uterus for the embryo implantation when a woman is older. Pregnancy at an older age is risky and needs to be monitored on a very regular basis.
The process of egg retrieval does not sound very pleasant. It is an intrusive procedure, but the patient is sedated while the egg retrieval is being done.The retrieval is done using a special syringe like instrument. A laparoscopic camera is used to see where the mature eggs are in the ovaries.
When eggs have to be retrieved the patient is given medication to mature a larger number of eggs. A greater number of eggs mean that more eggs can be fertilised. This improves the chances of forming more embryos. Not all eggs fertilise, even in the lab. Some embryos that fertilise do not survive more than a few days. Usually more than one embryo is used for an IVF procedure hence a larger number of embryos are required. Transferring a number of eggs to the uterus improves the probability of at least one egg resulting in a pregnancy.
If the quality of eggs is too poor it reduces the chances of fertilisation. Eggs that are too weak to fertilise are no good. Sometimes even if the weak eggs fertilise they do not survive for long. In a situation where a woman’s eggs are very poor quality the doctor may suggest the use of donor eggs.
Sometimes embryos formed with poor quality eggs are not able to implant and lead to IVF failure. In a few cases we have found that the eggs do implant which may be also due to the high receptivity of the uterine lining, however in these cases the woman very often ends up having a miscarriage.
Using a donor egg can be a great emotional challenge for a couple. The child you will be carrying during your pregnancy will be someone else’s child. It is the desperate desire to have a child that drives couples to opt for a donor egg.
The donor is anonymous and no details regarding the donor are revealed to the couple. However a profile match is conducted to ensure that the features of the donor and the mother match to some extent. There is also a background check and a profile match to ensure that there are similarities between the biological mother and the legal mother.
Fertility solutions with poor ovarian reserve
Women who have a reduced ovarian reserve are able to successfully conceive and have children with the help of IVF treatment. By stimulating the ovaries the doctors is able to retrieve as many mature eggs as possible. These eggs are fertilised in the lab and their development monitored at every stage.
Embryo pooling: Some couples are not keen on using a donor. In this case the couple can opt for a technique called embryo pooling. Since the female partner has a low ovarian reserve only one or two eggs may mature at each cycle. These eggs are extracted from the ovaries, fertilised in the lab and frozen. When there are a sufficient number of embryos they are transferred to the uterus together.
Blastocyst culture: Many clinics are now recommending blastocyst culture transfers to improve the likelihood of a successful pregnancy. The embryos are kept in an incubator for up to 5 or 6 days where they turn into blastocysts. Only one or two blastocyst embryos are required for the IVF transfer to the uterus. If there are more embryos they can be frozen for future use. A blastocyst transfer is done on a day when the uterus lining is receptive and hence this increases the probability of pregnancy multi fold.
Medicover IVF facilities for low ovarian reserve
Medicover Fertility Clinic has a state of the art lab with one of the best embryologist. This highly equipped lab ensures enables the embryologist to put to practice his skill and expertise in monitoring embryos and helping them to develop into blastocysts cultures.
Medicover specialises in helping childless couples have their own baby. Our fertility consultants go out of their way to find methods in which your fertility treatment can be assisted to become successful. Medicover uses the latest fertility techniques which are tried and proven to help patients with complicated and difficult fertility problems become parents.
Q: I was diagnosed with reduced ovarian reserve but the doctor was able to retrieve 9 eggs from ovaries after stimulation. 7 eggs fertilised but I was not able to get pregnant. What should I do?
A: It is likely that the test result of the ovarian reserve test was inaccurate. It is advisable to get a test done at a reputed fertility clinic. During your next egg retrieval have the extra embryos frozen for future use in case your IVF cycle is not successful.
Q: I am 32 and detected with low ovarian reserve. Does this mean that I will start menopause soon.
A: It is likely that you may start menopause sooner than most other women.
Q: What is the best option for a delayed pregnancy?
A: I would recommend that you have your eggs frozen. This will give you 10 years in which to use them and will safeguard you against a decline in your ovarian reserve.
Q: Is there any way that I improve my ovarian reserve?
A: Unfortunately, ovarian reserve is predetermined at birth and once you lose your eggs your body will not produce any new eggs.
Q: I am 30 and my doctor says I have poor quality eggs which are incapable of enabling me to have my own child. How can I improve my egg quality?
A: There is no known method to improve egg quality and similarly there is no way to say for certain that your egg quality is poor. Try IVF treatment at a reputed fertility clinic for better IVF success.
14 November, 2018
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