Low ovarian reserve explained

By Rehan Salim, Consultant Gynaecologist & Sub Specialist in Reproductive Medicine and Medical Director at the  Lister Fertility Clinic in the The Portland Hospital

Low ovarian reserve is a medical term used to describe a condition in which a woman’s ovaries contain fewer eggs than expected for her age. It is an important factor to consider in female fertility because the number and quality of eggs in the ovaries are critical for achieving a successful pregnancy, whether through natural conception or assisted reproductive technologies like in vitro fertilisation (IVF).

Before we go any further, we want to get straight to the question that every woman who has been diagnosed with low ovarian reserve wants to know…

Can I get pregnant if I have a low ovarian reserve?

The answer? Yes you can.

However, it’s important to be realistic. Remember, the more eggs you produce during stimulation, the higher the chances of creating good quality embryos to transfer. Unfortunately, not every egg will go on to create a healthy embryo, so having a high number of eggs gives you the best odds.

On average, a successful IVF cycle often requires the retrieval of 10 to 15 mature eggs. As a woman ages, the percentage of abnormal eggs contributing to abnormal embryos increases. So, the lower the number of eggs retrieved, the less percentage of embryos.

How do I know if I have low ovarian reserve?

The diagnosis of low ovarian reserve is typically made through tests that assess a woman’s ovarian reserve, including blood tests for hormone levels (such as anti-Müllerian hormone or AMH and follicle-stimulating hormone or FSH) and transvaginal ultrasound to count the number of antral follicles (small fluid-filled sacs that contain immature eggs).

During a transvaginal ultrasound, the doctor can count the number of small antral follicles (2-10 mm in size) in the ovaries. Generally, a low AFC, typically less than 5-7 follicles per ovary, may suggest reduced ovarian reserve.

It’s important to note that these values are not strict cut offs, and the interpretation of ovarian reserve results should consider an individual’s age, medical history, and specific circumstances.

Low ovarian reserve can make it more challenging to conceive naturally and may reduce the success rates of fertility treatments like IVF. However, it’s important to remember that having a low ovarian reserve doesn’t mean a woman can’t get pregnant, but it may require more aggressive fertility interventions or the use of donor eggs in some cases.

What do I do if I have low ovarian reserve?

If you have only a few eggs left due to low ovarian reserve, you can still undergo in vitro fertilisation (IVF). However, there are some important considerations to keep in mind:

Egg Quality: The quality of the remaining eggs becomes even more crucial when you have a low ovarian reserve. Eggs from women with low ovarian reserve may be more likely to have chromosomal abnormalities, which can affect embryo development and the chances of a successful pregnancy.
Individualised Treatment: Your fertility specialist will need to develop a tailored treatment plan based on your specific situation. This may involve using lower-dose medications (such as in Mini-IVF) to stimulate your ovaries, focusing on retrieving the best-quality eggs, and possibly considering multiple IVF cycles to accumulate embryos over time.
Donor Eggs: If the quantity and quality of your eggs are severely compromised, your fertility specialist may discuss the option of using donor eggs. Donor eggs come from healthy, young donors and can significantly increase the chances of a successful pregnancy.
Fertility Preservation: If you’re not ready to undergo IVF immediately but are concerned about future fertility, you might consider fertility preservation options, such as egg freezing. This can help you preserve your remaining eggs for future use.
Comprehensive Evaluation: Your fertility specialist will likely conduct a thorough evaluation to assess your ovarian reserve, overall reproductive health, and any underlying causes of low ovarian reserve. This evaluation can guide the development of an appropriate treatment plan.

While IVF can still be an option for individuals with low ovarian reserve, it’s essential to have realistic expectations and to work closely with a fertility specialist who can provide you with personalised guidance and the best possible chance of success given your unique circumstances. The choice of treatment, whether traditional IVF, Mini-IVF, or the use of donor eggs, should be based on a careful assessment of your specific fertility profile and goals.

We want to end by saying that we hope this guidance has given you some hope. Your path to parenthood is not over because you have a low ovarian reserve. Consult with a fertility specialist or reproductive endocrinologist who will discuss treatment options tailored to your specific situation.




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