If we are talking about IVF, decreased ovarian reserve means that we will receive less eggs.Of course, it is very important what age is patient. One egg give us the probability for live birth is around from 6-12% (around 10%) so, if we have two eggs, our probability is around 15-20%, if we have 20 eggs, we can do several transfers and has 80-90% pregnancy rate so, this is simple: more eggs we have, more chance we have to become pregnant because not all eggs has good quality. At the age of 30-35 around 50 of eggs has genetic abnormality, it means that if we receive 10 eggs, 9 will fertilize, 4 of them will reach blastocyst stage and from this blastocyst one half will have genetic abnormality, it means that only two will be potentially good enough to give pregnancy and delivery so, if we receive only two egg depends on which category we will arrive.
It certainly depends on other factors such as the age of the patient, the previous treatment history and the results of the previous treatment. There is still a chance to try and stimulate the ovaries if there’s no previous treatment we should always try as long as the ovaries are there, as long as they’re functional, as long as there’s a menstruation even if the AMH or anti-mullerian hormone as the sign of the ovarian reserve or the AFC, anthropological count which is the other parameter that we use to estimate the ovarian reserve in the patient, we can always try either with the minimal stimulation or rather with a classic stimulation with high doses of FSH and if you’re successful and get eggs this way then, there still might be a chance actually for successful cultivation of the embryos and a successful transfer. However, if the ovarian reserve gets critically low or the age of the patient is unfavorable, let’s say anything over 40 or 43, definitely if there were three or more previous stimulation cycles then, the chances that we’ll still win repeating the same approach are very slim and it’s time to to think and talk about egg donation. Fortunately this is an alternative which has excellent success rates, dramatically high and this is actually independent of the patient’s age and of the results of her own simulations so, this is eventually the ultimate alternative to the cycle with egg donation.
A low ovarian reserve, of course, does not mean that you have to proceed with IVF as soon as possible. It depends on whether you have tried already to conceive in a natural way; if you managed to conceive and then had a miscarriage, so it depends on your previous history, the age group and of course there are options. One option is to proceed and have an IUI for example. Usually after 45 years of age and an IVF cycle and IUI cycle and insemination, we can see the same success rates. But when we have a woman younger than 40 years old it depends on how low the ovarian reserve is and what level it is at. So if it declines a lot, then of course we must proceed with fertility treatment. But if we are speaking about a young woman with low ovarian reserve but not extremely low, then we still need to give the possibility to try in a natural way if we consider that all the rest of the parameters are normal such as the sperm quality and if the tubes are open. So if the rest of the conditions to conceive naturally are all clear and are all normal then of course you can try in a natural way to conceive if we are speaking about a woman younger than 35 years old.
When we are speaking about extreme measures of low AMH and we have irregularity in cycles, there is a possibility of having premature ovarian failure with extremely low AMH, almost zero irregular cycles so in these cases it is not easy to become pregnant anymore. According to case by case we need to consider if we can help the women with premature ovarian failure or to guide them to an alternative solution.
I think that even if your egg ovarian reserve is low, eggs change every month. They’re different in every cycle, so if you’re highly stressed, if you’ve had flu – all of these things will cause hormonal fluctuations and changes and those hormones are what you need to make a mature egg. What’s important to get on board here, like I said, fertility is black and white isn’t black and white there are lots of shades of grey, so I see those women with low reserves that come back magically pregnant and they’re absolutely shocked, so I think it’s important to take into account that fertile window doesn’t change just because your egg reserves are low – the more sex you have – just give it your best shot to do what you can but I think if they’re not too low, consider something like assisted fertility IVF because again you want to go with something where you’re going to get a good good success.
Well, the options are to start a protocol of IVF and try to see how we can handle low ovarian reserve. We can get good quality oocytes from an IVF protocol. There is also another way of doing this by repeating the protocols to collect more eggs or to collect more embryo’s depending on every center, there are two different ways of doing it. If we don’t have good quality eggs after that, the best way to get pregnant is by going through an egg donation programme.
So the next question is, what if my ovarian reserve is low? What are the options for getting pregnant? So what does a low ovarian reserve really mean? Usually, it would mean that you have a low number of antral follicles in your ovaries. So those are the little follicles are on the outside of your ovaries, and you have a low level of AMH for your age. It implies that if you do an IVF stimulation, you are unlikely to produce many eggs. And as you’re probably aware, the number of eggs a woman produces would usually relate directly to her chances of having a live birth. An exception to this might be a very young woman with a low ovarian reserve because when you’re very young, for example, you’re 30 or under 30. If you can only produce one egg, that egg is still likely, because of your youth, to be a good genetic quality. Whereas somebody who is 40, who can only produce one egg is less likely to be successful because, genetically, her egg is almost certainly going to be abnormal. So age can sometimes trump the low ovarian reserve.
What do you do if you can, if you do have a lower ovarian reserve? Well, there are certain IVF protocols that you can try, such as maybe the Duo-Stim protocol, the double stimulation. You could try to fall pregnant naturally because you only need one egg to be genetically normal and fall pregnant. So at some point in a woman’s life, you get to the stage where trying naturally gives you the same chances of success as trying, using a fertility treatment and working via a lab.
However, many women often with a low ovarian reserve will try to improve their chances of having a pregnancy by turning to egg donation, i.e. an egg from a younger woman or embryo donation, an embryo from another couple. Having a lower ovarian reserve doesn’t make your uterus any less able to carry a pregnancy. So the success rate for these treatments is high.
