Laura Villar Torres, MD
Gynecologist at Unidad de Reproducción Ciudad de México, Unidad de Reproducción Ciudad de México
Category:
Advanced Maternal Age, Low Ovarian Reserve, Success Rates, Success Stories
Ovarian reserve is defined as the quality and number of remaining follicles and oocytes (eggs) of the ovaries, at any given time, it is a measure of how well the ovaries are functioning.It is very much recognised that increased maternal chronological age does decrease female fertility, but why is this?
Dr Villar Torres explains how important it is to understand that a poor, or low, ovarian reserve test result does not constitute an absolute inability to conceive, and that alone should not be the sole criteria with which to limit, or deny, fertility treatment.Ovarian reserve testing usually falls into four categories which are: Clinical, where age and menstrual cycle characteristics are taken into account; Biochemical, including the measuring of FSH (Follicle-stimulating hormone) and AMH (Anti-Mullerian hormone) levels; antra follicle count, ovarian volume and blood flow tests, via an ultrasound and, finally, dynamic testing, such as gonadotrophin agonist stimulation and/or FSH ovarian response investigations. Dr Villar Torres advises the different methods of testing should be combined in order to get the clearest understanding of each individual woman’s ovarian reserve. Various protocols have been designed to assist patients with diminished quality and/or quantity, including the administering of fertility medications, however, Dr Villar Torres points out that it is incredibly difficult to judge how a woman will respond to these, based simply on her ovarian reserve markers, and advises that women should be offered the chance to try differing regimens of ovarian stimulation. If these medications are not shown to make a difference, or if the ovaries still don’t respond, then there are other options, such as assisted hatching or donation. Oocyte and /or embryo donation is now an established standard of practice, for the treatment of age-related infertility, and is associated with higher rates of pregnancy success; egg donation reverses the age-related decline in embryo quality and subsequent implantation, increasing live birth rates, in women post 40. When looking at the case study of a 44-year-old female trying to conceive who has gone through three unsuccessful IVF attempts, using her own eggs, Dr Villar Torres discusses the variation of medication and procedures used, noting some improvement. However, no cycles, for this patient, resulted in a pregnancy, until donor oocytes were used; the patient is now 34 weeks pregnant. You may be interested in reading: Low AMH and Egg Donation Treatment – Case Studies Overcoming Low Ovarian Reserve – Real-life Cases
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