Low ovarian reserve and age – IVF patients’ case study

Does low ovarian reserve mean early menopause? Is it always connected with age? Can it be reversed? What is the best fertility treatment for low ovarian reserve? What are my chances of pregnancy with low ovarian reserve? Find out the answers to these questions from our live webinar “IVF with donor eggs, low ovarian reserve and age – Patient Case Study” presented by Dr Laura Villar Torres, a gynaecologist specialising in Reproductive Medicine. It’s widely understood that increased age and decreased ovarian reserve are linked, but can one be a factor of failure to conceive without the other, and what options are available to women who are dealing with age-related infertility, or have been diagnosed with a low ovarian reserve? In this webinar, Dr Laura Villar Torres, a gynaecologist specialising in reproductive medicine, in the reproduction unit in Mexico, discusses the case study of a 44-year-old woman trying to conceive, via IVF, and looks into the issues, testing and treatments for patients wanting to a child, but whose reserve is diminished.

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?

Number of eggs will not regenerate

Women are born with a finite number of eggs and oocytes which do not regenerate. On average, during the fourth month of foetal development, females will have between six to seven million oocytes. A rapid loss, of eggs, is experienced at birth, when the total number decreases to between one to two million; this birth figure is classed as 100% of a woman’s oocytes. When menarche (the first occurrence of menstruation) is reached, this figure drops to around 300 – 400,000, 23% of the amount at birth. This further reduces to 12% (180,000) at age 30, and then again to 45,000, or just 3%, around the 40-year mark, continuously diminishing as a woman heads towards the menopause. Whilst it is known that reproductive decline does occur with age, external factors also play a role in influencing the quality and quantity of a woman’s eggs. Genetics, environmental factors and medical history, such as endometriosis, autoimmune disorders and treatments for cancer, just to name a few, can have a negative impact on fertility. However, from data, it appears as though age, over low ovarian reserve through other factors, has more ability to affect reproduction, when a woman uses her own eggs. So just how can ovarian reserve be measured and is it something which has symptoms that can be recognised?

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

What do the chances of pregnancy look like then, for women with increased age or low ovarian reserve?

Dr Villar Torres is keen to point out that it really does depend on all of the specific factors. Every patient, and case, is individual, and each woman will have a differing number of oocytes, of varying quality. She also advises clients that it’s important to understand IVF is an assisted reproduction treatment (ART) and science, and that not all practitioners will necessarily agree on the same strategies. However, whichever regimes or protocols clinics decide to use, they must always remember that each woman is unique, therefore the personalisation of treatment, in whatever form, always has the capacity to optimise reproductive outcomes.