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Female Infertility

What Is Low Ovarian Reserve?

You’ve heard about low sperm count — but low egg count? If you’re having trouble getting pregnant,diminished ovarian capacityor low egg count is a real possibility.

That doesn’t necessarily mean you can’t have children, but it does mean it may take a little extra effort and some luck.

Our team of fertility specialists at IVFMDin Irving and Grapevine, Texas, understands how frustrating it can be to learn that there may be a physical problem standing between you and your dream to conceive, and we have helped many women overcome these challenges. Many of them are mothers today, so don’t lose heart.

After we meet with you and discuss your symptoms, what you’ve tried, and how long you’ve been trying, we perform a thorough physical examination to gather all the pertinent information that may be contributing to your challenges. If we suspect low ovarian reserve, here’s what you can expect.

How many eggs do you have?

When you were in your mother’s womb, you had at least 6 million egg cells called oocytes. By the time you were born, that number dropped to about 1-2 million. Whatever you’re born with is all you’ll ever have, but you don’t keep them all. In fact, about 11,000 oocytes die every month before you even reach puberty.

When puberty hits, you likely have only about 300,000 eggs cells left, and you’ll lose more each month. That still leaves plenty of eggs for when you’re ready to start a family, but keep in mind that once you hit your late 30s, you start losing eggs at a faster rate, and once you enter menopause, you may only have about 1,000.

Why the numbers matter

Regardless of how many oocytes you have in reserve, you typically only release one mature egg each month (those who release two or three may end up with twins or triplets). The good news is that you only need one good egg to conceive. The bad news is that the older you get, the chances that your decreased supply contains viable eggs decreases as well.

That’s because your body releases the healthiest, strongest eggs early, so by the time you’re in your 30s and 40s, the chances are higher that your remaining eggs are low quality or contain chromosomal abnormalities.

Counting your eggs

Finding out how many eggs you have in reserve typically requires three tests to give us a good picture of your ovarian reserve and allow us to counsel you about treatment options and next steps.

Anti-müllerian hormone (AMH) test

While waiting in reserve, each of your eggs nestles into a sac of fluid called a follicle. These follicles produce a hormone called anti-müllerian hormone, so if we find a decent amount of AMH in your blood, it’s a good indicator of the number of follicles you have in your ovaries.

So, what’s a “decent amount”?

  • Borderline reserve: AMH between 1.0-1.4 ng/ml (8-11 follicles)
  • Low reserve: AMH 0.6-1.0 ng/ml (5-7 follicles)
  • Very low reserve: AMH less than 0.5 ng/ml (fewer than 5 follicles)

The AMH test gives us a good idea of how many eggs may be available per cycle, which can help us develop an effective treatment protocol.

Follicle-stimulating hormone (FSH) test

When needed, your pituitary gland releases a follicle-stimulating hormone that triggers the growth and maturation of your oocytes. It also stimulates the production of estrogen, progesterone, and AMH.

We expect to see your FSH level spike just before you ovulate, but if we see an abnormally high level, it may indicate a diminishing egg supply. Why? Because as your eggs decrease, the pituitary gland produces higher-than-normal supplies of FSH to make sure you have some viable eggs in every cycle. Again, this test offers us valuable information, but it’s not conclusive.


Basal antral follicle count

If it seems like it would be easier to just count your egg cells, you’re right. But unfortunately, they’re too small to be seen and counted. But once they reach a certain stage and develop a fluid-filled cavity called an antrum, we can see them using advanced ultrasound technology.

These are called antral follicles, and by counting them, we can get a better idea (though not exact) of how many eggs you have left.

What to do if you have a low ovarian reserve

This is where our experts come in. We understand that fertility treatment can be expensive and can take a toll on your physical and mental health. There are many options to help you overcome your low ovarian reserve. You may be a good candidate for in vitro fertilization (IVF)mini IVF protocolintrauterine insemination, or ovulation induction.

You have plenty of options and many reasons to be optimistic and hopeful. If you’re struggling to get pregnant and need some answers, schedule a consultation with our team at any of our three offices. Book online or call today.

Sy Le, M.D.
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