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So, you just received some news: you’ve been diagnosed with Diminished Ovarian Reserve (DOR). The combination of these three words can be terrifying to someone with the hope of growing their family. It’s natural to assume that a diagnosis of DOR means that the chances of getting pregnant are close to impossible. It’s a rational fear, with how easy it is to fixate on numbers. However, before you start to panic, let’s take a look at the facts.
With information more accessible than ever, there has been a large surge in the public and on social media for women to “get their levels checked,” and an increasing number of companies are selling at-home hormone tests. I have seen patients as young as 20 worrying about their AMH and FSH. Don’t get me wrong – it is very exciting to see so many young women taking control of their fertility so early, but there have been so many unnecessary tears shed due to this paralyzing fear of DOR.
Women should absolutely be informed of their ovarian reserve and do so early, but it is crucial to place these numbers within a context and not to panic, especially if you’re still young.
Diminished Ovarian Reserve is perfectly normal; and no, it doesn’t automatically mean you’re infertile. DOR happens to everyone as they age, but for some, it can come earlier than others. DOR can also make a surprise appearance when you have certain genetic issues or injuries.
Unfortunately, there is some bad news: the quantity of your eggs is decreasing, they aren’t coming back, and no, we can’t make you more. Still, that’s not the entire story. You are so much more than your egg count.
The good news is that your chances of getting pregnant are much more about the quality of the egg, rather than the quantity. There are three markers indicative of egg quantity: anti-mullerian hormone (AMH) level, day 3 follicle-stimulating hormone (FSH) level, and antral follicle count. A low AMH alone does not mean that you have DOR. It’s important to check your hormone levels and educate yourself, but knowing your levels alone is not enough.
Additionally, many of my patients often believe that having abnormal cycles means that there is something very wrong with their ovarian reserve. This is often not the case. Women are not machines, and every cycle is going to be different depending on their bodies. Although the average cycle length is 28 days, cycles can range anywhere from 21 to 35 days in adults. Shorter cycles do not always indicate DOR.
If you are truly worried about your levels, seek out a doctor, and empower yourself by placing your hormone levels in context. Women's bodies are not defined by a number. A low AMH level or a DOR diagnosis does not mean that you will not get pregnant.
As with all fertility treatments, your ability to get pregnant is the most dependent on your age. For example, if you are 46 years old with a high AMH, you likely will still have a lower chance of getting pregnant compared with a 31-year-old with a lower AMH.
Egg quality refers to whether an egg is genetically normal or not. All women have some percentage of abnormal eggs. However, as women get older, a higher percentage of eggs will have chromosomal abnormalities, which can mean that those eggs don’t fertilize at all or will lead to a miscarriage. Currently, there isn’t an absolute way to assess egg quality.
While aging is the biggest detriment to eggs, how we treat our bodies can also have a big effect on egg quality. The food we eat and the nutrients we absorb have the ability to affect the health and quality of our eggs[1]. If our eggs are constantly exposed to alcohol, tobacco, and toxins, their viability will begin to be affected.
For this reason, I always recommend that my patients, especially those with DOR, begin making these healthy lifestyle changes at least three months before their IVF cycle. As tough as it is to wait, these three months will allow for the body to partially reset from previous damage and release the best egg possible.
If you have a lower AMH with a history of infertility, go consult a doctor about the next steps. While traditional protocols may not be right for you, your doctor can tailor a stimulation protocol that can lead to success. If you have a lower AMH with no history of infertility, it’s still advised to seek out a doctor. While low AMH may predict a fertility issue, there is no need to think you are doomed!
Women need to know that ovarian reserve testing is not perfect, and they need to interpret the results with caution. It is not a definitive yes or no on whether or not you can get pregnant. Women with “normal” levels can still have fertility issues, while women with “bad” levels can still conceive naturally[2]. It’s understandable to feel intimidated by a DOR diagnosis, but success is by no means impossible!
Dr. Janelle Luk, MD FACOG, one of the top board-certified Reproductive Endocrinologists in New York City, is breaking barriers in the world of IVF as the Medical Director at Generation Next Fertility. She specializes in creating individualized fertility treatments based on each patient’s needs. To read more from Dr. Luk, click here.
Sources:
[1] C. Gopalan, A. Nadamuni Naidu, NUTRITION AND FERTILITY, The Lancet, Volume 300, Issue 7786, 1972,
Pages 1077-1079, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(72)92355-0.
(http://www.sciencedirect.com/science/article/pii/S0140673672923550)
[2] Koo, H. S., Song, I. O., Cha, S. H., Park, C. W., & Kim, H. O. (2018). The likelihood of achieving pregnancy through timed coitus in young infertile women with decreased ovarian reserve. Clinical and experimental reproductive medicine, 45(1), 31–37. https://doi.org/10.5653/cerm.2018.45.1.31'