This article explores how conceiving via IVF may be complicated by a poor ovarian reserve.

IVF (in-vitro fertilisation) is a procedure where eggs are fertilised with sperm in a lab, and the resulting embryo(s) are transferred into the uterus.

The success of IVF depends on several factors, including the quality of sperm, the womb’s ability to support implantation and ovarian reserve.

In this post, let’s look at how this can affect IVF success and how the challenge can be addressed and overcome.

Why is this subject important or who is this meant for?

You may have heard of IVF cycles failing and are worried it might happen to you.

Or you may be researching IVF generally.

This provides a little guide into one aspect of the assisted reproduction process and helps you have important and clearer conversations with your specialist.

Ovarian Activity and Reserve

By the time a female child is born, her ovaries contain her lifetime supply of eggs.

The number of these eggs gradually reduces through natural degeneration (atresia) and ovulation. Hence, from around ~1-2 million at birth, ~300,000 by puberty, women will end up with nearly zero at menopause (~age 50). No new eggs are created after birth.

Ovarian reserve refers to the total number and quality of eggs available in a woman’s ovaries. 

Ovarian reserve is critical to a woman’s fertility.

High ovarian reserve means you have a better chance of conceiving. It means that you have a good chance of responding to IVF treatments.

More often than not, you will have regular menstrual periods.

Normal ovarian reserve means you have an adequate supply of eggs and a good chance of pregnancy.

What is Poor Ovarian Reserve

A poor ovarian reserve (also called a low or diminished ovarian reserve), means that the number or quality of your eggs is lower than expected for your age.

This condition can lead to irregular cycles and reduced fertility.

Several factors can affect a woman’s ovarian reserve.

Mainly, they are your age, your genes and lifestyle choices.

As women age, the quantity and quality of the eggs naturally declines.

But some women may experience earlier changes to ovarian function or activity due to their inherited traits or conditions.

Our habits or environment play a part – whether you smoke or are overweight, as well as certain medical conditions like endometriosis or cancer, and cancer treatments could affect our ovarian function negatively.

Effect on IVF cycles

With these in mind, let’s examine the issues having a poor ovarian reserve can present at IVF.

1. Low ovarian response: With a reduced number of eggs available, there will be a low number of follicles/eggs retrieved for IVF despite ovarian stimulation treatment. Remember, the body does not create new eggs after birth. This can lead to a high risk of cycle cancellation if the response to ovarian stimulation is not good enough.
   • In the UK, a woman over the age of 35 years (and under 40 years) can get up to 3 IVF treatment cycles under the NHS. In other systems where people pay for their IVF cycles, this can mean a lot of expensive treatment without desired results.
2. Closely related to this is the concern over Egg Quality. Being older, which is a common reason for poor ovarian reserve, is associated with poorer egg quality.
   • This means the chance of fertilisation is lower. But it also means a greater chance of developing embryos with genetic problems that lead to more miscarriages. Poor egg quality can also be a factor in younger women.
3. Egg quality and quantity aside, what about the Hormone Environment? This also plays a role. Associated with poor ovarian reserve, women have low FSH and or low AMH levels.
   • AMH (anti-Mullerian Hormone plays a key role in developing a baby’s sex organs before birth. It provides a snapshot of the number of remaining eggs in the ovary in adult women. Low AMH means fewer eggs and a lower ovarian reserve.
   • Follicle Stimulating Hormone (FSH) is produced by the ovaries. It regulates the menstrual cycle and supports the maturation of the follicle before ovulation. High FSH levels on day three of the menstrual cycle can suggest diminished ovarian reserve.
   • With these abnormalities which do not support fertilisation, doctors may need to adjust the treatment protocols and attempt other ways to stimulate the ovaries or adjust hormone treatments to allow optimum outcomes.
4. With all these factors, poor ovarian reserve can lead to fewer live births per IVF cycle when compared to normal ovarian reserve cycles. Special adjustments or more IVF cycles may be needed to achieve success.

Now, let’s look at strategies that can make a difference when someone has a poor ovarian reserve.

Managing Lowered Ovarian reserve problems

They may not apply to every woman’s situation, but they are options that you could consider with your fertility specialist to help make the decision.

1. IVF is a clear option for women with low ovarian reserve. Some specialists may offer preimplantation genetic testing (PGT) to ensure a healthy embryo before transfer and reduce the risks of miscarriage.
   • As mentioned before, modifications to treatment to encourage stimulation and hormone adjustments may be necessary to allow retrieval of a viable egg.
2. Fertility medication helps the body produce more hormones that stimulate ovulation, like Clomid or other drugs.
3. Earlier, we talked about how lifestyle habits could influence ovarian reserve.
   • Thus, addressing ways that could help boost your ovarian reserve is important. A balanced diet and foods rich in antioxidants are supportive. Regular exercise helps to maintain a healthy weight, regulate hormones and improve blood circulation – all of this boosts fertility. (Women should aim for at least 150 minutes of moderate exercise weekly.) Avoid smoking and excess alcohol.
4. Supplements can help enhance egg quality and improve ovarian reserve.
   • Examples are folic acid, Coenzyme Q10 (CoQ10), omega-3 fatty acids, and more. Check out this video, for more tips about this.
5. Donor Eggs is another option available for women with poor ovarian reserve. Using eggs donated by someone else can improve the chances of IVF success. Making the decision to use donor eggs is a significant decision with emotional considerations.
   • You may feel a sense of loss or grief and find it hard to accept. It’s important to have conversations with your partner and healthcare provider, understanding the implications and how this option affects your personal values, culture and feelings about genetic links with the child and donor.
6. Some patients with a poor ovarian reserve may still conceive, and you may find individual variability in fertility depending on individual circumstances like age and egg quality. 

Conclusion

There is a lot to consider, as we’ve seen in this article. IVF can bring financial burdens, emotional stress from repeated failures, cycle cancellations, and uncertain outcomes.

However, understanding the process and available options can help guide and support you.

With medical advancements today, you have a higher chance of success and growing your family.

More Reading

• Donor Eggs & IVF: Benefits and How to Move Forward Easily
• Startling Truths About Ovarian Cysts: Little Known Facts
• Health At Home: What Issues Could Be Harming You?
• Age Effects on Fertility – Your Chance of Parenthood
• 6 Internal Heat Causes in Women Related to Hormone Imbalance

Editing and Disclaimer by  AskAwayHealth Team

All AskAwayHealth articles are written by practising Medical Practitioners on various healthcare conditions to provide evidence-based guidance and help promote quality healthcare.  

The advice in our material is not meant to replace the management of your specific condition by a qualified healthcare practitioner. To discuss your condition, don’t hesitate to contact a health practitioner or reach out to us directly. This blog post may contain marketing links to third-party sites with which  Askawayhealth is not affiliated. We do not endorse or guarantee the products or services offered on these sites.  Please exercise discretion when making purchases or using services from these third-party sites.  Askawayhealth is not responsible for any outcomes resulting from such actions.

Image Credits: Canva

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