What are the signs and symptoms of low ovarian reserve and how can it affect fertility?
Women are born with a fixed number of eggs in their ovaries. Throughout a women’s life she will start to have periods and each month a follicle will grow on the ovary and release an egg. The ovarian reserve is a reflection of a woman’s egg supply and this is closely related to their chance to have a baby. A low ovarian reserve suggests a much lower than average number of eggs in the ovaries. This can be an incredibly difficult problem to diagnose on symptoms alone. If a woman is struggling to fall pregnant or particularly if her periods stop spontaneously then this is of great concern. Assessment by a fertility specialist is essential to ensure that the egg supply in the ovaries is not depleted. This is important for future fertility but also for general health as when the ovaries fail early (Premature Ovarian Insufficiency) there can be long term health consequences. An early sign of possible low ovarian reserve can be a change to a much shorter and more irregular menstrual cycles after years of them being regular. If a woman has a family history of women reaching the menopause early then they may wish to have an assessment of their own egg supply.
How is it diagnosed?
A low ovarian reserve may not be immediately obvious and can be diagnosed quite late if a woman has no symptoms or warning signs. This can have an impact on fertility and the chances of having a baby naturally if a low ovarian reserve is discovered too late. There are different ways a doctor may check your ovarian reserve.
- Follicle Stimulating Hormone (FSH) measured between days 2-3 of the menstrual cycle can help diagnose low ovarian reserve. This hormome if raised in the blood at this time in the cycle suggests a low ovarian reserve.
- Anti-mullerian Hormone (AMH) is released into the blood from the active follicles in the ovaries. As a woman ages this level in the blood will decline as the egg reserve falls. The rate at which this falls varies significantly.
- Antral-follicle Count (AFC) is assessed by your doctor by ultrasound between days 2-5 of the menstrual cycle. The AFC is basically a guide to the number of small follicles in the ovaries that month that might develop.
All of the blood tests and ultrasound scans should be performed by a fertility specialist. To find a licenced fertility clinic for assessment in your area a great place to start is www.totalfertility.co.uk where you can quickly compare fertility clinics and find a specialist who can check your ovarian reserve and complete a fertility MOT.
How is it treated?
If you are assessed to have a low ovarian reserve this in isolation does not mean that you will not be able to fall pregnant. A number of factors such as age and underlying gynaecology conditions (such as blocked fallopian tubes, endometriosis, polycystic ovaries) will impact on your chances to fall pregnant. In severe cases it may be necessary to seek help with getting pregnant if you have been trying and are then found to have a low egg reserve. Some women require In Vitro Fertilisation (IVF) to help them conceive and some may even in extreme circumstances may need to consider using another woman’s eggs (donor eggs) to have a baby. The best place to seek advice is in a registered fertility clinic where a specialist will guide you.