Many Patients with confirmed decreased ovarian reserve see the diagnosis as a kind of sentence. On the one hand, difficult emotions appear; on the other hand – the need to take the decision on further steps. However, it is worth to look at this situation from the prognosis’s perspective. Early diagnosis of low ovarian reserve allows to take necessary actions in the scope of fertility protection, and to prompt the treatment which gives the chance of motherhood.
Causes of decrease in ovarian reserve
The key factor contributing to the decrease in ovarian reserve is a woman’s age. The number of egg cells is defined already at the time when a girl is born, and amounts to approximately 400 thousand on average. With age, the pool of eggs decreases, just like the level of anti-Müllerian hormone. In women of childbearing age, it amounts to approximately 40 thousand on average. A significant drop in fertility is observed from the 30th year of age, and the risk of failure in achieving pregnancy within a year grows from 5% (20-25 years of age) to 30% (35-38 years of age). A woman’s age and her ovarian reserve can also impact the quality of egg cells. It is worth being aware that surgical operations on adnexa can lead to partial, sometimes significant loss of ovarian reserve. In some cases, a very low AMH level is the consequence of premature ovarian failure (POF). Low level of ovarian reserve can have a genetic or autoimmune background, result from past inflammatory conditions or aggressive cancer therapies.
Ovarian reserve evaluation
The first test conducted to assess the ovarian reserve is the determination of the serum level of anti-Müllerian hormone (AMH). It is a unique endocrine parameter which assesses the function of female gonads, ideal as:
- fertility assessment indicator,
- parameter of the number of growing ovarian follicles – ovarian reserve marker,
- prognostic factor of premature ovarian failure.
AMH, as the fertility parameter, provides information on both the pool and the quality of ovarian follicles a woman in a given period of sexual maturity possesses. With a woman’s age, the reserve of ovarian follicles decreases, which is reflected by blood AMH levels. In case of premature ovarian failure (POF), serum AMH levels are very low, and sometimes even undetectable. Determination of the AMH level plays also a significant role in the diagnosis of the initial stage of premature ovarian failure in women who still menstruate normally. In its first stage, ovarian failure can manifest itself as irregular menstrual cycles (temporary ovarian failure), and, within 3 to 10 years, proceed to the stage of menopause. Previous studies have shown that the determination of the AMH level allows to differentiate precisely between the initial stage of POF with regular menstrual cycles and the stage of temporary ovarian failure in patients who do not meet all criteria of this syndrome.
Procedure in women with low ovarian reserve
In the case of women with low ovarian reserve, the treatment plan must be drawn up individually and preceded by assessment of the problem’s causes. Precise planning of the appropriate strategy of clinical management in the case of cancer patients or patients with premature ovarian failure is made possible by the analysis of dependencies between the levels of AMH and ovarian follicle pool. Close correlation with the number of primary ovarian follicles allows to assess the expected ovarian response to the medications given in assisted reproduction programs. Based on the results, the physician prepares the individual protocol of ovarian stimulation which will allow to obtain the possibly highest number of ovarian follicles while at the same time limiting the risk of adverse reactions.
The INVICTA specialists have the appropriate, long experience in the management of Patients with low AMH level. This is why we achieve high pregnancy rates and we can help many couples effectively.
The AMH (Anti-Müllerian Hormone) level is among the most effective markers of female fertility. It allows to determine a woman’s ovarian reserve and, thereby, her reproductive potential. AMH is produced by cells surrounding the eggs which are in the follicles in ovaries. The number of egg cells, called ovarian reserve, is defined already at the time when a girl is born, and amounts to approximately 400 thousand on average. With age, it decreases just like the anti-Müllerian hormone level.
Low AMH value becomes the reliable indicator of the decrease in fertility and of premature ovarian failure. At the same time, in women with PCO (polycystic ovary syndrome), AMH level is significantly increased.
Decrease in fertility is observed from the 30th year of age, and the risk of failure in achieving pregnancy within a year of efforts grows from 5% (20-25 years of age) to 30% (35-38 years of age). A woman’s age and her ovarian reserve can also impact the quality of egg cells.
Based on AMH results, the physician sets the individual path of medical procedures and selects the potential methods of treatment, therefore the reliability and credibility of the test are of fundamental importance.
The analysis of the anti-Müllerian hormone level measurements allows not only to assess the Patient’s current fertility but also to estimate the period of time during which the Patient will be able to get pregnant with her own egg cells. Low level of ovarian reserve can mean the necessity to collect and freeze egg cells before the reserve runs out and to use them in further treatment. Failure to take such measures means the risk of the natural exhaustion of the reserve before the completion of the treatment, i.e. before achieving pregnancy.
Recent studies conducted worldwide among Patients treated for infertility with the use of assisted reproductive technologies demonstrate the additional usefulness of this test. Its result not only indicates the ovarian reserve but also correlates with the percentage of eggs properly fertilized with the use of in vitro fertilization technique, and, therefore, allows to assess the chances of these patients for getting pregnant. Moreover, AMH shows the time when a woman will enter the period of menopause.