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Past Article of the Month Originally Published 10/07/2012
Diminished Ovarian Reserve: Why Me?

You are finally ready: you have found the right partner, established your career, perhaps youve even moved into the right neighborhood. You are in your early 30s and feel you are mentally set for the journey into parenthood. You are healthy and your periods have always been regular like clockwork every 28 days. Doesnt that mean you are fertile? Never do you expect that months will go by without conception. Didnt you spend all those years dutifully using birth control trying not to get pregnant? And never do you suspect that the cause of your problems is diminished ovarian reserve (DOR). <i>What is DOR and what causes it?</i> Because you have a regular menstrual cycle you may be shocked to learn that your store of eggs is at a low level and that you may have fertility issues. If you have been diagnosed with DOR it means that your supply of eggs is lower than expected for your age. The reserve of a womans eggs naturally decreases with age, as does her fertility. A woman in her 40s, who is near the end of her childbearing years, will naturally have lower eggs in reserve than someone in their 20s, who is in the prime of their fertility. When lower ovarian reserve is found in younger women (those in their 20s or early 30s) it means that their store of eggs is not as plentiful as other women their age, and will likely result in lower fertility. While the <i>quantity</i> of the egg supply is lower, a diagnosis of DOR may or may not mean that the <i>quality</i> of the eggs and fertilized embryos are poorer. The exact cause of DOR is unknown. Women are born with their entire stock of eggs; unlike men who produce new sperm on a regular basis, women do not produce more eggs. You may have been born with a lower supply, or you may have had a medical condition or surgery that had an impact on your quantity of eggs. <i>How do I know if I have DOR?</i> A simple blood test measuring Anti-Mullerian Hormone (AMH) will determine your reserve supply of eggs. The lower your AMH level, the lower your oocyte reserve, and the higher the chance that you will need some medical intervention in order to conceive. In the past, doctors relied on another blood test to measure FSH (follicle-stimulating hormone). There are advantages to testing AMH rather than FSH. FSH has to be measured on day 3 of your cycle, while AMH can be measured at any time. Additionally, an AMH level is a more reliable predictor of ovarian reserve: it does not fluctuate and vary from cycle to cycle as FSH does. <i>Why is this important?</i> If you have been trying to get pregnant without success, it may be time to consult with a doctor who specializes in reproductive medicine. Knowing what your AMH level is can help inform decisions about what path you should take next. Many women with low AMH go on to have a baby using interventions such as IVF. In the process of an IVF cycle, your ovaries will be stimulated to produce several mature eggs at once (rather than one or two in a normal cycle), giving you a better chance at having fertilized embryos to then transfer back to your uterus. If you are not quite ready to try but are thinking of having children some day, it may be helpful to have an idea of what your ovarian reserve looks like. Say, for example, you are a 30-year-old woman pursuing your career, hoping to get a promotion, and would like to postpone childbearing for a few years. If your AMH is lower than expected, you may want to rethink the decision to put off starting a family. This simple test can save a lot of heartache, regret, and emotional pain in the future. You can make better plans based on the medical information you receive. If your AMH is normal, you may be able to put things on hold for a bit, but it may make sense to have your levels tested once a year to monitor your internal store of eggs. <i>Psychological Ramifications of DOR</i> A diagnosis of DOR often comes as a shock. There may be no symptoms other than difficulty conceiving. Many women feel responsible for their diagnosis; after all, some might say, it is MY body that is not functioning the way it should. Although you may feel to blame, it is so important to remember that DOR is not your fault. For whatever reason, this is just the way your body works. Because reproduction is such an integral part of who we are, it may feel that you have somehow failed. But your ovaries are just a piece of you and should not define who you are. Someone who wears glasses, for example, will most likely not feel like a failure. They understand that a part of their body does not work as well as it should. The same thing is true when it comes to our reproductive organs, and yet it is not as easy to compartmentalize when it comes to fertility issues. Remember: you are not your ovaries! Keeping this in mind can help you process the grief and loss you may experience. Although it may be more difficult to conceive, it is not impossible, and working with a specialist in reproductive medicine can help you build the family of your dreams. * Back
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