Treatment for Diminished Ovarian Reserve
- Posted on: Nov 18 2013
For those women who have been diagnosed as having a diminished ovarian reserve (DOR), conception may be rather difficult without the help of a fertility specialist. Diminished ovarian reserve is defined as a large reduction in the ability of the ovary to produce good quality eggs. Reasons include advanced maternal age (older than 38), congenital, medical, or surgical causes.
DOR is only really a concern for women who desire to have a baby. Those with DOR who do not desire to ever conceive can be treated easily with Hormone replacement therapy. There are many tests to determine if you have DOR these include ovarian reserve blood tests (FSH, estradiol and AMH), an antral follicle count, Inhibin B levels, and age.
While most women will still have regular menstrual cycles despite having a diminished ovarian reserve, often there is still difficulty in the release of a good quality mature egg in each cycle due to the lower egg count and diminished egg quality. DOR is a common cause of infertility and your infertility doctor will assess your egg quality test results to determine the best option for treatment.
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Ovulation induction with IUI Therapy
The first option available to those with a diminished reserve is to undergo Controlled Ovarian Hyperstimulation (COH), after which an Intrauterine Insemination Cycle (IUI) is performed. The stimulation makes use of a hormonal tablets or injections to trigger the body to produce as many mature eggs as possible each cycle.
With pelvic ultrasounds to monitor the progression of the eggs, and blood tests, your fertility doctor will know exactly when your eggs are ready to be inseminated with your partner’s or donor sperm. For an insemination the sperm is prepared with a “wash” procedure then placed thru the cervix with a small catheter at the time of ovulation. Success of this treatment will depend on many factors including your ovarian reserve blood tests, antral follicle count and prior pregnancy history.
Controlled Ovarian Hyperstimulation (COH)
The second option available to those with a diminished reserve is to undergo Controlled Ovarian Hyperstimulation (COH), after which an Intrauterine Insemination Cycle (IUI) is administered. The stimulation makes use of a hormonal injection to trigger the body to produce as many mature eggs as possible each menstrual month.
With delicate pelvic ultrasounds to monitor the progression of the eggs, and with vigilant lab monitoring of these, your Denver fertility doctor will know exactly when your eggs are ready to be inseminated.
Often, the sperm that will be used in a COH/IUI treatment has been tweaked to maximize motility in order to get to the egg as quickly as possible. This sperm is delivered directly into the uterus, and is placed as close to the egg as possible to shorten the distance the sperm must travel to penetrate the egg.
Also available to some patients with a diminished ovarian reserve is In Vitro Fertilization (IVF). This treatment seeks to stimulate multiple eggs per cycle, hopefully improving the chance of finding a “good” egg. For IVF the female partner takes fertility shots on a daily basis and has ultrasounds performed to watch the growing eggs.
When the eggs are of the correct size, as measured by ultrasound, they are surgically removed from the ovary and fertilized in a laboratory. The fertilized eggs are then monitored until they are inserted into the uterus where they will hopefully implant. Success with IVF can be variable. Some women with DOR have such poor egg quality that the success with IVF may be less than 5%.
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Donor Egg IVF
Another option available to those with a diminished ovarian reserve is In Vitro Fertilization (IVF) using Donor eggs, and is used typically only after other options have been exhausted. This treatment uses another woman eggs to help the patient become pregnant. Eggs donors are typically between the ages of 21-32 years of age and are screened to make sure their eggs are healthy.
Egg donors can be anonymous or known. Some women chose to use relatives as egg donors. The egg donor undergoes the IVF process. Once the eggs are removed the recipient partner’s sperm will be used to fertilize the eggs. The fertilized eggs are then monitored until they are inserted into the recipient female partner’s uterus where they will hopefully implant. Success with egg donation is very high.
Another option available to those with a diminished ovarian reserve is In Vitro Fertilization (IVF) using Donor embryos. This treatment uses another couples “unwanted” frozen embryos to help the patient become pregnant. Embryo donors are typically patients that have gone thru IVF process that have conceived and have many excess frozen embryos after their family is complete.
Embryo donors are typically screened to make sure they are healthy. Like egg donors embryo donors can be anonymous or known. Success with embryo donation will depend on many factors including the age of the couple donating the embryos.
Adoption is also another option available to patient with DOR.
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