What is meant by less number of eggs?

A woman is born with a finite number of eggs in her ovaries. This is called “Ovarian Reserve”. In every month, a number of eggs are destroyed and this is unavoidable. However, in some women, this process of destruction is accelerated and this decreases the ovarian reserve markedly, compared to her age. This is called “Poor ovarian reserve (POR)” or “Less number of eggs”.

What may be the possible reasons?

In most cases, the exact reason is not known. It may be due to chromosomal problems, diseases running in families, surgery done in the ovary, endometriosis, exposure to chemotherapy or radiation, smoking etc.

How can I know that I have less number of eggs?

Blood results can show low AMH and sometimes FSH slightly higher than normal. The most definitive test is checking for the eggs (called AFC- Antral Follicular Count) by an ultrasound probe inserted in the vagina (TVS- Transvaginal sonography). However, it must be kept in mind that a single result is not confirmatory. In short, we have to look into age, AMH and AFC together, not separately.

What are the treatment options?

Only a low AMH or low AFC cannot decide what treatment you should have. Age is the most important factor to decide the mode of treatment. We also have to check your duration of infertility, previous pregnancy (if any), the condition of your tubes and also partner’s sperms. If all other factors are favourable and you have only low AMH and AFC, a short period of Ovulation Induction (OI-Giving medicines to stimulate the ovaries to release the eggs) and IUI (Intra-uterine insemination- partner’s sperms are inserted inside your womb through a small catheter) can be tried. If these fail, you may need to consider IVF. 

Is IVF done as the last resort? 

POR does not always mean that you need IVF. However, if your age is on the higher side or duration of infertility is long, IVF may be the better option for you. As only healthy embryos can give rise to pregnancy, if embryos were of good quality (Grade A), then you can try the second IVF with your own eggs. However, if embryo quality was not good (Grade B or C), it’s better to think about egg-donation.

What is the chance of success?

The chance of success depends on your age, duration of infertility and your response. In general, the chance of pregnancy after each cycle of IUI is 15-20% (out of 100 women having IUI, 15-20 can conceive after 1st cycle) and after IVF, it is 30-40%. However, the chance is slightly lower in women with POR. 

Is there no chance of natural conception?

In women who attain menopause before 40 years, 10% can conceive spontaneously, without any treatment. In women with POR, this chance of natural conception is even higher. So, POR does not always mean that you have to go for OI, IUI or IVF. 

Can any medicines be tried?

Some medicines may be tried to improve ovarian response, like DHEA, testosterone gel or antioxidants, vitamin D3 etc. However, whether the medicines are actually helpful, is a matter of debate and it needs further research.