Low Ovarian Reserve
The concept of biological clock is an old one. We know that every women is born with a fixed number of eggs and as the age advances, the number of eggs keep declining and after the age of 35 years, there is a steep decline in the quantity as well as quality of eggs. Also with certain procedures like ovarian cystectomy , ovariotomy etc,a lot of normal eggs are lost which can result in steep decline in ovarian reserve.
How do you measure ovarian reserve?
The two gold standard tests to diagnose ovarian reserve are Antral Follicle count (AFC) and Anti-Mullerian hormone (AMH) tests. The other tests like FSH, estradiol levels, inhibin etc are not that definitive in diagnosing poor ovarian reserve.
What is AMH or Anti-mullerian hormone?
AMH is the hormone which is produced by small follicles in ovary. Its value tells us about the quantity of eggs in ovary. Its level is tested by a blood test. The good part about AMH is that there is no variation with menstrual cycle and can be done at anytime in the cycle. Value of AMH less than 1.5 ng/ml is considered as low normal and values below 1 ng/ml are considered as low.
What is Antral Follicle Count?
Antral Follicles are small follicles in the ovary seen through a trans-vaginal ultrasound. An antral follicle count is done between day 2-5 of cycles, when ovaries are dormant. An antral follicle count (AFC) gives us a good idea of the number of eggs available each cycle for stimulation. An antral follicle count of more than 10 , counting eggs in both ovaries, is a good AFC.
Why is ovarian reserve important?
Ovarian reserve tells us about the number of eggs, hence might indirectly tell us about fertility span. It does not predict pregnancy, but with poor or low ovarian reserve, the time we have available to plan pregnancy does decline. Also in patients undergoing IVF, the number of eggs is an important determinant of IVF success. In patients with long standing infertility, low AMH values might be an indication for IVF or assisted reproduction directly.
Can you increase your AMH?
AMH values are an indication of ovarian ageing. As ageing is an irreversible process, there is little which can be done to increase your AMH values. Certain supplements might be beneficial in improving oocyte quality.
With low AMH do we need IVF?
There are multiple indications for IVF and poor ovarian reserve and Low AMH is one of them. DO you need IVF is more individual question and it is better to consult our fertility expert DR Prerna Gupta to get a clear picture.