How to Get Pregnant with Low Ovarian Reserve?


Examining ovarian reserve is one of the first steps to finding the cause of infertility in women. Many women with low ovarian reserve wonder if this problem will affect their pregnancy or IVF treatment or not. This article mentions low ovarian reserve symptoms, causes, treatments, etc., and discusses its impact on fertility.

What Is Ovarian Reserve?

Ovarian reserve refers to the number of oocytes in a woman's ovaries. A 20th-week female fetus has seven million eggs when she is in her mother's womb. Over time, this number decreases, and she has almost 200,000 eggs when she is born. Of course, every baby girl is born with a certain number of follicles in her ovaries.

As the girl reaches puberty and her ovulation begins, one of these follicles is released in the form of an egg every month until she reaches the age of menopause. Therefore, her ovarian reserve decreases gradually as she gets older.

Ovarian reserve refers to the number of oocytes in a woman's ovaries.

Normal Ovarian Reserve for Pregnancy

Ovarian reserve is directly related to females' fertility. The normal range for ovarian reserve is between 5 and 5.6. An ovarian reserve of less than one greatly reduces the chance of pregnancy, in which case ovarian induction drugs should be used to boost egg production. Usually, fertility specialists prescribe these drugs for women with irregular periods and IVF candidates.

Low Ovarian Reserve Symptoms

The diminished ovarian reserve does not have any specific symptoms, and in most cases, it can only be diagnosed through medical examinations and physical checkups. However, low egg reserve symptoms in most women are as follows:

  • Heavy menstrual bleeding;
  • Multiple delayed or missed periods without pregnancy symptoms;
  • Abortion;
  • Not being able to conceive after a year o trying; and
  • Short menstrual cycles (usually less than 28 days).


What Causes Low Ovarian Reserve?

One of the main reasons for low ovarian reserve is aging. However, some factors lead to diminished ovarian reserve at a young age. The most common causes of the decreased ovarian reserve include:

  • Having endometriosis;
  • History of mumps disease;
  • Having a disorder in the fallopian tubes;
  • Genetic and congenital abnormalities such as fragile X syndrome (FXS);
  • Pelvic infection;
  • Radiation therapy and chemotherapy;
  • Some autoimmune disorders; and
  • Smoking.


These factors are only part of the known causes of low ovarian reserve. At the same time, the reason for this problem is sometimes entirely unknown. It should also be noted that follicular puncture -one of the steps in assisted reproductive techniques such as IVF- does not cause low ovarian reserve because only a few eggs are retrieved during this process.  

What Causes Low Ovarian Reserve?

Does Ovarian Volume Affect Ovarian Reserve?

Ovarian reserve is directly related to the size of the ovaries. The larger the size of the ovary, the higher the ovarian reserve. As the age increases and the ovarian reserve decreases, the volume of the ovaries reduces. This process will continue until the age of menopause when the woman's ovarian reserve becomes zero.

Evaluation of Ovarian Reserve 

In the following, some ways of measuring the ovarian reserve are mentioned:

Taking estradiol test 

Estradiol is one of the female sex hormones. The estradiol test, also called the E2 test, is performed on the third day of the period cycle to measure the hormone estradiol in the blood. In premenopausal women, the average estradiol level is 30 to 400 pg/ml; in postmenopausal women, it is 0 to 30 pg/ml. A low estradiol level in the blood signifies diminished ovarian reserve. 

Performing ultrasound to count antral follicles

The number of follicles with a diameter of 2 to 10 mm can be identified by performing an ultrasound on the second to fourth days of the menstrual cycle. These follicles, which are known as antral follicles and resting follicles, contain immature eggs and indicate how much the body has responded to gonadotropin medications. If the number of eggs is less than 10, the patient has a low ovarian reserve. Although this method is very practical, its results highly depend on the doctor's accuracy and skill and the ultrasound machine's quality. Also, this test can only measure the number of eggs, not their quality.

The number of follicles can be identified by performing an ultrasound test.

Taking FSH test 

In this test, which is a part of the infertility treatment process, the quantity of eggs is measured. This test is performed on the second or third day of the menstrual period, and if the level of FSH is low, the patient has diminished ovarian reserves. In fact, during this test, hormonal drugs containing FSH or a combination of FSH and LH are injected to stimulate the ovaries. If the maternal age is over 35, higher doses of hormones should be injected. Unfortunately, taking too many of these drugs reduces the chance of IVF success.

Taking clomiphene citrate challenge test (CCCT)

The CCCT test consists of two phases. In the first phase, the patient takes a blood test to measure the amount of FSH and estradiol in her blood. In the second phase, the patient should take ovulation induction drugs and take a blood test to measure the FSH and estradiol levels. Usually, high levels of these hormones before and after taking the drugs indicate low ovarian reserve and a lower chance of pregnancy.

Taking tests to measure AMH level

Females are not born with the Anti-Müllerian hormone. When a girl reaches puberty, this hormone is secreted by the granulosa cells that exist in the follicles in her ovaries. When she reaches menopause age, her body's amount of AMH hormone becomes almost zero. The AMH test results show that the patient has a low ovarian reserve. Since the amount of this hormone does not fluctuate much during menstruation, this test can be done on the first day of the period.

what is a good amh level to get pregnant
Read more: AMH Test: All About Anti-Mullerian Hormone Levels and Normal Range


The AMH test results show that the patient has a low ovarian reserve or not.

Determining Egg Quality for IVF

The quality of a female’s egg highly depends on her age. Usually, in women over the age of 40, the quality of the eggs decreases to such an extent that the chance of IVF success becomes zero, even if they have a high ovarian reserve. Although pre-pregnancy tests and ultrasounds evaluate the ovarian reserve, they do not check the quality of the eggs. Therefore, the only factor determining their quality is checking the mother’s age.

Low Ovarian Reserve Treatment

Unfortunately, there is no specific method to treat low ovarian reserve or prevent its progression; however, some medical procedures and home remedies can increase the chances of pregnancy in women with low ovarian reserve.

The most common ways to treat infertility caused by diminished ovarian reserves are taking ovulation induction drugs and using assisted reproductive techniques such as IVF. Other methods of treating low ovarian reserve include:

  • Freezing egg and embryo: couples who want future children can freeze their eggs or embryos at a young age.
  • Hormone therapy: women with a low ovarian reserve can use hormone therapy to balance their hormones and increase their chance of pregnancy. Dehydroepiandrosterone (DHEA) and coenzyme Q10 are useful medications that improve the quality and quantity of eggs.
  • Using donated embryos: in some couples, not only the female's ovarian reserve is low, but also the sperms lack necessary parameters such as motility, normal morphology, etc.; therefore, the doctor suggests using a donated embryo. In this method, the baby does not share genetic features with their parents, but she will grow in the recipient's womb.


Use assisted reproductive methods, is a means of low ovarian reserve treatment


  • Exercising regularly: exercising at a gym, swimming, walking, and cycling twice or three times a week can maintain the ovarian reserve and improve sperm parameters. 
  • Taking vitamins: consuming vitamin C and antioxidants increases the number of eggs and sperm's motility. Moreover, a suitable level of vitamin A in the body increases fertility because it increases the production of sex hormones in both men and women.
  • Massaging the abdomen: Massaging the uterus and ovaries can increase blood flow in the reproductive system and increase the chance of pregnancy. You can either receive a fertility massage from a professional therapist or do it yourself at home. It is better to start the fertility massage after the end of your period.


How to Increase Your Chances of IVF Success
Read more: How to Increase Chances of Successful IVF?

Pregnancy with Diminished Ovarian Reserve

Having enough ovarian reserve is one of the main factors in the success of assisted reproductive techniques such as IVF. Normally, if the amount of ovarian reserve is between 1 ng/ml and three ng/ml, IVF will be successful; however, if the number of follicles is less than one ng/ml, the chance of IVF success is low, and the couple should use a donor egg.

Keep in mind that diminished ovarian reserve does not always lead to infertility. If a woman with low ovarian reserve has healthy fallopian tubes and uterus and his partner's sperm are healthy, she can still get pregnant (natural or IVF). On the other hand, if the couple needs invitro fertilization due to problems in the uterus, ovaries, fallopian tubes, or even the sperm of the male partner, the low ovarian reserve can be a problem and lead to infertility or IVF failure.

IVF failure
Read more: IVF Failure Reasons: Why Implantation Fails After IVF?


Diminished ovarian reserve does not always lead to infertility.

IVF with Low Ovarian Reserve

Ovarian reserve is strongly correlated with the success of IVF. The lower the ovarian reserve, the lower the chance of IVF pregnancy. Of course, the success rate of IVF does not depend only on the ovarian reserve and the number of eggs. Other factors, such as the quality of eggs and sperm, will also affect the result of this method. The quality of the egg is more important than its quantity; so, if someone has a low ovarian reserve but high-quality eggs, her chance of successful IVF is high.

IVF with Donor Egg

Sometimes, in cases where the woman has a low ovarian reserve, and the remaining eggs lack enough quality, the doctor suggests using a donor egg to treat infertility. Egg donation is a simple procedure through which a donor is asked to donate one or more eggs to be used in IVF. After fertilization with the male partner’s sperm, the resulting embryo is transferred into the intended mother’s uterus. Although the mother gives birth to the baby, she does not share biological features with them.

Egg Donation in Iran

conclusion

Overall, the quality and quantity of eggs are the most important factors in increasing the chance of low-risk pregnancy. Other factors affecting successful pregnancy include hormonal balance, proper blood flow in the female reproductive system, and having a healthy lifestyle.

Iran is a central hub in fertility treatment, especially IVF, where you can benefit from high-quality healthcare services at a reasonable price. Contact us for more information on IVF in Iran.

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