Success with diminished ovarian reserve !

 " I am very happy to see Anisha kutty's photos/videos in FB and in your blog. 

To reintroduce myself:

- I follow your blog very closely

- I have talked to you when i visited Zurich over phone

- I tried to reach you when you were in India

- I have had conversations with you through mail, (i have written it over my old mail so that you get the context)

Good news from my side: We are blessed with a girl baby - Shreya. She is 6 months old today.

I am so happy that we as new mothers are going to travel together bringing up our daughters

My IVFs were a failure. My AMH was so low. In my IVF cycle, there were only 3 follicles, out of that only two eggs were retrieved, out of that only one fertilized, that too was only 3-celled. It did not implant. I did not conceive. Doctors gave me up. I was devastated.

I wanted a baby. I was not ready to go for donor egg option. I was given an option of modified natural IVF cycle and egg-pooling. I was told that it is experimental. I still went ahead, since i had no other choice to have my own baby.

I underwent four cycles of egg-retrieval. Those 4 cycles resulted in 1 or 2 eggs. One of the cycles was a total failure. I came back empty handed. All those eggs retrieved were frozen.

After undergoing egg-retrieval cycles for an year, at the end of it there were 6 eggs for the embryologist to work upon.

With God's grace, out of that 6 eggs, 5 got fertilized, 3(eight celled) were transferred, and our Shreya was conceived from one of them. Two of the embryos(seven celled) are frozen.

It was Dr. X who was of great moral support and technical support during these tough times. She is my friend, doctor, God sent Angel all in one ".

Success stories like these are amazing. These stories teach why you shouldn't give up too soon. Not every women with poor ovarian reserve takes home a baby which is genetically related to them. This emailer is relatively young ( 28 years ! ). She had a doctor who is willing to support her and tailor an individual protocol which suited her need. Many doctors will be reluctant to do so because they don't have the time or interest to invest their energy on a single patient. They treat poor ovarian reserve patients like other patients and send them back with a suggestion of donor eggs when they couldn't retrieve good amount of eggs from their ovaries. 

The message from this story is :

If you are young , poor ovarian reserve will not be a major deterrent for having a baby which is genetically related to you. You can overcome your problem with these ingredients -  lots of patience , perseverance , a good doctor , and of course , money !

But , if you are of advanced maternal age , and produce only a couple of eggs , the chance of having success with IVF is greatly reduced. So , if you are a woman who is above 35 years of age , and who is fighting infertility with diminished ovarian reserve ,  you must have a realistic expectation of your chance of success . This helps to chose your battles wisely !

I haven't published the doctor's name who was mentioned in this email. I do not want that my blog becomes a source of advertisement. But if you are interested , please write to me : manjupadmasekar@yahoo.com. I will redirect your emails to the person who sent the above email  so that she can give you the necessary information.

Poor Ovarian Reserve

(A) Follicular dynamics and illustration of the folliculogenesis process in physiology. (B) The possible mechanisms generating POI may affect different stages of folliculogene © 2011 Society for Endocrinology
POI - Primary Ovarian Insufficiency or premature ovarian failure

What is poor ovarian reserve ?

Poor ovarian reserve or diminished ovarian reserve ( DOR) is a condition where the amount of eggs which have the potential to give rise to a healthy baby decline.  Most women develop poor ovarian reserve 6 to 8 years before reaching menopause. As women age, their ovarian reserve declines too. But there are some women who develop diminished ovarian reserve much earlier in their reproductive period and their ovarian age does not match their calendar age . In 90% of cases there is no explanation (idiopathic) why such premature ovarian aging happens.  But there are a few explanations for premature ovarian aging . These include :

• Mutation in genes which codes for proteins that are involved in reproductive function
• Autoimmune disorders
• Certain viral infections
• Chemotherapy or radiation exposure during cancer treatment
• Surgery on the ovaries to remove cyst , or to remove endometriosis implants

Read more at : http://blog.drmalpani.com/2010/04/poor-ovarian-reserve-as-cause-of.html

http://www.drmalpani.com/ovarianreserve.htm

How will I know whether I have poor ovarian reserve ?

There are three important tests which are routinely used in the field of ART for predicting a woman’s ovarian reserve :

1)      Measuring Anti-Müllerian Hormone levels (AMH) in blood

2)      Measuring FSH levels in blood

3)      Counting antral follicles (AFC count) present in your ovaries using vaginal ultrasound

Read more at : http://www.drmalpani.com/ovarianreserve.htm

These are very simple tests to perform and the information they provide is pretty accurate.  

How does poor ovarian reserve compromise IVF success ?

• Women with poor ovarian reserve have fewer antral follicles in their ovaries. Antral follicles are the ones which grow in response to ovarian stimulation. This is why they produce fewer eggs when their ovaries are stimulated with gonodotropins (FSH and LH), which reduces their chances of IVF success .
• Older women with poor ovarian reserve have poorer egg quality too. Older eggs are more prone to genetic errors , like aneuploidy. Embryos formed from these eggs either fail to implant or fail to achieve a healthy pregnancy.

I am diagnosed with poor ovarian reserve , will I be able to have my genetic child ?

Women with poor ovarian reserve have a poor prognosis with IVF treatment. However, younger women who are diagnosed with poor ovarian reserve have a better chance of success than their older counterparts. This is because these younger women still produce some eggs which are of good genetic quality. This means they produce fewer eggs , but the quality of their eggs is comparable to women of their age. This improves their chances of achieving a pregnancy and carrying a baby to term is high too. 

If you are diagnosed with poor ovarian reserve, it is wise to try one IVF cycle by stimulating your own ovaries , before deciding what to do. Remember, the final proof of your ovarian reserve status depends on how well you respond to ovarian stimulation during IVF. There are women who have very good AMH levels, and yet they respond poorly to ovarian stimulation - and vice versa. Theoretically, as long as you produce eggs, you have a chance of achieving a pregnancy.  During your IVF cycle, if your doctor finds that even with maximal stimulation, you are unable to produce a decent amount of eggs ; and  if those eggs give rise to very poor quality embryos, you may want to consider the option of using donor eggs. This is a decision only you can make !