Chris, a 35-year-old woman from Illinois, was 33 and had been trying to conceive for six months when she had day 3 bloodwork done to check her FSH levels. “My FSH levels came back at 45 - menopausal,” she wrote in an email. “I was shocked.”
Chris had never missed a period, and was getting indicators that she was ovulating, including temperature spikes on her chart and positive ovulation prediction tests. “Never in a million years did I expect, at the age of 33, to hear that my eggs were bad and that I would most probably never have a child of my own,” she wrote. “I remember hanging up the phone and collapsing in the doorway of my bathroom, screaming and crying. My life really did change that day.”
How Ovarian Reserve Screening Can Predict Diminished Ovarian Reserve
While high FSH levels are one predictor of poor ovarian reserve, most reproductive endocrinologists will perform several tests to determine a diagnosis of DOR. Additional bloodwork to test Inihibin B and Anti-Mullerian Hormone (AMH) will help determine if a woman has diminished ovarian reserve.
An Antral Follicle Count (AFC) is also crucial. “An antral follicle count is a sonogram that shows how many follicles (eggs) you have in reserve,” writes New Hope Fertility Center on their website. “This will tell us how much time you have left on your fertility clock.” At the Fertility Center of Illinois, Chris found that despite her high FSH, she had a high AFC, about 8 – 12 per month, which made her situation a bit more optimistic.
Why is Ovarian Reserve Screening Important?
Besides the emotional blow of learning their reproductive time is running out, women with a diagnosis of DOR face specific challenges when trying to conceive. REs usually recommend procedures such as in-vitro fertilization (IVF) to maximize the chance of success. IVF procedures are costly, but IVF medications can be even more expensive.
Most women with DOR are poor responders to fertility medications. High-stimulation protocols are one way REs try to recruit more follicles in a woman with DOR. The amount of medication needed for protocols such as Estrogen Priming or Micro-Dose Lupron Flare can run into several thousands of dollars.
“The best hope to minimize the emotional and financial toll of DOR,” said Dr. Drew Tortoriello of Sher Institutes for Reproductive Medicine (SIRM), “is to work hand-in-hand with OB/GYN physicians to foster yearly ovarian reserve screening in their patients so any woman manifesting a premature decline in her ovarian function can be identified early and properly counseled.”
Ovarian Reserve Screening and a Woman’s Options
Chris agrees that every woman, whether she is trying to conceive or not, should be informed about ovarian reserve screening. “I thought that I was doing everything I could to ensure my fertility by going to see my OB every year,” she said. “That they were testing for whatever they needed to test for and if there was a problem, they would tell me.”
New Hope Fertility recommends hormonal bloodwork and an AFC sonogram every year with a woman’s pap smear. If results indicate a premature decline in ovarian reserve but the patient is not ready to have a family, her eggs can be frozen. Technological improvements in the field of egg freezing make this a viable option for many women.
SIRM examines eggs using comparative genomic hybridization (CGH) to select only healthy eggs to freeze. Dr. Tortoriello feels that ovarian reserve screening in conjunction with new technologies such as CGH will hopefully reduce the emotional and financial burden of trying to conceive with DOR. “Given our recent huge strides in egg freezing,” he said, “we can realistically offer that option to any woman interested in preserving her fertility for the future.”
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