A diagnosis of a low egg count, medically termed diminished ovarian reserve (DOR), can be deeply concerning for anyone hoping to conceive. This condition reflects a lower quantity of eggs remaining in the ovaries than is typical for a person’s age. While DOR introduces significant challenges, it does not eliminate the possibility of conceiving, as success depends heavily on the quality of the remaining eggs and individual age. Many people with this diagnosis achieve pregnancy through both natural means and assisted reproductive technologies.
Defining Ovarian Reserve
Ovarian reserve refers to the capacity of the ovary to provide egg cells capable of fertilization. This reserve naturally declines with age, but it can decrease prematurely due to factors like genetics, prior ovarian surgery, or certain medical treatments. A low egg count measures the remaining quantity of follicles, which are the fluid-filled sacs that contain the eggs.
Fertility specialists use specific diagnostic tools to assess ovarian reserve. The Anti-Müllerian Hormone (AMH) blood test is a reliable indicator; a low AMH level (often below 1.0 ng/mL) suggests a diminished reserve. Another assessment is the Antral Follicle Count (AFC), measured via a transvaginal ultrasound early in the menstrual cycle. An AFC of five or fewer visible follicles is commonly used to indicate DOR, though these tests primarily measure quantity, not the viability of the eggs.
Assessing the Chance of Natural Conception
The possibility of natural conception rests on the distinction between egg quantity and egg quality. Egg quality, which refers to the chromosomal normality and structural integrity of the egg, is the most important factor for a successful pregnancy and is strongly linked to age. While a low egg count reduces the number of opportunities, the quality of the single egg released each month determines viability.
For women under 35 with low ovarian reserve, the chance of natural conception can be similar to that of peers with a normal reserve because egg quality is often preserved at a younger age. Biomarkers like AMH levels do not reliably predict the chance of natural conception when regular menstrual cycles are maintained. However, DOR shrinks the window of opportunity, indicating a faster decline in egg supply. For older individuals, a low count means remaining eggs are more likely to have chromosomal abnormalities, increasing the risk of miscarriage.
Assisted Reproductive Technologies Using Own Eggs
When natural conception is not achieved, various medical treatments can maximize the chance of pregnancy using the individual’s own eggs. Intrauterine Insemination (IUI), which involves placing washed sperm directly into the uterus, is sometimes attempted but is less effective for those with severely diminished ovarian reserve. IUI success rates are often lower because the treatment relies on the ovaries responding adequately to mild stimulation.
In Vitro Fertilization (IVF) is the most effective treatment, allowing for the controlled stimulation and retrieval of eggs, followed by laboratory fertilization. Standard IVF protocols, which aim to retrieve a large number of eggs, are modified for patients with DOR to focus on quality over quantity. Specific protocols, such as the micro-dose flare or antagonist protocols, are designed to boost the ovary’s limited response.
Specific IVF Protocols
The micro-dose Lupron flare protocol uses a small dose of a GnRH agonist to create an initial surge of natural hormones to stimulate follicle development. Another common approach is minimal stimulation IVF, sometimes called Mini-IVF, which uses lower doses of medication or oral agents like letrozole. This strategy focuses on retrieving a few high-quality eggs rather than many low-quality ones. Studies suggest these less aggressive protocols can result in comparable or higher live birth rates than high-dose stimulation for poor responders.
Exploring Alternative Paths to Parenthood
For individuals whose ovarian reserve is low or whose egg quality is compromised, using donor eggs becomes the most viable path to pregnancy. Egg donation involves fertilizing a younger donor’s eggs with the partner’s sperm and transferring the resulting embryo to the recipient’s uterus. This option bypasses the issues of low egg quantity and poor egg quality associated with the patient’s own eggs.
The success rates of IVF using donor eggs are substantially higher than those using a patient’s own eggs when DOR is the primary issue. For recipients under 35, success rates can reach as high as 69% per cycle, as the outcome is linked to the young age and health of the donor’s eggs. Other alternatives include embryo adoption, which utilizes embryos created by other couples, and gestational surrogacy, considered if a medical condition makes carrying a pregnancy unsafe.