What is Diminished Ovarian Reserve?
You may have had this experience: You or your partner go in to see your reproductive specialist for an ultrasound. During the visit, your provider does an ultrasound to count antral follicles and may also do a blood test to look for something called AMH. Between the antral follicle count and the AMH level, your doctor gets an idea (which they may or may not share with you!) about the state of your “ovarian reserve.”
So what is ovarian reserve? What are AMH and your antral follicle count, and what affect can these have on your fertility?
So what is ovarian reserve? What are AMH and your antral follicle count, and what affect can these have on your fertility?
Ovarian Reserve: Your Body’s “Fertility Clock.”
You are born with every egg cell you’ll ever have. Throughout childhood these eggs are tiny immature primordial cells, and they stay that way till puberty, when the menstrual cycle begins. During each cycle, hormones released by your brain trigger dozens of eggs to start to mature, but during ovulation only one to two of those eggs will be released. The rest will die away. During your next cycle this happens all over again.
Over time, so long as your cycles continue, the amount of healthy eggs “in reserve” will naturally decline. The amount of eggs you still have in your ovaries at any point in your life is called your “ovarian reserve.”
Over time, so long as your cycles continue, the amount of healthy eggs “in reserve” will naturally decline. The amount of eggs you still have in your ovaries at any point in your life is called your “ovarian reserve.”
 | For some people, this decrease in ovarian reserve happens later in life, such as their early 40’s, while for others it can happen at a younger age - in their 30’s or even their 20’s. This may be due to genetic reasons, hormonal reasons, due to other health issues such as autoimmune disease, or due to lifestyle factors and overall health. |
At any age, a decrease in ovarian reserve can make it much harder to conceive - even when using assisted reproductive technologies like IVF.
How is Ovarian Reserve Measured?
Ovarian reserve can be estimated in two ways: by doing an antral follicle count, and by testing your blood’s levels of a hormone called Anti-Mullerian Hormone, or AMH. While some providers only do an antral follicle count, many RE's will look at both of these numbers to get an idea of overall ovarian reserve.
The Antral Follicle Count
Every egg cell is housed in it's own little follicle in the ovary. As your egg matures, the follicle grows and fills with fluid. When looking at fertility factors and especially when prepping for IVF, a reproductive specialist will do an ultrasound to look at your ovaries and count how many little follicles are filling up with fluid and expanding in preparation for possible release of an egg. These tiny follicles are called antral follicles, and can range in number from one or two per ovary to as many as twenty follicles in each.
| During an ultrasound, a specialist can count the number of these follicles in any given cycle to get an idea of how many healthy follicles are likely to remain in total - the general assumption is the higher the number of antral follicles, the higher ovarian reserve. |  |
Anti-Mullerian Hormone (AMH)
AMH is a hormone that is put out by the antral (and pre-antral) follicles of the ovaries that can be measured by a simple blood test. Because high AMH is a sign of a higher number of premature and antral follicles, a higher AMH is associated with a higher ovarian reserve and a higher rate of pregnancy, both in people using assisted reproductive technologies such as IVF and people trying to conceive at home.
What causes a diminished ovarian reserve?
There are lots of reasons a person may have a higher or a lower ovarian reserve. Some people are naturally born with less egg cells than average, or are born on the lower side of the “bell curve” that represents what’s normal in our population. At other times, low ovarian reserve can be due to hormonal imbalances such as very low or absent testosterone levels (yep, everyone has testosterone!) or even autoimmune diseases that damage the ovaries and egg cells.
Another very common factor that can lead to early reductions in follicle count is oxidative stress. Oxidative stress happens in a variety of ways - some of the most common things that cause it are a diet that’s low in fresh fruits and vegetables and high in inflammatory foods, physical or emotional stress, and exposure to toxins such as cigarette smoke (both direct and second-hand). Oxidative stress can damage egg cells, causing them to die off before they’re even recruited. If this happens over many years it can have a huge impact on overall ovarian reserve.
Another very common factor that can lead to early reductions in follicle count is oxidative stress. Oxidative stress happens in a variety of ways - some of the most common things that cause it are a diet that’s low in fresh fruits and vegetables and high in inflammatory foods, physical or emotional stress, and exposure to toxins such as cigarette smoke (both direct and second-hand). Oxidative stress can damage egg cells, causing them to die off before they’re even recruited. If this happens over many years it can have a huge impact on overall ovarian reserve.
The Good News!
While all of this can sound pretty intimidating, there is actually a lot that natural therapies can do to improve the issues that lead to low ovarian reserve, or even boost your body’s ability to effectively use the eggs that remain.
 | Specific herbs and occasionally even hormone precursors such as DHEA may increase antral follicle count, depending on your body’s unique hormone balance. However, balancing and supporting hormone levels, especially with supplements such as DHEA, can have unpredicted and unwanted side effects and should be done only under careful medical guidance. |
In addition to these more focused therapies, many of the same nutritional and herbal therapies that preserve egg quality can also help preserve ovarian reserve (click the link for an article all about that!). These healthy changes can have the added effect of increasing overall health and preventing future issues such as heart disease or cancer.
Would you like Dr Silver’s help with fertility or any other health-related issue you might be struggling with? Call (248) 629-0224 or click here to set up an appointment for a visit or a free 15 minute phone consult.
