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For many people, diving into the world of infertility or fertility preservation comes with a lot of realizations about their own bodies and health — things they never even knew were possibilities. For example: Maybe you’re undergoing fertility testing to take control of your reproductive future…and you learn that you have a thing called diminished ovarian reserve.
Terms like this — which sound like a foreign language to someone who hasn’t stepped into the world of reproductive medicine, but quickly become a part of your vocabulary as you navigate this world — can be frightening to hear. And while at the moment, you’re most likely worried about how a diagnosis like this will affect your family planning, you may also wonder what it means for your future, even beyond your family-building efforts.
Being told you have diminished ovarian reserve can be scary, and you may wonder if this means you’ll be unable to get pregnant, be at greater risk for health issues down the line, or even enter menopause prematurely. We’ve tapped CCRM reproductive endocrinologist Elizabeth Dilday, MD, to explain what a diagnosis of diminished ovarian reserve means — both in the context of getting pregnant and beyond. For example: Can diminished ovarian reserve lead to early menopause? Read on for the answer to that (and more).
First up: What is diminished ovarian reserve?
It’s all about oocytes, which are cells in the ovaries that mature to become ovum or eggs.
“Ovarian reserve is defined as the number of oocytes remaining in the ovary, or oocyte quantity (oocyte number). It is important to differentiate oocyte quantity from oocyte quality,” says Dr. Dilday.
Your ovarian reserve declines with age, but there’s a wide range here.
“There are many ways to measure one's ovarian reserve, including a variety of blood tests and ultrasound imaging.,” says Dr. Dilday. “Typically, diminished ovarian reserve is defined as an antimullerian hormone (AMH) level [of less than] 1 ng/mL, an antral follicle count of fewer than 10 follicles seen in the ovary on a pelvic ultrasound during the early follicular phase of one's menstrual cycle, or fewer than 10 oocytes retrieved at the time of [egg retrieval].”
So yes. Diminished ovarian reserve sounds awful, but Dr, Dilday wants to make one thing clear: Ovarian reserve alone does not fully predict your reproductive potential. This diagnosis absolutely does not mean you’ll be unable to get pregnant.
What are the long-term effects of low ovarian reserve?
“The diagnosis of low ovarian reserve does not necessarily mean that you are infertile,” says Dr. Dilday. “However, the diagnosis of low ovarian reserve can predict a lower response to ovarian stimulation medications and therefore fewer oocytes retrieved during a transvaginal oocyte retrieval done for an oocyte cryopreservation (egg freezing) or in vitro fertilization (IVF) cycle.”
According to Dr. Dilday, many studies have attempted to nail down the exact link between low ovarian reserve and fertility.
There have been many studies aimed to define the relationship between low ovarian reserve and the chance for spontaneous pregnancy — and several have indicated that lower ovarian reserve can hamper someone’s chances of conceiving spontaneously.
People who have low ovarian reserve may produce fewer eggs or embryos during IVF or egg freezing, so multiple rounds of treatment may be the best course of action.
Can diminished ovarian reserve lead to premature menopause?
Not necessarily — ovarian reserve only measures a snapshot in time.
The number of oocytes in your ovaries is actually at its peak before you’re even born. After birth, that number drops and you cannot generate any new oocytes after birth.
“At the time of menopause, a woman will have fewer than 1,000 oocytes remaining in the ovarian follicle pool,” says Dr. Dilday. “While we know that oocyte quantity downtrends with time and that the rate of oocyte loss is increasingly faster as one nears menopause, the rate of one’s downtrend varies from patient to patient. Ovarian reserve tests only offer a snapshot in time, and cannot reveal very much about the rate of one’s loss of oocytes.
Concerned about early menopause? Consider these factors.
The average age of menopause, which is defined as 12 months without a menstrual period, is 51.2 years in the United States. The typical range for menopause’s onset is between the ages of 50 and 55.
However, some people can experience menopause much earlier — if you’re under 40 when you experience menopause, that’s called primary ovarian insufficiency (POI).
About 1 percent of women experience this, and Dr. Dilday breaks down some factors that can affect your risk of POI.
"Some women may be at risk of early menopause if they have family members who have had early menopause. Genetic factors such as having Turner's Syndrome (Monosomy X) or carrying a Fragile X premutation, and iatrogenic factors such as surgery to remove one or both ovaries, chemotherapy, and radiation can cause early onset of menopause,” says Dr. Dilday. "Certain autoimmune diseases and infectious causes such as mumps can be linked to early menopause as well. Cigarette smoking is a modifiable lifestyle factor that is linked to earlier menopause.”
With that being said, there is not always an identifiable cause behind POI.
Unfortunately, there aren’t many ways to delay menopause (but if you’re a smoker, quitting may help). Luckily, there are treatments that can help you deal with some of the pesky symptoms, such as hot flashes.
If you have diminished ovarian reserve, here’s what you can do:
“I would recommend referral to a reproductive endocrinologist and infertility specialist to further discuss your diagnosis within the context of your family-building goals,” says Dr. Dilday, who adds that you may be a good candidate for egg or embryo freezing if you’re not quite ready to have children.
“Even if you do not choose to move forward with any treatment or fertility preservation procedures after you receive counseling, your physician can explain the implications of your diagnosis to you in the context of your overall reproductive goals,” Dr. Dilday adds.
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.
