Poor Ovarian Reserve (POR)
POR indicates a reduction in quantity and quality of oocytes in women of reproductive age group. Early detection and active management are essential to minimize the need for egg donation in these women. Diminishing ovarian reserve is a phenomenon often noted in women in their late to mid-'30s, but it may affect younger women as well. However, the pregnancy rate remains low despite a plethora of interventions and is associated with high pregnancy loss. Antral follicle count(AFC) and Antimullerian hormone(AMH) are the most sensitive markers of ovarian reserve identified to date and are ideal for planning personalized ovarian stimulation protocol.
Bologna criteria recommend the presence of a minimum of 2 of the following 3 for diagnosis of POR
1. Advanced maternal age (>40yrs)
2. A previous POR (Less than 3 oocytes with a conventional stimulation protocol)
3. An abnormal ORT (i,e AFC 5-7 or AMH 0.5-1.1 ng/ml)
Other than the age-related decline, factors that may further deplete the ovarian reserve are endometrioma, pelvic infection, ovarian surgery / ovarian tumour or post CT RT for tumours.
We at GarbhaGudi feel that ovarian reserve testing should be offered to women who wish to delay childbearing and assist them in making informed decisions. AMH is being increasingly used as a tool to predict the fertility potential of such women. They then have the choice of changing their priorities and decide not to delay conception or may undergo IVF to freeze eggs or embryos for future use (social freezing).
At present, there is no known mechanism to reduce follicular atresia and prolong fertility. Social egg freezing is a step towards this but doesn’t always ensure pregnancy.
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