My Doctor Says I Have a Low Ovarian Reserve. Help!
One of the toughest and more common diagnoses women get for infertility is low or diminished ovarian reserve. This blog focuses on what the diagnosis is and a supplement that has been shown to improve both eqq quality and egg count in women with low ovarian reserve.
How is ovarian reserve assessed?
“Ovarian reserve” is the number and quality of your eggs. This is what your physician counts in a vaginal ultrasound and why you should get one if you’re experiencing issues with fertility. They also do blood tests such as FSH and AMH to assess your reserve. If your ovarian reserve is “low” or diminished” it means that the egg count is lower than expected for your age.
What is with declining eggs, anyway?
When we hear about fertility “falling off a cliff” as we age, the reference is to the fact that women have our “ovarian age,” which is time-limited.
We are born with over a million eggs and that declines throughout life with menopause being the final drop off.
According to the American College of Obstetricians and Gynecologists, these are the average number of eggs you have at each age:
20 weeks of gestation: 6 to 7 million oocytes
birth: 1 to 2 million oocytes
puberty: 300,000 to 500,000 oocytes
around age 37: roughly 25,000 oocytes
around age 51, the average age of menopause in the United States: roughly 1,000 oocytes
This is a natural process that happens in life and why the “clock is clicking” metaphor is so often used.
Why would I have a low ovarian reserve?
Yes, this is the big question in the fertility community. What causes some women to have fewer eggs and lower quality eggs for their age? There are a number of reasons that have been documented and the official list is likely much longer:
Being overweight
Exposure to endocrine disrupting chemicals like phthalates and BPA
Prior surgery on your ovaries
Chemotherapy
Radiation therapy
Smoking
Pelvic infection
Chronic inflammation
Autoimmune disorders
Mumps
Genetics such as fragile X syndrome
So, what can I do about a low ovarian reserve?
Improve your egg quality.
Lifestyle matters for egg health. As I mentioned in my blog post The Importance of Egg Quality, there are a number of things you can do to improve egg health. While we can’t entirely prevent your egg count from declining with age, you can have better quality eggs as you age.
Your tools are:
an excellent, anti-aging type diet,
deep sleep
moderate regular exercise
a more relaxed mental state, and
avoiding household and personal products with harsh chemicals.
Can you also reduce the decline in the number of eggs?
There is some research that certain foods and herbs can decrease the rate of decline in AMH or ovarian reserve. Dairy products, notably fermented foods, have been found to reduce the rate of AMH decline. Vitamin D, found in sunlight and fatty fish and dairy, seems to correlate with low-AMH so people with higher Vitamin D status and not deficient have higher AMH levels. We know that women who are more physically active over time have better AMH levels for their age than those who are not active.
One supplement shown to improve both egg quality and count: DHEA
DHEA (dehydroepiandrosterone) is a hormone produced by your body's adrenal glands. The adrenals are two little glands just above your kidneys that are pretty important because they help balance your body’s response to stress.
DHEA is upstream of the hormones you commonly know, and functions as a precursor to male and female sex hormones, including testosterone and estrogen. Precursors are substances that are converted by the body into a hormone.
What does DHEA do for fertility?
Male and female sex hormones are vital to fertility, as estrogen is necessary for ovulation (the release of an egg from a woman's ovaries) and testosterone stimulates sperm production. Therefore, if a woman or a man has low DHEA levels, it can lead to low estrogen and testosterone which may make it more difficult for the family to conceive a baby.
DHEA and IVF
Much of the research on DHEA has focused on IVF candidates, where DHEA seems to improve egg quality and reduce miscarriage rate.
In one study, researchers retroactively compared miscarriage rates in 73 DHEA supplemented pregnancies at two independent North American infertility centers to miscarriages reported in a national U.S. IVF database. They found that miscarriage rates after DHEA were significantly lower at all ages but most pronounced above age 35.
Another study found that supplementation with DHEA positively affects spontaneous conception in women with diminished ovarian function. The researchers established three groups: the first group that included 39 young women under 40 years, all treated with DHEA because of a previous poor response. The second group included 38 women over 40 years who received DHEA supplementation. The third group was the controls which were 24 comparable women who had not been treated with DHEA before the first IVF cycle, to evaluate the spontaneous pregnancy rate during preparation to IVF.
Three tablets of 25 mg micronized DHEA were given to the women 12 weeks before starting a stimulation protocol for IVF.
Can DHEA help with natural conception?
Interestingly, DHEA also seems to help with natural pregnancy, too. Of the women in the IVF study, the researchers found that the spontaneous pregnancy rate increased after DHEA treatment and the pregnancy rate and ongoing pregnancy rate before starting the IVF cycle were significantly higher in older women treated with DHEA than in the control group.
DHEA and your sex drive
Not only has it been proven that DHEA supplements improve fertility even in the over 40 crowd, it has also been shown to boost sexual function in premenopausal infertile women.
In an observational study conducted in an academically affiliated private fertility center, researchers gathered 87 premenopausal infertile women, 50 of whom completed the study including the Female Sexual Function Index (FSFI) questionnaires and comprehensive endocrine evaluation before and 4 to 8 weeks after initiating 25 mg of oral micronized DHEA TID.
After DHEA supplements were taken, the researchers found that all serum androgen levels increased while FSH levels decreased.
DHEA can help—but it’s a little complicated
DHEA is an androgen, i.e. it can drive up testosterone. For women, testosterone is important but also a careful balance. We need it for our sex drive, but too much can lead to facial hair, acne, hair loss and other symptoms associated with high testosterone.
That’s why it is important to use DHEA carefully, and under clinical supervision, and only if you really need it. Many IVF clinics in the US are using it especially in older women who have not responded well to IVF earlier. It should only be taken for the time in which you are trying to conceive and not taken longer, especially at the high doses recommended in studies that have been shown to help with fertility.
Hopeful, but confused? DHEA does offer some promise with good evidence. Yet, supplements can be tricky, which is why your nutrition plan should be personalized to your individual needs.
Need help? That’s why I am here. Feel free to book an appointment to figure out what you need for your fertility.