About Fertility

5 Causes of Diminished Ovarian Reserve


Women are born with all the eggs (oocytes) they’ll ever have. And these eggs die off by the thousands each year. This process is entirely normal. However, some women are born with less-than-normal eggs, or their egg stores diminish more rapidly than usual. This leads to diminished ovarian reserve.

Diminished ovarian reserve is normal in women 40-years-old and over because it is a natural byproduct of perimenopause. However, some women’s egg stores are diminished by the time they reach their 30s, which dramatically reduces their fertility chances. Unfortunately, there are no signs or symptoms of diminished ovarian reserve until it’s in its latter stages and you experience perimenopause.

Non-Age-Related Causes of Diminished Ovarian Reserve

While age is a naturally progressing infertility factor, there are other reasons women experience diminished ovarian reserve or ovarian failure. If you’ve been diagnosed with a low egg count, time is of the essence, and it’s essential to meet with a fertility specialist to learn more about your treatment options. While women with diminished ovarian reserve have similar IVF conception rates as their counterparts, they have a higher risk of miscarriage due to diminished egg quality.

Here are five of the most common, non-age-related causes of diminished eggs stores:

1. Ovarian failure (early menopause)

About one in one hundred (1 in 100) women experience early menopause. Sometimes the event is genetic; other times, it results from a health condition or curative medical treatments. This is one of the reasons that fertility preservation is a hot topic in the cancer field. Women facing chemotherapy or other cancer treatments may risk compromising fertility, so freezing eggs beforehand makes sense.

2. Fragile X syndrome (as well as other X chromosome abnormalities)

Fragile X syndrome (FXS) is a chromosomal abnormality. While some people exhibit clear symptoms of FXS, others do not. Those with a partial mutation may never know they have FXS but experience some side effects.

Women with FXS are more prone to diminished ovarian reserve and early menopause. When we have a client with diminished ovarian reserve, we recommend genetic testing to see if fragile X syndrome is the cause. It’s important to know because women with fragile X can pass it to their offspring (there’s a 50% chance), so many opt to use donor eggs instead.

3. Smoking

There are so many reasons to stop smoking. There isn’t a single healthy thing that can be said about it. However, women who plan to get pregnant should stop ASAP. In addition to having higher miscarriage rates, premature births, babies born with lower birth weights, and higher rates of babies born with respiratory issues (we could go on), women who smoke have lower egg stores. A smoker’s egg quality is diminished as well.

4. Aggressive medical treatments

The good news is that oncologists and other specialists are getting better about screening female patients about their fertility plans before initiating aggressive medical treatments. However, it’s not always the case. Women may find that specific treatments or medications are more likely to reduce their numbers of viable eggs or harm reproductive organs, making fertility more challenging. Aggressive surgeries, chemotherapy, and a wide range of specific medications (thyroid, anti-epileptic, certain prescription NSAIDs used to treat arthritis, neuroleptic anti-psychotics) threaten female fertility. Be clear that you want to get pregnant in the future before moving forward with any aggressive medical treatment, so you have the opportunity to meet with a fertility specialist if the treatment risks fertility.

5. Ovarian surgery

Ovarian surgery always poses a slight risk to fertility because the ovaries are very delicate. Depending on how your body and tissues heal, a textbook-perfect surgery can still result in scarring and residual damage that threatens egg production. If you opt to have ovarian surgery to treat endometriosis, non-cancerous tumors, and cysts, choose your surgeon very wisely. You are on the lookout for a surgeon who has a first-class track record performing your surgery and with patients who got pregnant afterward.

Contact the Fertility Centers of New England to learn more about treating diminished ovarian reserve and determine which fertility treatment plan makes the most sense for you and your family-building goals.

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