Diminished Ovarian Reserve (AMH)

Ovarian reserve refers to the amount of eggs (follicles) present in a woman’s ovaries at any given time. Diminished ovarian reserve is the decrease in the number of eggs.

The most important factor determining diminished ovarian reserve is the age of the woman. The older the woman, the lower the ovarian reserve. Especially after the age of 35, the number and quality of follicles decrease rapidly. In some cases, the ovarian reserve decreases without a cause, even though the patient may be young. In these cases, it should be noted that the factor causing the decrease in ovarian reserve may have reduced the quality of the eggs as well.

A regular menstrual cycle does not necessarily indicate that the ovarian reserve is good. A low ovarian reserve does not prevent regular menstruations for a long period. When the menstrual cycle becomes irregular, we can say that the reserve is starting to drain.

The most important cause of a diminished ovarian reserve is advanced age. The ovarian reserve may diminish at a younger age especially if the woman has a family history of early menopause. In addition to advanced age, the following causes play an active role in diminishing the number and quality of eggs.

• Surgery related to the ovaries

• Radiotherapy and chemotherapy

• Use of cigarettes and alcohol

• Endometrioma (chocolate cysts)

• Excess weight, obesity

• Turner syndrome

The menstrual cycle of a healthy woman occurs every 21 to 35 days. When the ovarian reserve is diminished, the menstrual cycle becomes shorter than usual. Although the amount of bleeding may be the same, a doctor should be consulted if menstruation frequency increases.

With age, even when fertilisation occurs, the embryo may not hold onto the uterus and the pregnancy may end in miscarriage. The risk of chromosomal abnormality increases in ongoing pregnancies.

Another symptom of diminished ovarian reserve is the lower chance of pregnancy in assisted reproductive methods such as IVF. For patients with diminished ovarian reserve, a more intensive treatment program may be appropriate.

The most accurate way to evaluate the ovarian reserve is an ultrasound examination. The patient is examined in the first days of her period and the antral follicles are counted. In addition to ultrasound testing, AMH and FSH tests can also give information about the ovarian reserve.

The anti-mullerian hormone (AMH) test is done by taking a blood sample from the patient. It provides information about the ovarian reserve. For reliability purposes, the standardisation of the laboratory is of great importance.

As the woman ages, the level of AMH in the body begins to decrease. Very low levels of AMH may indicate menopause, while very high levels of AMH may be a symptom of polycystic ovary syndrome.

<strong>AMH values:</strong>

High (AMH &gt; 4 ng/ml)

Normal (AMH 1,5-4 ng/ml)

Low (AMH &lt; 1,5 ng/ml) Very low (AMH &lt; 0,5 ng/ml) Since the low level of AMH in women under the age of 35 may be a precursor of early menopause, the doctor should guide her patient as to what she should do. If the patient is married and wants to have children, pregnancy can be achieved through IVF. Many of our patients with diminished ovarian reserve have achieved pregnancy. Our unmarried patients might consider egg freezing to increase their chances of achieving pregnancy in the future.

The FSH (Follicle-Stimulating Hormone) test is a blood performed on the 2nd or 3rd day of menstruation. FSH is a hormone released from the pituitary gland and which contributes to egg development. The FSH test may yield different results every month; only the highest value is taken into consideration. While high FSH levels signal a diminished ovarian reserve, normal FSH levels do not necessarily mean that the ovarian reserve is normal. The AMH testing results should also be taken in consideration when assessing the ovarian reserve.

Women with diminished ovarian reserves can fall pregnant with IVF. The occurrence of pregnancy depends on the presence of a healthy embryo and a suitable uterus to accept this embryo. A healthy embryo requires good-quality eggs and sperms.

In the treatment of IVF, sperm and egg cells are cultured in the laboratory and fertilisation is carried out. The production of healthy embryos is directly related to the experience of embryologists and the technological equipment of the embryology laboratory of the IVF centre.

As Bahçeci IVF Centre, we are happy to have helped in the birth of over 80,000 babies thanks to our state-of-the-art embryology laboratory and our team of expert embryologists. We achieve highly rates of successful pregnancies thanks to our personalised treatment approach.

The Embryoscope, which increases the chances of successful pregnancy in patients with diminished ovarian reserve, is one of our success-boosting methods. With this technique, which offers the chance to observe the embryo continuously, the best-quality embryo can be selected and transferred into the uterus of the mother to increase the chance of pregnancy.