In today’s hurried lifestyle with the increased responsibilities and tasks, women find themselves deferring having a baby until they have fulfilled their career aspirations first or until their financial state within the family allows them to consider having a child. Unfortunately, egg quality decreases with advancing age, which is why women over their late 30s face more issues related to chromosomal abnormality of their eggs (aneuploid).

This means that their ability to propagate embryos which can lead to a live birth declines over time. Plus, at around menopause, there are not as many eggs available for harvesting through IVF. It is a condition called Diminution in Ovarian Reserve. Combine those two, and you get reduced fertility, alongside increased chances of giving birth to a child with birth defects (i.e. Down Syndrome) and higher risk of miscarriage due to the progressive decline in a woman’s reproductive performance. So, it comes as no surprise to see so many women in their 40s seek IVF services here, at the Cyprus IVF Clinic.

What is Ovarian Reserve ?

In short, it is the pool of eggs a woman has in her ovaries at any given time. But, let’s take it a step back and explain a few important things. Female embryos begin life with about 2 million eggs, whose majority decays before they are required for reproduction. At 16-20 weeks of gestation, a female fetus has around 7 million eggs, which drop to a couple of million at birth, which further reduce to about 250,000-500,000 at puberty. By the time a woman reaches her late 30s, she has 25,000 eggs and only 1000 at menopause.

When a woman has a low ovarian reserve, it means that she has insufficient number of eggs to give her a chance to conceive and get pregnant. It is an age-related condition, most of the times. However, this doesn’t necessarily mean that the ovarian function is affected in any way.

That said, there are 3 types of eggs (1) immature eggs, (2) mature eggs selected to prepare for ovulation in a menstrual cycle, and (3) dead or atrophic eggs. Every month, a specific number of immature eggs are selected to mature. The exact number of the eggs selected depends on the overall number of immature eggs a woman has. Then, one of them ovulates and the remaining ones are reabsorbed into the ovary through a complex process. It should be noted that although all the eggs are supported and nourished by follicles that encase them until maturation, the overwhelming majority never matures.

What Causes Low Ovarian Reserve

It could be attributed to chromosomal or gene anomalies (i.e. Turner Syndrome and Fragile X). However, it can also be caused by:

  •  Endometriosis that creates ovarian cysts
  •  Chemotherapy
  •  Radiation
  •  Surgical removal of the ovary (partial or completely)
  •  Pelvic adhesions,
  •  Immunological conditions,
  •  High body mass index
  •  Ovarian torsion

How Low Ovarian Reserve Affects IVF Chances

When a woman has issues conceiving, low ovarian reserve becomes an issue that has to be dealt with. Low ovarian reserve can also occur in women in their 30s, as well as older ones. However, if they have had children before that, having a low ovarian reserve will not affect them negatively.

The number of eggs the doctor can retrieve when it’s time to harvest them defines IVF success, regardless of the patient’s age.

Usually, a woman with less than 4 mature follicles formed after ovarian stimulation is what we call a poor responder and has about 3 times less chances to conceive. This is because having fewer eggs equals fewer embryos to select for transfer. If the poor responder is also of an older age, the risk of miscarriage is also increased (should she get pregnant). So, a patient’s ovarian reserve is proportionate to her response to ovarian stimulation.

How to Determine Whether a Woman is a Poor Responder

Team Miracle and Dr. Firdevs take into account the results of FSH (Follicle Stimulating Hormone), AMH (Anti-Mullerian Hormone), and AFC (Antral Follicle Count) levels, among other, more dynamic, tests to determine if the patient has a low ovarian reserve, and determine the best ovarian stimulation protocol for her particular case.

What we need is to get the maximum number of eggs we can harvest and of course, we need as many quality ones as possible. Unfortunately, age also affects the quality of the eggs produced, which is why there are less implications for a woman in her mid-thirties producing a couple of eggs than a woman in her mid-forties producing the same number of eggs.

What are the Options you Can Consider ?

i) Egg donor

Most women want to have a baby using their own DNA. However, you should have in mind that this might not be an available option for you. To address these issues and give the chance to couples that can’t have children using their own DNA (meaning the eggs and sperm) to start a family, we have implemented an egg donation program. Our large database of young (20-26 years of age) egg donors – all meticulously pre-screened for genetic and heritable diseases – comprises of the freshest egg from every donor cycle during an IVF procedure (for more information and details, please check our Egg Donation in North Cyprus page).
So, it is critical to decide whether you need to use your own eggs or donor eggs. For women with completely depleted ovarian reserve, though, egg donation is the only resource. It is a a treatment Dr. Firdevs highly recommends for women in their mid-forties and older, who, otherwise, have no more than 10% chance of undergoing an IVF cycle and result in getting pregnant (using her own eggs). Of course, we will never deprive you the chance to try using your own DNA if that’s what you wish.

ii) Strictly Customised Protocols

To help women of an older age have a child, we take full advantage of the remarkable developments in the field of advanced assisted reproduction. So, instead of standard protocols of ovarian stimulation, we customise them to meet the needs of each patient precisely.

iii) Blastocyst Transfer

Other than that, Dr. Firdevs performs a blastocyst transfer, which is the transfer of an advanced, Day 5 or 6 embryo (>100 cells), which helps improve your IVF chances.

iv) Embryo Freezing (Vitrification)

With conventional freezing, the cells are damaged, which is why thawing eggs and embryos 600 times faster will help prevent the formation of killer ice crystals. As a result, more than 95% of the frozen embryos and eggs survive and are ready to use, when you need them. It is a great option that many young women utilise and freeze their eggs or embryos until they decide to get pregnant (stored for up to 2 years). And, the best part about embryo freezing is that the frozen embryos are just as viable as their unfrozen (fresh) counterparts.

v) Embryo Donation

You can opt for a fresh or frozen embryo donation treatment, where your partner’s sperm is used to fertilise the eggs of an egg donor (for fresh embryo donation treatment) or you have your own frozen embryos defrosted and transferred into your uterus. Both treatments comes with high IVF success rates at the Cyprus IVF Clinic as they are performed by medical experts with a wealth of experience in the field of assisted reproduction.

There are many things we can do to help you experience the joys of parenthood, even if you have low ovarian reserve or face other fertility problems. We are here for you and your partner start your family soon, so don’t hesitate to contact us for any questions or enquiries.