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If you have less number of eggs- What to do?

If you have less number of eggs- What to do?

What is meant by less number of eggs?

A woman is born with finite number of eggs in her ovaries. This is called “Ovarian Reserve”. In every month, number of eggs are destroyed and this is unavoidable. From adolescent years, one mature egg is released from the ovaries and if it can meet with the sperm, pregnancy is possible, However, the process of destruction continues. As a result, when she attains menopause (permanent cessation of menstruation), there ovarian reserve is severely diminished, making pregnancy almost impossible.

However, in some women, this process of destruction is accelerated and this decreases the ovarian reserve markedly, compared to her age. This is called “Poor ovarian reserve (POR)” or “Less number of eggs”.

What may be the possible reasons?

In most cases, the exact reason is not known. It may be due to chromosomal problems, diseases running in families, surgery done in ovary, endometriosis, exposure to chemotherapy or radiation etc. Smoking and environmental factors may also be responsible.

How can I know that I have less number of eggs?

Unfortunately, majority of the women, who are having “less number of eggs”, do not know that they are suffering from it. It is suspected if you have any risk factors like previous operation, family history or chemotherapy treatment. Blood results can show low AMH and sometimes FSH slightly higher than normal. The most definitive test is checking for the eggs (called AFC- Antral Follicular Count) by ultrasound probe inserted in vagina (TVS- Transvaginal sonography).

However, it must be kept in mind that a single result is not confirmatory. AMH level varies from one laboratory to another. A single low AMH does not always mean POR. Similarly, low AFC needs to be interpreted with care. In short, we have to look into age, AMH and AFC together, not separately.

What are the treatment options?

Only a low AMH or low AFC cannot decide what treatment you should have. Age is the most important factor to decide the mode of treatment. We also have to check your duration of infertility, previous pregnancy (if any), condition of your tubes and also partner’s sperms.

If all other factors are favourable and you have only low AMH and AFC, a short period of Ovulation Induction (OI- Giving medicines to stimulate the ovaries to release the eggs) and IUI (Intra-uterine insemination- partner’s sperms are inserted inside your womb through a small catheter) can be tried. If these fail, you may need to consider IVF.

Is IVF done as the last resort?

POR does not always mean that you need IVF. However, if your age is on the higher side or duration of infertility of long, IVF may be the better option for you, rather than OI or IUI. IVF should also be considered if your tubes are blocked or partner’s sperm count is very low.

In IVF, your eggs are stimulated with hormones and are then collected in the laboratory. The eggs are then “fertilized” with the sperms to produce the embryos, which are then transferred inside your uterus. However, in small number of women with POR, the chance of obtaining eggs is reduced and even if, eggs are obtained, these may not be of good quality. If pregnancy does not result and embryos are not of good quality, then you may be offered “Egg Donation-IVF”

“Egg Donation”- What is it actually?

In POR, egg donation is usually done as a last resort. Here, the eggs are collected from another woman (donor), who has been checked to ensure that she is healthy and does not contain any diseases like HIV, hepatitis or thalassaemia. These eggs are then fertilized with your husband’s sperms and the embryo is inserted inside your uterus. The process will remain confidential, that means except you and your husband, nobody will know that donor-egg has been used.

However, before using donor eggs, we usually advise the couples to try IVF (if required) with self-eggs.

My previous IVF failed- What can I do?

In case of POR, if you had good number of healthy embryos produced from your own eggs, the excess embryos can be frozen. So, if the first embryo-transfer fails, you still have your own embryos for transfer in future.

But if you had small number of embryos and all have been transferred (none remained for freezing), we have to review whether the quality of the embryos was good or not. As only one healthy embryo can give rise to pregnancy, if embryos were of good quality (Grade A), then you can try second IVF with your own eggs. However, if embryo quality was not good (Grade B or C), it’s better to think about egg-donation.

What is the chance of success?

The chance of success depends on your age, duration of infertility and your response. In general, the chance of pregnancy after each cycle of IUI is 15-20% (out of 100 women having IUI, 15-20 can conceive after 1st cycle) and after IVF, it is 30-40%. However, the chance is slightly lower in women with POR.

Is there any risk in pregnancy?

Every pregnancy carries some risk of miscarriage, abnormalities in the baby, premature delivery and growth problems. The mother can suffer from diabetes, high blood pressure (Preeclampsia) and bleeding. All these risks are slightly increased in women who conceive with POR. However, majority of these women will have uncomplicated pregnancy.

Is there no chance of natural conception?

In women who attain menopause before 40 years, 10% can conceive spontaneously, without any treatment. In women with POR, this chance of natural conception is even higher. So, POR does not always mean that you have to go for OI, IUI or IVF. But it again depends on your age and other factors.

What medicines can be tried? Or anything else?

Some medicines may be tried to improve ovarian response. DHEA (dehydroepiandrosterone) showed some positive results. In some women, testosterone gel or antioxidants, vitamin D3 etc can be helpful. However, whether the medicines are actually helpful, is a matter of debate and it needs further research.

Conclusion

POR does not always mean that you cannot become mother. Most of the women conceive either spontaneously or by medicines or by IUI. Few of them require IVF. Donor-IVF is usually used as a last resort.