Diminished ovarian reserve (DOR) is a natural phenomenon in which the number and quality of a woman’s eggs diminish as she ages. As the pool of eggs diminished, a woman’s chances of getting pregnant simultaneously begins to fall. Women with diminished ovarian reserve may have regular periods and no other symptoms that they have suboptimal fertility; therefore they often present to their doctor’s office after months of unsuccessfully trying to get pregnant. Gynecologist, reproductive endocrinologist and even your naturopathic doctor can assess your ovarian reserve through a number of diagnostic tests. Your doctor may order a pelvic ultrasound early in the menstrual cycle to evaluate the number of follicles. Another test for assessing ovarian reserve is hormone blood tests like follicle stimulating hormone (FSH) and estradiol on day 3 of the menstrual cycle. An FSH greater than 10-12 mIU/mL and estradiol greater than 50-80 pg/mL indicates low ovarian reserve. Another blood test that your doctor may order is the anti-Mullerian hormone (AMH) test, which may be drawn on any day of your cycle. The lower the AMH level, the lower the ovarian reserves. As a general rule of thumb, an AMH between 1.7-4.5 ng/ml is considered good while an AMH less than 0.8 ng/ml reflects diminished ovarian reserve.
Management options and natural medicines
Women diagnosed with diminished ovarian reserve are often recommended assisted reproductive technologies like IVF (in vitro fertilization). Fortunately for women seeking natural and integrative reproductive care, there has been growing evidence to support the use of natural medicines to improve ovarian reserves and improve pregnancy rates.
Dehydroepiandrosterone (DHEA) supplementation has been shown to improve the number of eggs retrieved, fertilization rate, and quality of early embryos in women undergoing IVF. In women with diminished ovarian reserves who supplemented with DHEA for up to four months, there was a shorter time to pregnancy as well as higher pregnancy rates when compared to women who did not take DHEA supplementation. There has even been case reports amongst naturopathic physicians of pregnancy occurring naturally in women taking DHEA for diminished ovarian reserve. DHEA is not without side effects and should always be prescribed by your doctor. The most common side effects reported with the use of DHEA are oily skin, acne and mild hair loss – all of which resolve when DHEA is discontinued. Less common side effects include inflammation in the oral mucosa, myalgias, headaches, irritability, and nausea.
Melatonin has been studied as an antioxidant, free radical scavenger and nutrient that can modulate gene transcription for antioxidant enzymes in the ovarian follicular fluid. Melatonin is thought to improve egg quality. In fact, one study demonstrated that women who had failed their first round of IVF, were slightly more likely to get pregnant on their next round of IVF if they had been taking a melatonin supplement (of 3 mg per day) compared to women who received no melatonin. Women that received melatonin supplementation had modest improvement in the percentage of mature eggs retrieved during their IVF cycle, embryo quality and clinical pregnancy rate. Although the difference was not statistically significant, researcher believe that melatonin has a positive impact on egg and embryo quality.
Myo-inositol, an isomer of inositol made from glucose-6-phosphate, has been said to improve insulin sensitivity and oocyte maturation. Myo-inositol has been shown to be an important constituent in the follicular microenvironment associated with improved egg quality and maturation. Studies have shown that infertile women undergoing IVF given 2 grams of myo-inositol twice daily required a lower dose of ovarian stimulation medication and a decreased mean number of immature oocytes. A similar double blind study was conducted in Italy in which women diagnosed with polycystic ovaries were given 2 grams of myo-inositol twice daily for 3 months. During ovarian stimulation protocols, women who had taken the myo-inositol had more follicles measuring greater than 15 mm on their ultrasound exam, a greater number of oocytes recovered at retrieval and a greater number of embryos suitable for transfer, suggesting that myo-inositol can influence ovarian reserve and egg quality.
Setareh Tais, ND is a naturopathic doctor practicing general family medicine with a focus on women’s health, pediatrics, and reproductive health in Fresno, CA. She received her doctorate of naturopathic medicine from Bastyr University and completed a naturopathic family medicine residency program with additional training in reproductive endocrinology and infertility. She is President of the California Naturopathic Doctors Association, a founding board member of the Endocrinology Association of Naturopathic Physicians, a member of the American Association of Naturopathic Physicians, and a member of the Pediatric Association of Naturopathic Physicians.
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