Diminished ovarian reserve (DOR) is an important factor that can impact likelihood of pregnancy. As egg counts drop and the reserve of follicles in the ovary declines there are various hormonal and physiological changes that occur.
What causes Diminished Ovarian Reserve?
DOR is often associated with advanced age as the egg reserve naturally declines with time. However, in some cases, ovarian reserve can decline sooner than usual for some patients. This has been postulated to be related to genetics and certain lifestyle behaviours. Some medications have also been observed to be associated with a higher risk of decline in ovarian reserve compared to patients that do not use the same medications. One particular study found this association with long-term use of specific birth control treatments. It is important to speak with your healthcare provider to help determine if the birth control they have recommended has been associated with a decrease in egg reserve.
Another predictor for early ovarian reserve decline is the age at which the Patient's biological mother entered into menopause. Research has observed a close correlation between early decline in ovarian reserve with Patients that had Mother's who experienced menopause earlier than anticipated. This suggests a potential genetic role in ovarian reserve as well.
New Research on Traditional Chinese Medicine in the treatment of DOR:
A new systematic review published in the Journal of Traditional Chinese Medicine evaluated 9 randomized clinical trials that compared parameters of DOR after 3 month of therapy with allopathic medication (namely hormone therapies creating an artificial cycle using estrogen, or estrogen + progesterone), traditional Chinese medicine (TCM), or a combination of both.
The systematic review found similar results for TCM and Allopathic similar outcomes for various parameters, such as, anti-mullerian hormone (AMH) levels, and follicle-stimulating hormone (FSH) to luteinizing hormone (LH) ratio.
Patients that received TCM treatment were seen to have a greater reduction in the FSH levels after 3 months of treatment and a higher antral follicle count (AFC) after 3 months of treatment. These are important parameters as higher FSH levels and lower AFC are associated with lower egg reserve.
While these results are encouraging, it is still not clear if a reduction in FSH levels or AFC in Patients with DOR is correlated with an actual increase in pregnancy rates. Some medications and herbal treatments can artificially suppress production of FSH levels, and while this may look positive on blood work, it may not actually represent a change in fertility treatment outcomes. So it is still unclear if these positive benefits are actually associated with an increase chance for pregnancy.
Additional Considerations for DOR:
It is important to understand that as ovarian reserve declines, so does egg quality. This is arguably one of the most important changes we see with declining ovarian reserve. Various interventions have been studied over the last decade and suggested to help support egg quality and have been associated with an increased likelihood for pregnancy.
Liuquing, L., Yanfeng, L., Ming, Y., Guiqin, X., Ruiqi, L., Xiuli, X., Xue, P., & Jialing, L. (2020). Effectiveness of tonifying-kidney and regulating-liver therapy on diminished ovarian reserve: a systematic review and Meta-analysis of randomized controlled trials. Journal of Traditional Chinese Medicine, 40(30), 343–354.
This article is being shared as educational content and is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healtcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance.