What Causes Low Ovarian Reserve?

Posted on Thu, 16 Feb 2017

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 16 Feb 2017 Answered on

Wed, 8 Mar 2017 Last reviewed on

Question : Hi I am female 45. Trying for baby No 2. I have one child already who was born in 2013 with no problems conceiving or delivering. I have been diagnosed with low ovarian reserve as would be expected at this age. Have been taking DHEA 3 x 25mg daily supplements for 11 weeks with intention to take it for 20 weeks prior to ivf. Currently on a monitoring cycle. On day 1 of monitoring cycle was FSH 12.2, and LH 1.5. 4 folicles were observed on the Antral Folicle count. Previously AMH less than 1.
On day 26, LH had risen to 9.7 and one folicle 20.8 mm and another about 22mm suspected cyst.
No actual ovulation has been confirm by ovulation home test kit as yet and now it is day 29. I am worried that the egg is not rupturing/ovulation is not happening. Why could this be? My cycle was quite irregular before so it is difficult to define 'normal cycle range' for me. I am worried that the DHEA maybe having an impact on this issue. Or is this not really so unusual given my age. Every month that goes by and every egg seems precious. What happens to eggs that do not rupture? Any comments/ suggestions /observations particularly about the DHEA supplementation.

Answered by Dr. Dr. B. Radhakrishnan. Nair (40 minutes later)

Brief Answer:
Follicular study with hormonal analysis is important to confirm ovulation

Detailed Answer:
Hi
GREETINGS
I can understand your concern
You have mentioned that 4 follies were seen on day 2.
But we need follow up scan regularly with titration of hormonal injections.
In between FSH LH and E2 has to be done to know the follicular development.
Follicular size alone will not be help us to predict any thing.That would have been an empty follicle without ovum.
I suggest you to discuss with your infertility specialist before proceeding with IVF again.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. B. Radhakrishnan. Nair (56 minutes later)

Any comments/ suggestions /observations about the DHEA supplementation.

Answered by Dr. Dr. B. Radhakrishnan. Nair (9 minutes later)

Brief Answer:
It has to be analysed with hormonal levels

Detailed Answer:
Hi
We need to know the effect of DHEA in your case before and after .Was there improvement in E2 level ?
The effect of DHEA varies from person to person.I think in your case there was no proper follicular development irrespective of DHEA
.Hence I suggested to discuss with your doctor as she would know your details better.
Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj