Women are born with all of the eggs (oocytes) we will ever have. Over time, women spend these eggs, and when we reach a certain critical threshold, that’s when we undergo the menopause. Reproductive lifespan, or the time remaining to complete a genetic family, is therefore dependent in part upon the number of eggs a woman has remaining (also called ovarian reserve).
There are two main ways to assess ovarian reserve: AMH (Anti-Mullerian Hormone) and AFC (Antral Follicle Count). AMH is a blood test of the hormone that comes from the remaining eggs, and results do not vary widely with menstrual cycle. AMH decreases over the lifespan as the number of eggs decreases. AFC (Antral follicle Count) can be done in office as part of an ultrasound at the new patient visit. Although the egg itself is microscopic, the follicle that houses the egg is visible on ultrasound. Counting these antral follicles gives an estimation of ovarian reserve. AFC also decreases over the lifespan as the number of eggs decreases.
At FORA we will provide AMH and AFC as a part of your fertility assessment and discuss these results with you to tailor a treatment plan.
While women are all born with a similar number of eggs, some reproductive age women have fewer eggs than would be expected by age alone. This is called diminished ovarian reserve (DOR). Reasons for DOR can include genetics, autoimmune disease, prior surgical and medical treatments (e.g, ovarian surgery to remove cysts for endometriosis, chemotherapy for cancer) and environmental toxins (such as smoking).
Having DOR is not a cause of infertility. However, DOR can limit the amount of time a woman has to complete a genetic family. DOR can also limit expectations in any given treatment cycle since ovarian reserve correlates with the number of available eggs for a cycle. Unfortunately, women are often told that having low ovarian reserve means that they are not candidates for using their own eggs for fertility preservation or fertility treatment. While expectations on a per cycle basis may be lower, and while it may take more than one cycle to achieve goals, having DOR does not preclude a woman from pursuing fertility treatments with her own eggs.
Dr Skillern has a special interest in diminished ovarian reserve, and has been involved in basic science research to better understand the underlying genetic reasons for DOR. She has helped many patients grow their genetic families who had previously been told that their DOR made that impossible.
At FORA, we will discuss your ovarian reserve parameters and realistic expectations with you. Taking into account age, family goals, and other factors, we will make a decision along with you about your best course of action in the setting of DOR.
Sometimes women have a combination of DOR and age related aneuploidy (percentage of abnormal eggs which increases with age) or have failed prior treatment cycles using their own eggs. In these cases, egg donation (ovum donation) can become an alternative family building strategy. Egg donation is the process of obtaining eggs from egg donors, who are healthy women between the ages of 21-30, and thus have higher numbers of eggs and lower percentages of abnormal eggs. These eggs are then fertilized, and a resulting embryo transferred to a woman’s uterus to affect a pregnancy.
Family building with donor eggs can sometimes seem like a daunting task. That is why we at FORA have partnered with Simplify Egg Bank to simplify this process for our patients. A multi-ethnic donor population, concierge patient care, and guaranteed PGT-A chromosomally normal (euploid) embryo for transfer are only some of the reasons FORA celebrates this collaboration.
Dr Skillern also has a special interest in egg (oocyte) donation as a family building option She has authored peer reviewed articles on the ethics of egg donation and has presented at numerous invited speaking engagements in support of her interest.. With her guidance, FORA has composed a world class team to assist you through the egg donation experience. At FORA, we know there are many pathways to a family, and egg donation is one option that we are poised to discuss further should the need arise