Causes and Risk Factors of Poor Ovarian ReserveDr Asha S Vijay

Poor ovarian reserve is a clinical condition in which the ovaries contain less number of oocytes (eggs) as expected for that particular age of a woman. Women are born with 1 to 2 million oocytes in their ovaries which rapidly declines, reaching 5 lakh oocytes at puberty. Out of these, only about 400 oocytes ovulate and can give a pregnancy. The rest of the oocytes regress and are lost. The rate of loss is genetically predetermined. Most women will experience a significant decline in the number of their oocytes in their forties, while others may experience this much earlier. Those women who experience premature drop are considered to have diminished ovarian reserve or poor ovarian reserve. Although genetic factors are a significant cause of poor ovarian reserve, this may also happen because of other reasons.

1. Age: Natural decline in ovarian reserve is observed as age advances. Decline starts after age 32 and accelerates after age 35.

2. Cigarette smoking and Alcohol: have been proved to accelerate ovarian aging and harm fertility.

3. Genetic abnormalities: like Fragile X and other X chromosome abnormalities. Approximately 20 to 25% of women with Fragile X syndrome experience primary ovarian failure, and about 25% experience early diminished ovarian failure.

4. Radiotherapy and Chemotherapy: It reduces ovarian reserve by causing damage to germ cells for various cancer treatments.

5. Ovarian surgery: endometriosis, adenomas, and other ovarian benign and malignant tumors. During the excision of these tumors, some amount of normal ovarian tissue may be lost, causing poor ovarian reserve.

6. Idiopathic: This means that there is no apparent cause which accounts for nearly 50% of cases with poor ovarian reserve.

7. Autoimmune diseases in which antibodies are produced against own cells.

8. Adrenal gland impairment.

9. Iatrogenic, e.g., due to radiation, chemotherapy, or surgery, such as laserization of the surface of the ovary to treat endometriosis. Excessive laparoscopic ovarian drilling for PCOS, Uterine artery embolization for fibroids has been reported to cause premature ovarian failure.

10. Genital Infections: Tuberculosis, Herpes Simplex virus, Chlamydial infections also cause poor ovarian reserve.

11. Lifestyle factors like dietary habits, lack of exercise, obesity may also have a role to play.

The diminished ovarian reserve does not eliminate the possibility of pregnancy. However, this problem should encourage a woman to be more aggressive in her quest to become pregnant as time is clearly of the essence. Early detection and active management are essential to minimize egg donation in these women.