By: Erica Ferraro
Ah, diminished ovarian reserve (DOR), one of the leading silent culprits behind female infertility. A condition so discreet, it can remain undiagnosed throughout a woman’s entire life unless she seeks help from a fertility clinic.
DOR reveals itself when a woman’s egg quantity, and often quality, fall short of what is expected for her age. While all women will eventually experience a natural decline in egg reserve with menopause, the medical diagnosis of DOR occurs outside the realm of menopause. To delve deeper into the intricacies of DOR, its diagnosis, and comprehensive information about this condition, don’t miss my article here.
DOR has, without a doubt, proven to be one of the cruelest, most unfair, expensive, and heart-wrenching causes of infertility. Imagine the daunting reality of not having enough high-quality eggs to create embryos—a challenge that can shatter the hopes of anyone yearning to become a parent. This reality becomes especially pronounced the younger you are, as the connection between egg quality and age looms large. Aging affects women differently from men, as women do not continuously generate new eggs the way men regenerate their sperm. Consequently, older women face higher rates of miscarriage due to declining egg quality and the formation of abnormal embryos. This reality, heart-breaking as it is, becomes less shocking to women of progressed age, whereas their younger counterparts confront a devastating blow upon receiving a DOR diagnosis. I know this all too well—I was diagnosed at 29 years old through a blood test, which revealed my Anti-Müllerian hormone (AMH) level was 0.9, coupled with just five follicles across both ovaries. To put this into perspective, a close friend of mine, the same age, recently had her AMH tested, showing a level of 4.75, with 29 follicles across both ovaries. She has experienced two spontaneous, unplanned pregnancies, while I have had none despite tracking ovulation and engaging in timed intercourse for two years. That, my friends, is the harsh reality of DOR. No one at 29 should be told their egg quality and quantity resemble that of a 45-year-old—yet, here I am. Thanks endometriosis.
In my battle with DOR, I have encountered numerous vigilant, dedicated, resilient, and brave warriors at various stages of their In Vitro Fertilization (IVF) journeys. The sad truth is that DOR often necessitates IVF, often through multiple rounds. Any doctor who insists on Intrauterine Insemination (IUI) for a DOR diagnosis may not be the most suitable fit for you. The reason being, a low egg reserve often corresponds with low egg quality. The only way to ascertain whether healthy embryos can be formed is through the process of IVF, which includes genetic testing. Have I met a few DOR warriors who produced healthy embryos? Certainly! However, I have also encountered plenty, including myself, who, despite multiple rounds of IVF, couldn’t even create one. Such experiences reinforce the importance of IVF and genetic testing, which provides answers to your DOR diagnosis, answers that IUI simply cannot provide. Thankfully, my husband and I were fortunate to work with a doctor who specialized in DOR, and he encouraged us to skip IUI altogether and proceed directly to IVF. We are grateful for that decision, as it allowed us to progress more swiftly and determine our next steps more effectively.
Today’s article does not intend to be a dissertation on DOR. Instead, I aim to focus on the two choices that DOR warriors face—choices that may feel overwhelming, isolating, and downright terrifying. The choices, my dear readers, are these: continue with egg retrievals, hoping to create genetically normal embryos, or explore alternative paths to parenthood. Drawing from my experience and the countless DOR warriors I have connected with online, these choices ultimately hinge on three factors: finances, expectations, and odds. Your unique perspective on each of these factors will guide you toward your next best step.
You are not alone in this journey; let’s explore each factor in detail:
- Finances: As one would expect, financial constraints dictate how many rounds of egg retrievals one can undertake. Having insurance coverage can significantly impact the feasibility of multiple egg retrievals. However, it is crucial not to take what your clinic says at face value. Take the initiative to call your insurance provider directly and request comprehensive information on coverage. Clarify the distinction between your medical and pharmacy benefits to make informed decisions. Understanding these aspects can make a world of difference in deciding your best plan forward. I know a close friend whose clinic initially claimed she would pay out-of-pocket for services. Yet, after following up with her insurance provider, she discovered they were in-network, and costs should have been covered. Needless to say, she is now in litigation with the clinic, which wrongly charged her out-of-network costs. This serves as a valuable lesson—do your homework and ask in-depth questions of your insurance provider.
- Expectations: This category branches into two realms: expectations for your future family and expectations for your current life. Every couple’s aspirations differ, and that is perfectly okay. It is essential, however, to confront these aspirations openly with yourself and your partner. Here are some questions to ponder:
- Future Family Expectations: How important is it to you that your children are genetically related to you? How many children do you desire to have? Do all children need to be genetically linked to you, to each other, or does that matter less to you? How do you define motherhood/parenthood and family? Does it revolve around genetics, or does it encompass a broader sense of connection? What are your partner’s thoughts on these matters?
- Current Life Expectations: How are you handling the emotional and physical toll of egg retrievals? Have they taken a drastic toll on your body, leaving you uncomfortable with the changes? How is your mental health amid the uncertainties of this season? How many more egg retrievals can you handle mentally, especially if they result in poor outcomes, before it becomes too much to bear? Does the fear of more egg retrieval failures outweigh the prospect of exploring alternative paths to parenthood? At what point does that shift occur? If you cannot easily produce healthy embryos, how many more rounds of egg retrievals are you willing to endure? How do you envision spending the next few months or years of your life? Paint that picture, create a timeline, and sit with it for a while. You may not be able to control your medical diagnosis, but you have the power to shape how you spend your time and preserve your mental well-being.
- Odds: This is a topic best discussed with your doctor and then pondered personally. IVF success hinges on odds, based on factors like your medical diagnosis, age, and lifestyle. Your doctor can provide insights into your likelihood of success, but the final decision lies with you. When my husband and I consulted our doctor, we were informed that we had a 30-40% chance of success. As we underwent a few failed egg retrievals and witnessed my AMH levels continue to decline, the odds plummeted to 5%-10%. With natural conception rates hovering around 25%-30% each month of a woman’s cycle, investing a significant sum of money for a lower chance of success didn’t make financial sense to us. We were grateful for the opportunity to try, but we didn’t want to accrue massive debt only to comprehend the risk vs. reward tradeoff for our specific situation. Instead, we chose to channel our funds into an option that offered higher odds of success, which led us to explore the use of an egg donor. For more on this topic, read my article on how to process the idea of using an egg donor here.
Along this journey, I have encountered many DOR warriors who have undergone five, eight, ten, and even an astounding 16 rounds of egg retrieval! Yes, after five years or more of egg retrievals, putting their lives on hold, and amassing a mountain of medical bills, some warriors do achieve their dream of having a genetic child. For them, I have no doubt that every ounce of struggle was worth it. However, for us, we decided that path would not be our own and chose to explore the use of an egg donor after two failed IVF cycles and an unsuccessful PRP therapy. I initially worried that by doing so, I might be “giving up.” Yet, I soon realized that shifting directions mentally is extraordinarily challenging, and it is a process to work through. I also learned that regardless of the choice you make, it will be tough. The key lies in understanding that you HAVE CHOICES, and they extend far beyond being stuck in an endless egg retrieval loop.
During conversations with warriors, I’ve come to understand that feelings of hopelessness and even frightening darkness are not uncommon. Many of us who realize that we cannot create healthy embryos struggle to see light at the end of the tunnel, and suicidal-like feelings are not foreign to this community. So, if you’re reading this now, I hope you understand that YOU possess choices. There are numerous beautiful routes to motherhood, and if egg retrievals aren’t going as planned, it is NOT the end of your story or your future. When the time is right for you, you can pivot, and nobody but you and your partner can determine when that moment comes. This includes your doctor; the decision to pivot or continue rests solely with you. Remember, the choice you make is personal and rests on the three factors discussed above, among others.
I believe in your ability to make the decision that best suits you, your mental health, and your family. I believe in you, and I hope you do too.
Moving Mountains For Motherhood 