Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs

1. Dr. Laxmi Shrikhande
MD; FICOG ;FICMU
• Director-Shrikhande Fertility Clinic, Nagpur
• President Menopause Society, Nagpur
• National Corresponding Editor-The Journal of Obstetrics & Gynecology of India
• Senior Vice President FOGSI 2012
• Vice Chairperson ICOG
• Governing Council member ICOG 2012-2017
• Governing Council Member ISAR 2014-2019
• Governing Council Member IAGE for 3 terms
• Patron-Vidarbha Chapter ISOPARB
• Chairperson-HIV/AIDS Committee, FOGSI (2007-09)
• Received Best Committee Award of FOGSI
• Received Bharat excellence Award for women’s health
• President Nagpur OB/GY Society 2005-06
• Associate member of RCOG
• Member of European Society of Human Reproduction
• Visited 96 FOGSI Societies as invited faculty
• Delivered 3 orations
• Publications-Thirteen National & seven International
• Presented Papers in FIGO, AICOG, SAFOG, AICC-RCOG conferences
• Conducted adolescent health programme for more than 15,000 adolescent girls

2. Treatment of Decreased
Ovarian reserve
Dr Laxmi Shrikhande
Chief Consultant | Shrikhande fertility Clinic
Nagpur [Maharashtra] INDIA

3. Decline in Ovarian reserve
• Age related decline in female fertility well
recognised
– Starts at 30,
– rapid decline after 37,
– virtually zero at 43.
• Due to decrease in
– Oocyte quantity
– Oocyte quality

4. Why we need markers of ovarian reserve ?
• Age of onset of decline in ovarian reserve is highly
variable
• Hence, the need for a marker to predict ovarian
reserve and fertility potential
• To identify young women with diminished ovarian
reserve
• To identify women with adequate OR even at the
age where natural fertility is lost (41 yrs)

5. Ovarian reserve tests

6. summary
• ORTs till date have modest predictive value for
pregnancy outcome as this is dependent on many
more factors apart from OR
• ORTs are indicative of ovarian reserve status in both
the quantitative and qualitative sense
• ORTs at best should be considered as screening
tests and not as diagnostic tests
• Treatment should not be denied based on these
tests to assumed ovarian aged woman

7. Treatment for Women with Diminished Ovarian
Reserve
• If no other cause, active treatment of unexplained
infertility
• Lipiodol
• Stimulated IUI
• IVF
• IVF with low ovarian reserve
• Fewer eggs
• Maybe none of ‘good quality’ in any cycle
• Younger age may compensate
• Does low ovarian reserve ↓ chance of success?
• Adjuvant treatments for poor responders

8. DHEA supplementation
• Investigated 120 women with diminished ovarian
reserve. DHEA 25mg was supplemented thrice
daily from 30 to 120 days.
• AMH concentration significantly improved after
DHEA (p=0.002)
• Women under 38 years demonstrated better
response.
• Gleicher et al Reprod Online 2010 Sept 21(3)
8

9. Conclusions
• Knowledge of low ovarian reserve can help to ‘change’
the approach
• Treat ‘unexplained’ with greater intensity
• Adjuvants in IVF for women with low response
• Transdermal testosterone (OR 2.6, 95%CI 1.3-5.2) or DHEA (OR
2.0, 95% 1.8-3.6)
• LH addition (OR 1.9, 95%CI 1.1-3.1)
• Growth hormone (OR 3.3, 95%CI 1.7-6.2)
• Egg donation is effective, but it is not the only option
and should be used ‘last line’

10. My World of
sharing happiness!
Shrikhande Fertility Clinic
Ph- 91 8805577600
shrikhandedrlaxmi@gmail.com