Diminished Ovarian reserve -POF

,  Q. 1: What is  DOR(Dwindling Ovarian function  or DOR?  It  is a state of defined as reduced capacity of the ovaries to produce oocytes; the oocytes produced are of poorer quality leading to the formation of poor quality embryos.

Q.2: What is the difference between DOR & POF ?? Ans:   The most severe form of DOR can be represented as premature ovarian failure (POF).

Q3: Etiology of DOR??  There are various reasons leading to DOR, the most important factor being A)  increasing age, B) endometriosis and C) surgeries on the ovary.  D)  chromosomal aberrations or F) secondary to chemotherapy, radiotherapy, infections, or surgeries involving the ovaries.

Q.4: What may be symptoms?? Patients with DOR may present with infertility and menstrual cycle abnormalities; patients with sudden onset POF may also present with hot flushes and vaginal dryness.

Q5. Diag by what tests?? There are various tests for finding ovarian reserve, the most widely used being A) follicle-stimulating hormone (FSH), B) anti-Mullerian hormone, and C) antral follicle count. It is important to know a patient's ovarian reserve before recruiting her for in vitro fertilization.

Q.6. How best to improve the situation? Various modalities have been tried to improve the outcome in candidates with DOR undergoing assisted reproductive technology. This includes 1) high-dose FSH treatment 250 / 300 FSH to start with ,2)  luteinizing hormone supplementation, 3) GnRH antagonist cycle, thereby avoiding long agonist cycle  4)  use of adjuvant treatments such as estrogen priming, growth hormone, L-arginine, and dehydroepiandrosterone.

Q.7: Take home message for future gynecologists  :-To try to preserve as much as  ovarian tissue as far as possible while  excising / enucleating   Dermoid cyst( Benign cystic teratoma) / Serous/Mucinous cystadenoma in  young women or say  surgery on endometriotic cyst . Pre and Post op counsellling and AMH  value estimation and  documentation are essential .Patients who are planned for chemotherapy or radiotherapy may undergo oocyte or embryo cryopreservation before the cancer treatment., Such  women,  like PCO women , DOR women also warrant   good counseling and emotional support, more so women with AMH value of < 0.5 ng/ml.