On the podcast today, I’m answering a question from Diana who wrote in to Ask The Egg Whisperer. She has diminished ovarian reserve and wanted to know what she should do to have 2 children. Diminished ovarian reserve is a diagnosis often related to age, where the ovaries have a diminished supply of eggs. Here’s what she had to say,” Just got diagnosed with DOR (amh 0.37 and 8 follicles) and a large fibroid (9cm, asymptomatic until recently which is why I booked my appt) and trying to figure out next steps. How would you advise to proceed, as I was not able to find that much info about this (dor + fibroid). How many cycles do you think I would need for 2 live births?” I’m going to assume that Diana is about 37 years old (the average age of patients I see), and here’s what I have to say: Knowing that you have eight follicles with a nine centimeter fibroid, I would say this let's take things in stages. Stage one is the diagnosis phase. It’s important to take supplements to support your egg quality. We know another part of the diagnosis is the fibroid. Stage two: Create an IVF plan that is based on your diagnosis. I’d focus on creating embryos and freezing them. And if you're a patient of mine, we would talk about something called PGT-A, I know this sounds like an alphabet soup of fertility, but it stands for pre-implantation genetic testing for aneuploidy. Stage three: We would then plan your embryo transfer. That would include a myomectomy to remove your fibroid. We don't want that fibroid to compete with the growing embryo or pregnancy. Leaving it puts you at higher risk of having preterm labor and preterm delivery. Talk to your doctor about the IVF protocol they're going to use for you. Talk to them about how many cycles they think that they're going to need to do for you to reach your family size goals, and then go for it. And before you do surgery, make sure you're seeing a surgeon for that fibroid that is super excited to make your uterus as strong as possible to carry a pregnancy. If you want to hear everything I have to say about Diana’s question, tune in today’s podcast episode at the link in my profile. It’s episode #302 and titled, “I was just diagnosed with DOR (depleted ovarian reserve). How many IVF cycles do I need to do to have 2 children?”
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