Diminished ovarian reserve
Ovarian reserve refers to the number and quality of a person’s remaining eggs. Diminished ovarian reserve (DOR) means that the egg supply is lower than expected for a given age, which can make it more difficult to conceive. While this is a natural part of aging, some people experience a decline earlier than anticipated.
If you’ve been told you have diminished ovarian reserve, you’re not alone—and it doesn’t mean pregnancy is out of reach. There are effective treatments available, and early action can often make a meaningful difference in your fertility journey.
What is diminished ovarian reserve?
Each person is born with all the eggs they will ever have. Over time, the number of eggs naturally declines. DOR occurs when the quantity or quality of eggs drops more quickly or earlier than expected. This can reduce the chances of conception, especially without fertility support.
While DOR is more common after age 35, it can occur at any age and often comes with no obvious symptoms. In some cases, it’s only discovered through fertility testing.
What causes diminished ovarian reserve?
Age is the most common factor in declining ovarian reserve, but other causes may include:
- Genetic conditions or chromosomal abnormalities
- Family history of early menopause
- Autoimmune disorders
- Previous ovarian surgery or cancer treatments like chemotherapy or radiation
- Environmental exposures to toxins or cigarette smoke
Sometimes, there’s no identifiable cause—which can make the diagnosis feel unexpected or frustrating. Still, many patients with DOR go on to have healthy pregnancies with the right care.
How diminished ovarian reserve affects fertility
Lower egg reserve can affect both the likelihood of ovulation and the quality of the eggs that remain. As egg quality declines, so does the chance of fertilization, implantation, and healthy embryo development.
Common challenges associated with DOR include:
- Irregular menstrual cycles or shorter cycle lengths
- Lower response to fertility medications
- Higher chance of miscarriage, especially as age increases
Even with fewer eggs, successful treatment is possible—and a personalized approach is key.
How diminished ovarian reserve is diagnosed
Your fertility specialist may recommend a series of tests to assess ovarian reserve. These include:
- Anti-müllerian hormone (AMH): A hormone produced by the ovaries that reflects the number of remaining follicles.
- Antral follicle count (AFC): An ultrasound that counts the small resting follicles in the ovaries at the beginning of a cycle.
- Follicle-stimulating hormone (FSH) and Estradiol (E2) levels: Measured early in the menstrual cycle to assess how the brain and ovaries are communicating.
These tests help guide treatment—not just by confirming DOR, but by helping your care team tailor your plan based on how your body is responding.
Treatment options for diminished ovarian reserve
There is no way to increase egg quantity, but treatment can improve your chances of pregnancy. Options may include:
- Ovulation induction with IUI: May be appropriate for some patients with mild DOR and good ovarian response.
- In vitro fertilization (IVF): Allows for greater control over egg stimulation and embryo selection. Often the most effective option for DOR.
- Preimplantation genetic testing (PGT-A): Helps identify chromosomally normal embryos for transfer.
- Donor egg IVF: May be recommended when very few or no viable eggs are available.
Some individuals also consider egg freezing to preserve fertility at a younger age, especially if DOR is diagnosed early. This is an excellent option for some patients who are not yet ready to have children but want to try to preserve their future fertility.
IVF Florida offers comprehensive testing and expert guidance to help you make confident choices about your next steps—now and for the future.
Without Dr. Gualtieri and his amazing team, we would not have our sweet little girl. I will never be able to thank him enough for helping us. A huge thanks also goes to his team. Without those lovely ladies, I don’t know if I could have kept going for the length of time it took us to conceive. We are beyond thankful and blessed.