Diminished ovarian reserve and fertility
Diminished ovarian reserve (DOR) indicates that there are fewer eggs in a woman’s ovaries compared with other women of similar age or that her eggs are of poor quality, both of which can result in infertility. A woman’s egg count naturally diminishes with age, however, diminished ovarian reserve can occur at any age due to genetics, medical treatments, environmental factors or prior surgeries.
Schedule an AppointmentWhat is diminished ovarian reserve?
Diminished ovarian reserve is caused by women being born with fewer eggs than is normal, losing eggs more rapidly than other women her age, or experiencing more damage to eggs than normal. Even with every best effort made to prepare for conceiving naturally, some women and couples find they just can’t get pregnant. If the woman is in her mid- to late-thirties or older, there’s a strong chance the reason could be diminished ovarian reserve.
What causes diminished ovarian reserve?
Diminished ovarian reserve (DOR) occurs when the quantity and quality of a woman’s eggs decline, reducing fertility potential. Several factors may contribute to this condition:
- Aging: The natural decline in egg supply accelerates after age 35.
- Genetics: A family history of early menopause or fertility issues may increase the risk.
- Medical conditions and treatments: Endometriosis, autoimmune disorders, chemotherapy, or ovarian surgery can impact egg count.
- Lifestyle factors: Smoking, excessive alcohol use, and certain environmental exposures may contribute to premature ovarian aging.
Symptoms of diminished ovarian reserve
Other than a woman’s age and difficulty conceiving naturally, there are few symptoms of diminished ovarian reserve. Infertility is the main symptom that causes women to seek help. Otherwise, most women have no symptoms. Some may notice their menstrual cycle shortening, particularly in older years.
How diminished ovarian reserve affects fertility
DOR is the result of a biological process that occurs in women as they age. Females are born with approximately 1-2 million eggs – all the eggs she’ll ever have. By the time they reach puberty, the quantity falls to between 300,000 to 400,000.
During each menstrual cycle, several follicles (which house the eggs in the ovaries) start to develop, but ultimately only one follicle releases an egg. All the other eggs in that cycle die during a natural process called atresia. In fact, the majority of a woman’s eggs eventually disintegrate. This process occurs whether a woman is cycling regularly, takes oral contraceptive pills, becomes pregnant or gives birth.
The number and health of a woman’s eggs are crucial when trying to get pregnant. As a woman gets older, her eggs are more likely to have genetic problems, which can result in embryos with abnormal chromosomes. These embryos are less likely to develop properly and can lead to difficulties in getting pregnant or miscarriages, whether she is trying to conceive naturally or with fertility treatments.
Diagnosing diminished ovarian reserve
At RSC, we use advanced diagnostic tools to evaluate ovarian reserve and assess fertility potential, including:
- Blood tests to measure key reproductive hormones, including follicle-stimulating hormone (FSH), estradiol, and anti-Müllerian hormone (AMH). High FSH and estradiol levels, along with low AMH, may indicate diminished ovarian reserve.
- Antral follicle count (AFC) using transvaginal ultrasound to estimate the number of small follicles in the ovaries, providing insight into egg supply.
- Comprehensive assessment that considers hormone levels, ultrasound findings, age, and medical history to guide personalized fertility treatment recommendations.
These evaluations help our specialists determine the best approach to optimizing your fertility and family-building goals.
Fertility treatment options for diminished ovarian reserve
Treatment plans for diminished ovarian reserve depend on the severity of the condition and your family-building goals. At RSC, we offer a range of personalized fertility treatments, including:
- Fertility medications: Hormonal treatments to stimulate ovulation.
- Intrauterine insemination (IUI): A low-tech option for mild cases.
- In vitro fertilization (IVF): Often recommended for moderate to severe cases, especially if other treatments have not been successful.
- Donor eggs: If a woman’s egg reserve is severely limited or she does not respond well to ovarian stimulation, she may still be a good candidate for donor eggs. Donor eggs are fertilized in the embryology laboratory. The resulting embryo(s) are then implanted in the woman’s uterus with the hopes of achieving a pregnancy.
Our specialists will work closely with you to determine the best approach, combining medical expertise with compassionate care.
Take control of your fertility journey
Diminished ovarian reserve doesn’t have to stand in the way of your dreams of parenthood. At RSC, we’re committed to helping you understand your condition, explore your options, and take confident steps forward.
