Diminished Ovarian Reserve & Infertility in Women

Diminished ovarian reserve at a glance

  • 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.
  • Also known as low egg count or low ovarian reserve, fewer eggs can make it harder for a woman to get pregnant naturally.
  • 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.
  • The main symptom of DOR is inability to get pregnant, though some women may experience their menstrual cycle becoming shorter or skipping cycles.
  • Blood tests and ultrasound performed by a fertility specialist are two ways to establish a diagnosis.
  • It’s still possible to conceive if a woman has diminished ovarian reserve. Ovarian stimulation and donor eggs used with in vitro fertilization (IVF) are possible treatment options, although it is still possible to conceive naturally.

Diminished ovarian reserve guide

What causes diminished ovarian reserve?
Symptoms of diminished ovarian reserve & testing
Video: How to stabilize your hormones
Diminished ovarian reserve treatment
Low ovarian reserve is not a lost cause

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What causes 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.

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.

Other risk factors for DOR include smoking, previous ovarian surgery, family history and environmental conditions.

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.

Symptoms of diminished ovarian reserve & testing

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.

Assessing FSH & AMH

The first step in checking for diminished ovarian reserve involves a blood test. This test is typically done on the third day of a woman’s menstrual cycle and measures certain hormones related to reproduction. These hormones include follicle stimulating hormone (FSH), estradiol (a hormone from the ovaries), and anti-Müllerian hormone (AMH), which is linked to fertility.

If FSH and estradiol levels are high, and AMH levels are low, it could indicate a reduced ovarian reserve. It’s important to note that AMH can be tested at any point in the menstrual cycle and even while using birth control, although in the latter case, the levels may be lower because of the contraceptive’s hormonal effects.

Antral follicle count

A fertility specialist may also obtain an antral follicle count (AFC) using transvaginal ultrasound. This test helps us assess the number of follicles under 6mm in diameter present in the ovary at a given time, which is reflective of a woman’s ovarian reserve. Fewer follicles indicate a lower ovarian reserve.

These test results, along with a woman’s age and medical history, will help inform a physician’s advised course of fertility treatment.

Diminished ovarian reserve treatment

By the time a woman has been officially diagnosed with diminished ovarian reserve, her options for achieving successful conception naturally are also likely diminished. Thankfully, there are treatment options through our fertility clinic.

Ovarian stimulation with high-dose hormones

If a woman’s test results suggest that she still has sufficient ovarian reserve, a fertility specialist may recommend medications to stimulate ovulation using FSH and luteinizing hormone (LH) to produce eggs in larger quantities than normal. This option is suitable for intrauterine insemination (IUI) or IVF treatments, though the latter is typically more effective.

Egg donation and IVF

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 and IVF. In this process, donor eggs are collected from younger adult woman and are fertilized using sperm from the intended mother’s partner (or donated sperm) in the embryology laboratory. The resulting embryo(s) are then implanted in the woman’s uterus with the hopes of achieving a pregnancy.

Video: Treatment Options for Diminished Ovarian Reserve

Low ovarian reserve is not a lost cause

We recommend that women over the age of 35 who have tried unsuccessfully to conceive naturally for six months speak with a fertility specialist. Either through IUI, IVF or donor egg, women can achieve a pregnancy and grow their family.


Related Fertility Edge Podcast: Egg Donation