Diminished Ovarian Reserve (DOR) is a reproductive condition where the ovaries show a reduced capacity to produce eggs of good quality or quantity. It represents a decline in the pool of remaining follicles, which compromises a woman’s fertility potential. This condition is a significant factor contributing to female infertility, especially as individuals delay childbearing. Understanding the biological basis and available treatments offers a path forward for those hoping to conceive. DOR affects the likelihood of both natural conception and success with assisted reproductive technologies.
What Diminished Ovarian Reserve Means
Diminished Ovarian Reserve describes a state where the egg supply within the ovaries is lower than expected for a woman’s age. Every woman is born with a finite number of eggs, or oocytes, stored in primordial follicles. DOR signifies an accelerated or prematurely low rate of depletion, resulting in a smaller ovarian reserve.
DOR creates a distinction between chronological age and ovarian age, which reflects the biological state of the reproductive system. A woman may be chronologically young but have an “older” ovarian age due to a low egg count. The reduction in the number of eggs also often coincides with a decrease in their overall quality.
The pool of follicles is continuously drawn upon each menstrual cycle, and DOR means this reserve is nearing exhaustion sooner than the natural onset of menopause. The primary challenge is the reduced number of eggs available for ovulation or retrieval during fertility treatments.
Factors Contributing to DOR
Aging is the most common factor contributing to Diminished Ovarian Reserve, as the natural decline in egg supply accelerates significantly after a woman reaches her mid-thirties. DOR can also affect younger individuals due to genetic predisposition, such as a family history of early menopause or certain X-chromosome abnormalities.
Certain medical interventions can severely impact the ovarian reserve. This includes aggressive treatments like chemotherapy or radiation therapy. Prior surgical procedures on the ovaries, such as those to remove cysts or treat endometriosis, can also inadvertently reduce the number of healthy follicles.
Cigarette smoking and tobacco use are the only lifestyle factors consistently linked to a decrease in ovarian reserve. In many cases, the specific cause for a woman’s DOR remains unknown, which is referred to as idiopathic Diminished Ovarian Reserve.
Confirming the Diagnosis
The diagnosis of Diminished Ovarian Reserve relies on a combination of blood tests and imaging to assess the quantity of the remaining follicle pool.
Anti-Müllerian Hormone (AMH)
The Anti-Müllerian Hormone (AMH) blood test is considered one of the best indicators. AMH is produced by the small, growing follicles within the ovaries. A low AMH level, typically less than \(1.0\text{ ng}/\text{mL}\), suggests a reduced ovarian reserve and a lower predicted response to ovarian stimulation medications.
Follicle-Stimulating Hormone (FSH)
Testing the levels of Follicle-Stimulating Hormone (FSH) and Estradiol is usually performed on the second or third day of the menstrual cycle. A basal FSH level greater than \(10\text{ mIU}/\text{mL}\) is suggestive of diminished reserve, as the body is working harder to stimulate the remaining follicles.
Antral Follicle Count (AFC)
The third main diagnostic tool is the Antral Follicle Count (AFC), obtained via a transvaginal ultrasound during the early part of the menstrual cycle. The AFC involves counting the small, fluid-filled sacs, or antral follicles. A low count, often between three and ten follicles across both ovaries, indicates a reduced reserve.
Treatment Strategies for DOR-Related Infertility
The management of infertility related to Diminished Ovarian Reserve is highly individualized and focuses on maximizing the potential of the remaining eggs. Since there is no method to reverse DOR or create new eggs, treatment centers on optimizing the retrieval of high-quality oocytes or using third-party reproduction.
In Vitro Fertilization (IVF)
For women pursuing IVF with their own eggs, specialized protocols are often employed to achieve the best possible outcome. These modified approaches might include minimal stimulation or micro-dose flare protocols, which use adjusted doses of gonadotropins to encourage the development of available follicles.
Donor Eggs
In cases of severe DOR, or when multiple IVF cycles with the woman’s own eggs have been unsuccessful, using donor eggs is often the most successful treatment alternative. Egg donation offers significantly higher success rates because it bypasses the issue of low egg quantity and poor egg quality associated with DOR.
Supplements
Some patients explore lifestyle adjustments and nutritional supplements. Supplements like Dehydroepiandrosterone (DHEA) and testosterone have been studied in populations with DOR. Any decision regarding these supplements should be made in consultation with a reproductive endocrinologist.