What is Diminished Ovarian Reserve (DOR)?

By Madison
February 26, 2025

Reading Time: 3 minutes

When trying to conceive, one key factor that plays a crucial role in fertility is ovarian reserve is the number and quality of eggs in the ovaries. Diminished ovarian reserve (DOR) refers to a decrease in the quantity and/or quality of these eggs, which can impact a person’s ability to get pregnant. At RPSD, we want to help you better understand DOR, how it is diagnosed, and the treatment options available to support your fertility journey.

What is Diminished Ovarian Reserve?

Diminished ovarian reserve is a condition where the ovaries contain fewer healthy eggs than expected for a person’s age. The quality of these eggs may also be lower, making conception more challenging. While it’s a natural part of aging, DOR can also affect younger individuals, making early diagnosis and intervention important for improving fertility outcomes.

How is Diminished Ovarian Reserve Diagnosed?

Diagnosing diminished ovarian reserve typically involves a combination of tests. These tests measure hormone levels and assess the number of eggs present in the ovaries:

Follicle Stimulating Hormone (FSH) Test: FSH levels are tested at the beginning of the menstrual cycle. Elevated levels can indicate a diminished ovarian reserve.
Anti-Müllerian Hormone (AMH) Test: AMH levels provide an estimate of the number of eggs in the ovaries. Lower AMH levels can suggest a reduced ovarian reserve.
Ultrasound: A transvaginal ultrasound can be used to visualize the ovaries and count the number of antral follicles, which contain immature eggs. Fewer antral follicles can indicate a lower ovarian reserve.
Clomiphene Citrate Challenge Test (CCCT): This test evaluates ovarian function by measuring how the ovaries respond to clomiphene citrate, a medication used to stimulate ovulation.

Symptoms of Diminished Ovarian Reserve

The symptoms of diminished ovarian reserve are not always obvious, as DOR primarily affects a person’s ability to conceive rather than causing overt physical signs. However, some individuals may experience:

Irregular or absent periods: This could indicate hormonal imbalances affecting ovulation.
Difficulty getting pregnant: A reduced number or quality of eggs can make conception harder.
Early menopause: In some cases, diminished ovarian reserve can lead to early menopause, with symptoms like hot flashes, night sweats, and vaginal dryness.

What Causes Diminished Ovarian Reserve?

The most common cause of diminished ovarian reserve is age, as the number of eggs naturally declines with time. However, other factors can contribute to or accelerate the process:

Genetics: A family history of early menopause or DOR can increase the likelihood of developing a diminished ovarian reserve.
Medical conditions: Conditions like polycystic ovary syndrome (PCOS), endometriosis, or autoimmune disorders can affect ovarian function.
Chemotherapy or radiation: These cancer treatments can damage the ovaries, leading to a reduced ovarian reserve.
Surgical removal of ovaries: Surgery to remove one or both ovaries can directly impact the number of eggs available.
Lifestyle factors: Smoking, excessive alcohol consumption, and poor nutrition can all contribute to diminished ovarian reserve.

How is Diminished Ovarian Reserve Treated?

While diminished ovarian reserve cannot be reversed, there are several treatment options available to help individuals with DOR improve their chances of conception:

Fertility medications: Hormonal treatments like Clomid or gonadotropins can stimulate the ovaries to produce multiple eggs, improving the chances of successful fertilization.
In vitro fertilization (IVF): IVF can be an effective option for those with diminished ovarian reserve. With IVF, eggs are retrieved from the ovaries, fertilized in a lab, and then implanted into the uterus. In cases where egg quality is a concern, pre-implantation genetic testing (PGT) may be used to select the best embryos.
Egg donation: For individuals with very low ovarian reserve or poor egg quality, using donor eggs may be a viable option. This allows for the possibility of pregnancy using a younger, healthier donor’s eggs.
Lifestyle changes: A healthy lifestyle can help optimize fertility. This includes maintaining a balanced diet, exercising regularly, avoiding smoking and excessive alcohol use, and managing stress.
Ovarian rejuvenation therapies: In some cases, new treatments like platelet-rich plasma (PRP) injections into the ovaries are being explored as potential ways to improve egg quality and ovarian function. While the effectiveness of these treatments is still being studied, they may offer hope for some individuals with diminished ovarian reserve.

Diminished ovarian reserve is a condition that can impact fertility, but it doesn’t mean that conception is impossible. Early diagnosis and the right treatment plan can improve your chances of having a baby. At RPSD, we are committed to supporting you on your fertility journey with personalized care and the latest advancements in reproductive medicine.

If you suspect that you may have diminished ovarian reserve or are struggling to conceive, reach out to our team today. We’re here to provide guidance and help you explore all available options. Schedule a consultation with our double board-certified expert physicians today!