What is Diminished Ovarian Reserve (DOR)? 

We are born with a certain number of eggs in our ovaries – this is our ovarian reserve. If you are told you have a low or diminished ovarian reserve (DOR), this means that your egg number is lower than what is expected for your age. 

This is completely different to premature ovarian failure, which is the loss of function of your ovaries before the age of 40.

How is DOR diagnosed?

Diminished ovarian reserve is diagnosed through blood tests that measure follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels. It is completely natural for FSH levels to increase and AMH levels to drop as you age, so it is important to assess these hormone levels against a baseline for your age. 

Those with diminished ovarian reserve will have higher FSH levels and lower AMH levels compared to others of their age range.

What Is The Average Egg Count For My Age?

The “average” number of eggs in our ovarian reserve depends on age. All the eggs we will ever have were formed before we were born, while in our mother’s womb! From there, our egg reserve decreases over time.

According to the American College of Obstetricians and Gynecologists, these are the average number of eggs at each age:

  • 20 weeks of gestation: 6 to 7 million oocytes
  • Birth: 1 to 2 million oocytes
  • Puberty: 300,000 to 500,000 oocytes
  • Around age 37: roughly 25,000 oocytes

51 is considered the average age of menopause, but when you have DOR, menopause is likely to arrive at an earlier age.

How does DOR impact my fertility?

If you don’t have the expected amount of eggs for your age, pregnancy is still possible, but keep two things in mind; 

  • Heightened FSH can mean that egg quality is lower.
  • Lower egg count may mean your fertile period is shortened, and you may not be able to achieve pregnancy as you get older.

What Fertility Treatments Are Recommended If You Have Diminished Ovarian Reserve?

The key is to take action to improve egg quality right away, as you may be able to get pregnant naturally.

Various treatments can be offered to patients with DOR which include high gonadotropins (stimulation drugs), natural and modified natural cycles, estrogen priming, supplementation with LH, luteal antagonists, etc. Co-treatment with adjuncts like androgens (DHEA), growth hormone (GH), melatonin, aspirin, etc.

In cases where DOR is accompanied by additional diagnosis, such as recurring miscarriages or endometriosis, IUI or IVF may be recommended.