Diminished ovarian reserve

Diminished ovarian reserve (DOR) means that the majority of the eggs in your ovaries have been used up. Unlike men who continuously produce sperm throughout their lifetime, women are born with a set number of eggs (around 1 to 2 million). This number decreases naturally each month, but for some it can happen more quickly than for others.

When there are almost no eggs left (less than 1,000), it triggers the transition into menopause. Around 1% of women reach menopause before the age of 40, which is known as primary ovarian insufficiency.

This article has been verified by a medical professional

Impact of diminished ovarian reserve on fertility

Having fewer eggs in your ovaries can make it more difficult to get pregnant, but it’s by no means impossible. It just takes one egg and one sperm to conceive. In fact, women under 35 with DOR who ovulate regularly have around the same chances of getting pregnant per cycle as other women the same age with a normal ovarian reserve. Egg quality is another important factor for fertility, which begins to go down around age 35.

Potential causes of diminished ovarian reserve

Normal aging causes the egg reserve to go down most of the time. But it may decrease faster for some women due to:

• Genetic disorders that impact that X chromosome
• Cancer treatment
• Ovarian surgery (such as for endometriosis)
• Autoimmune disorders
• Smoking

Symptoms of diminished ovarian reserve

There generally aren’t noticeable symptoms of diminished ovarian reserve. As you approach menopause, lower estrogen levels can cause:

• Hot flashes
• Trouble sleeping
• Irregular or missed periods
• Vaginal dryness

Diagnosis of diminished ovarian reserve

Doctors can diagnose diminished ovarian reserve through blood tests on days 2–5 of the cycle. Low AMH levels are the best indication that the egg supply is reduced, and can be analyzed in combination with FSH and estrogen levels. 

Treatment to improve the chances of getting pregnant

While it’s unfortunately not possible to reverse diminished ovarian reserve or get the ovaries to produce more eggs, there are ways to help you achieve your reproductive goals. In vitro fertilization (IVF) is a good option for women with a low egg reserve who are struggling to conceive. 

In short, IVF is a medical treatment where you take hormonal medication to make your ovaries mature several eggs in one menstrual cycle, which get extracted and combined with sperm in a petri dish. If a sperm successfully fertilizes an egg, it will be placed into the uterus. You can choose to freeze eggs or embryos for use in a future IVF in case you need to try again or if you wish to have more children. 

It’s also important to protect the quality of your eggs to improve your chances of conceiving. You can do this by not smoking, taking vitamins (including folic acid), and leading a healthy lifestyle including proper nutrition and plenty of exercise. 

Beyond that, research from 2018 found that women under 35 with DOR who were treated with a supplement called CoQ10 for 60 days before undergoing IVF had higher numbers of retrieved eggs, higher fertilization rates, and higher quality embryos than those who didn’t receive treatment. 

If these treatments are unsuccessful, using donor eggs together with IVF is a good option for women with a low egg reserve, especially if the eggs that are left are low quality.

This article has been verified by a medical professional

• Diminished Ovarian Reserve. Columbia University Irving Medical Center. Accessed 08 Oct 2022.
• Diminished Ovarian Reserve. Cleveland Clinic. Accessed 08 Oct 2022.
• Xu Yangying et al.: Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol. 2018;16(1):29. 
• Exercise to improve fertility and pregnancy outcome. LAIVF. Accessed 10 Oct 2022.
• American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee: Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril. 2014;101(3):633-4.
• What is diminished ovarian reserve? Women & Infants | Care New England Health System. Accessed 18 October 2022.