What You Should Know About Diminished Ovarian Reserve

Dr. Amy Beckley, PhD

Founder and Inventor of the Proov test — the first and only FDA-cleared test to check for successful ovulation at home.

The term “diminished ovarian reserve” can sound a little intimidating if you’re unfamiliar with it. But it’s a natural process for anyone with ovaries.

The more you know about diminished ovarian reserve (DOR) and your own fertility, the better set up for success you can be on your journey. 

What is diminished ovarian reserve?

Unlike men who produce new sperm daily, a woman is born with her entire ovarian reserve, i.e all the eggs she will ever have. Each cycle the body prepares and releases an egg — this is called ovulation.

As women get older, have many cycles, and approach the end of their reproductive years, the ovarian reserve depletes over time. Eventually, there will be no eggs left, they no longer have periods, and will reach menopause.

But of course, running out of eggs doesn’t just happen overnight. When a woman has a low number of eggs left on her ovaries, this is considered diminished ovarian reserve. 

DOR usually starts around ages 35-40 for most women. It’s generally accompanied by symptoms of perimenopause, like hot flashes, trouble sleeping, and irregular periods. 

It’s important to note that DOR just pertains to the number or quantity of eggs left in your ovaries. It has nothing to do with egg quality — another common buzzword in the fertility world that we’ll come back to later!

How do you know you have DOR?

If you are between 35-40 years old, you likely have a diminished ovarian reserve which, again, is totally normal!

However, some women may experience less eggs earlier in life. This is referred to as premature ovarian insufficiency

Today there are multiple ways of testing and assessing ovarian reserve, so that we know where we stand and we plan accordingly. Your doctor may recommend testing one of a few different hormones or a transvaginal ultrasound that will count the number and measure the sizes of the follicles containing eggs.

The hormones traditionally measured in blood on cycle day 3, are follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone. Each of these hormones needs to be in certain ranges in order to indicate you still have enough eggs left.

When the egg pool starts to decrease, the first hormone that will be out of whack is FSH. FSH is produced by the brain in order to help your ovaries grow an egg each month.

As we get older and there are less and less eggs left in the ovary, the brain produces more FSH to compensate and provide the ovary with more fuel. High FSH is therefore a good marker for low ovarian reserve.

When the ovary has a difficult time recruiting an egg during any given cycle, this can mess up your overall hormone balance. Your estrogen levels may be lower than normal and LH levels may be higher than normal. 

While you can ask your doctor for blood hormone tests, this may mean you’ll need to get your blood drawn several times, as a draw at a single point in time won’t show an overall hormone pattern. 

You can also measure these hormones via urine-based tests, non-invasively and at home. An at-home FSH test is often an awesome place to start to get a better idea of how many eggs you have on hand and what your ovarian reserve looks like. 

A low FSH level at the beginning of your cycle typically indicates a normal ovarian reserve, while an elevated FSH level may indicate a lower ovarian reserve. The appropriate FSH level for you will depend on your age, so it’s important to follow the results interpretation included in your chosen test kit. 

If you are considering fertility treatments, you may want to have your anti-mullerian hormone (AMH) tested as well. All the little follicles sleeping in your ovaries put out a bit of this hormone at all times, therefore AMH is a reflection of your ovarian reserve.

AMH is usually more valuable for those trying to conceive via fertility treatments, as it can give you a better idea of how your body will respond to stimulation medications. This is because stimulation medications help you produce more than one egg in a single cycle. 

For those trying to conceive naturally, AMH isn’t as valuable of a metric as you only need to recruit one egg each cycle in order to get pregnant. 

Last but not least, a transvaginal ultrasound is usually recommended in conjunction with the fertility tests. Again, the number of follicles one starts the month with may be a good indicator of the ovarian reserve and the response to stimulation protocols.

You have DOR — now what?

So, what if you have been diagnosed with DOR and you haven’t completed your family yet? Should you be concerned?

Not at all!

First of all, DOR is not to be confused with menopause. As long as a woman is still having periods and ovulating, she still has a chance to conceive naturally.

However, if you are trying to conceive via in vitro fertilization (IVF) — whether it be for medical reasons or by choice — ovarian reserve may be something you’ll want to check.

A diminished ovarian reserve may mean that your response to stimulation medications might be less than ideal, as there are not as many eggs left to stimulate. 

But IVF is not a perfect science. Most clinics offer individualized treatment options, adjusted to your test results, your needs, and your body. We always recommend being your own advocate to find the right treatment for you!

In some cases, egg donation may be a better option for some DOR patients. Chances of getting pregnant with a donated egg are over 50%, whereas chances of pregnancy with her own eggs for a woman over 40 years old may be up to 10 times lower.

The success of egg donation is due to the thorough screening of the donors, which are young, healthy, and very well assessed before being accepted to donate.

Whatever option you may choose, remember that there is more than one way to grow a family. Being a parent means so much more than just a biological connection, and regardless of how parenthood came to you, it is always love, not DNA, that makes us moms and dads.