Facing a diagnosis of diminished ovarian reserve (DOR) can feel overwhelming and a bit like a race against time. Many people may be concerned to learn that diminished ovarian reserve (DOR) is a condition in which the ovaries lose some of their normal reproductive potential, which can significantly affect fertility.
DOR is surprisingly common, affecting about 10–30% of all infertility cases, but navigating this challenge can be emotionally and physically difficult. However, the good news is that many women with DOR successfully conceive, either naturally or with the help of fertility treatments. It is also reassuring to know that new research and personalized support options, such as those offered by clinics like the Hormone Health Clinic for Fertility, are helping women navigate this condition more effectively.
What Is Diminished Ovarian Reserve?
A woman's ability to get pregnant decreases as she ages, but the age at which this happens can vary for each woman. Some women may experience a decline in fertility earlier than expected. Some tests can help determine a woman's fertility potential, also known as ovarian reserve. So your “ovarian reserve” is a term that refers to the quantity and quality of your remaining eggs.
For example, anti-Müllerian hormone (AMH) is a key factor in diagnosing DOR, as it can serve as a marker of egg count, an early indicator, and a predictor of treatment response. AMH is a hormone produced by the granulosa cells of your developing follicles (the tiny sacs that house and release eggs). The level of AMH in your blood shows your ovarian reserve, or the quantity of eggs you have remaining. Some subtle symptoms of low AMH may indicate an issue.
A diagnosis of DOR means that your egg count is lower than what’s typical for your age. This situation can arise from various factors, including disease or injury, but it often occurs naturally as a part of aging. It can also affect younger women, a condition known as premature ovarian aging.
Your ovarian reserve is a combination of two key factors: the quantity of eggs you have left and their overall quality. Unlike sperm, which are produced throughout a man's life, you are born with all the eggs you will ever have.
|
Age group |
Average Egg Count |
Key Insights |
|
Diminished ovarian reserve in 20s |
~200,000-300,000 |
Most women in their 20s have a high egg reserve, which can be affected by genetics, medical treatments, or ovarian surgery. Early testing is essential if fertility issues are suspected. |
|
Low egg count at 30 |
~150,000-100,000 |
At age 30, egg quantity starts to decline gradually. While fertility is still good for most women, a low egg count at 30 may indicate the need for earlier family planning or fertility preservation. |
|
Low egg count at 35 |
~80,000 |
Around age 35, both egg count and egg quality decline more rapidly, increasing time to conception and reducing IVF success rates. A low egg count at 35 often prompts discussions about egg freezing or assisted reproduction. |
|
Age 40 |
~25,000 |
Significant drop in both quantity and quality; natural conception becomes less likely. Many women consider donor eggs at this stage. |
|
Menopause |
< 1,000 |
Marks the end of natural fertility. Only donor eggs or embryos can achieve pregnancy. |
This natural, age-related decline is different from premature ovarian aging. In a woman with normal aging, the decline is gradual, whereas in a woman with DOR, the number of viable eggs decreases rapidly. While this can make conceiving more challenging, it's not a definitive end to your fertility journey. Support and understanding are crucial, which includes knowing what diminished ovarian reserve symptoms look like and what causes them.
What Causes Low Ovarian Reserve?
While the primary cause of low egg count or ovarian reserve is natural aging, several other factors can contribute to its onset, even in younger women.
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Genetic Abnormalities: Conditions like Fragile X syndrome or other X chromosome defects can be linked to a reduced ovarian reserve.
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Medical Treatments: Cancer treatments such as chemotherapy and radiation can severely impact egg count.
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Ovarian Surgery: Surgeries to remove ovarian cysts, treat endometriosis, or perform other pelvic procedures can accidentally remove or damage ovarian tissue.
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Autoimmune Conditions: Certain autoimmune diseases may cause the body to attack its own ovarian tissue.
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Idiopathic: In some cases, there is no known cause for the accelerated decline in egg count, a condition referred to as "idiopathic" DOR.
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Lifestyle Factors: Smoking is a confirmed risk factor, as the chemicals in cigarettes can speed up the loss of eggs.
Low Ovarian Reserve Symptoms
One of the biggest challenges with DOR is that it's often a silent condition with no apparent signs until a woman has trouble conceiving. However, possible low ovarian reserve symptoms can include:
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Shortened menstrual cycles: A typical 28-day cycle might shorten to 21 or 22 days.
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Irregular periods: Unpredictable or skipped periods can be a hint.
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Signs of perimenopause: Some women may experience hot flashes, vaginal dryness, or sleep disturbances, which are all low ovarian reserve symptoms.
Tools like the Mira App, Hormone Monitor, and Wands can help track your menstrual cycle and hormonal changes at home. While they can't diagnose DOR, they can analyze data on hormone levels, such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol metabolite (E3G), and progesterone metabolite (PdG). They can help you understand your unique hormone patterns, which may provide clues about your ovarian function and help you notice the signs of low ovarian reserve.
Does Low Ovarian Reserve Mean Early Menopause?
A diagnosis of DOR does not automatically mean you are headed for early menopause. While both conditions involve a reduced number of eggs, they are distinct from each other.
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DOR indicates a reduced egg quantity, but you still have regular cycles and ovulate.
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Primary Ovarian Insufficiency (POI) is when a woman's ovaries stop working before age 40, leading to a complete lack of periods and often infertility.
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Menopause is the stage in a woman's life when she permanently stops having menstrual periods and has lower hormone levels. It typically occurs around the age of 51 as a natural, biological stage of life.
Although there may be a genetic connection between diminished ovarian reserve (DOR) and premature menopause, it's essential to understand that they are distinct medical conditions. Genetic factors can influence both conditions, but they manifest differently and have unique implications for reproductive health.
Testing and Diagnosis
Accurate diagnosis is the first and most crucial step to developing a treatment plan. A doctor can use a combination of tests to assess your ovarian reserve.
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Transvaginal Ultrasound: Your doctor can perform a low ovarian reserve ultrasound to get an antral follicle count (AFC). Antral follicles are small sacs in the ovary that contain immature eggs. Counting these follicles provides a reasonable estimate of your remaining egg supply.
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Blood Tests: These tests are typically done on day 2 or 3 of your menstrual cycle and are combined with the ultrasound results.
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Anti-Müllerian Hormone (AMH): A low AMH level is a strong indicator of a reduced ovarian reserve, which is often associated with a lower egg count.
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Follicle-Stimulating Hormone (FSH) and Estradiol: High FSH levels and low estradiol levels can indicate that your brain works harder to stimulate your ovaries, which may suggest a lower reserve.
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The Panorama Lab Test can be an option for detailed hormone health screening.
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The clomiphene citrate challenge test (CCCT) assesses ovarian reserve in women. It involves taking Clomiphene Citrate on days 5-9 of the menstrual cycle and measuring FSH levels on day 3 and day 10. Elevated FSH levels on either day indicate poor ovarian reserve, which may result in lower success rates for fertility treatments.
Low Egg Count — Can I Still Get Pregnant?
Yes, getting pregnant with a low ovarian reserve is still possible. While your chances may be lower, it is a possibility, even naturally. Success rates are highly dependent on the quality of your remaining eggs. It only takes one healthy egg to get pregnant, and focusing on improving egg quality can make a big difference. Other factors, such as the health of your partner's sperm and the health of your uterus, also play crucial roles.
Optimizing your preconception health with a high-quality prenatal vitamin, such as Mira prenatal vitamins, for at least three months before trying to conceive can help support egg quality.
How to Increase Eggs in the Ovary?
You can't increase your egg count. The number of eggs you have is set, but you can focus on protecting and preserving the ones you have.
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Avoid Environmental Toxins: Stay away from smoking and other environmental toxins that can speed up the aging process of your eggs.
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Maintain a Healthy Weight: A healthy body mass index (BMI) can positively impact your hormonal balance and egg health.
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Eat an Antioxidant- and Omega-3-Rich Diet: Incorporate foods like berries, leafy greens, nuts, and fatty fish to combat oxidative stress, which can harm eggs. You can also try supportive herbal blends like the Mira Fertility Tea to maintain overall hormone health.
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Manage Chronic Conditions: Proactively manage any chronic illnesses with your doctor.
Diminished Ovarian Reserve Treatment
If you're facing DOR infertility, there are several treatment options to discuss with a fertility specialist.
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Fertility Preservation: If detected early, you may consider freezing your eggs or embryos for future use.
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In Vitro Fertilization (IVF) with Your Own Eggs: Doctors can use higher-dose stimulation protocols to maximize the number of eggs retrieved in a single cycle.
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Donor Eggs: When a woman's egg quality or quantity is too low, using eggs from a younger, healthy donor offers the highest success rate.
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Ovarian Superovulation: This is the process of stimulating multiple eggs in a single retrieval, which increases the chances of finding a viable egg for fertilization.
Outlook and When to Seek Help
Your success will depend on your age, egg quality, and the treatment plan you and your doctor choose together. If you are under 35 and have been trying to conceive for a year, or over 35 and have been trying for six months, it’s a good idea to seek a fertility evaluation. If you have known risk factors, it’s best to get an assessment as soon as possible.
Remember, a diagnosis of DOR is a challenge, but it is not the end of your fertility journey. Many women successfully have children after a DOR diagnosis.
Frequently Asked Questions
What is low ovarian reserve, and how does it affect fertility?
Low ovarian reserve means you have a lower egg count than average for your age, which can make it more challenging to get pregnant naturally, and in some cases, with fertility treatments.
What does low AMH mean, and how does this affect fertility?
Low AMH (anti-Müllerian hormone) levels indicate that you have a lower number of remaining follicles, which reflects a reduced ovarian reserve and can impact your fertility by decreasing the chances of a successful pregnancy.
Is it possible to raise AMH hormone in women?
While some studies suggest that certain supplements and lifestyle changes may help improve AMH levels, there is no proven way to reverse a low AMH level, and the focus should remain on enhancing the quality of existing eggs.
How can a woman determine the quality and quantity of her eggs after the age of 30?
The only way to estimate your egg quantity is through fertility testing with a doctor, which includes an ultrasound to count your antral follicles and blood tests to measure your AMH and FSH levels.
How many eggs does a woman have at the age of 40?
At 40 years old, a woman has around 25,000 to 5,000 eggs left, a significant reduction from the 1 to 2 million she was born with. This decline occurs naturally over time through a process called atresia.
