Ovarian reserve refers to the number and quality of eggs remaining in a woman’s ovaries. These eggs determine reproductive potential and play a central role in both natural conception and assisted reproductive treatments.
Diminished Ovarian Reserve (DOR) is a condition in which the number of eggs is lower than expected for a woman’s age. As a result, fertility declines and the response to fertility treatments such as IVF may be reduced. DOR accounts for approximately 10% of infertility cases.
While egg decline is a natural part of aging, in some women this process occurs earlier or more rapidly, limiting reproductive options.
Women are born with a finite number of eggs—approximately 1 to 2 million at birth. By puberty, this number decreases to around 300,000–500,000. Throughout the reproductive years, only about 300–500 eggs will actually be ovulated. The remaining eggs gradually degenerate through a natural process called atresia.
After age 35, both egg quantity and quality decline more rapidly. By the early 40s, fertility drops significantly, and the risk of miscarriage or chromosomal abnormalities increases. In women with DOR, this decline happens earlier or progresses faster than expected.
Ovarian reserve is typically evaluated using:
AMH (Anti-Müllerian Hormone) blood test
FSH (Follicle-Stimulating Hormone) levels (usually measured on cycle day 3)
Antral Follicle Count (AFC) via ultrasound
Low AMH, elevated FSH, and a reduced follicle count may indicate diminished ovarian reserve.
Although aging is the most common cause, several additional factors can accelerate ovarian depletion.
Fertility begins to gradually decrease in the late 20s, with a more noticeable drop after age 35. By the early 40s, egg quantity and quality are significantly reduced.
Certain genetic conditions are associated with early ovarian decline, including:
Fragile X syndrome
Turner syndrome
BRCA gene mutations
These conditions may lead to early ovarian insufficiency or premature menopause.
Autoimmune diseases such as lupus, rheumatoid arthritis, or thyroid-related conditions can cause the immune system to attack ovarian tissue, resulting in inflammation and reduced ovarian function.
Chemotherapy and pelvic radiation can be toxic to ovarian tissue and may accelerate egg loss. In some cases, they may cause permanent ovarian failure. Fertility preservation (such as egg or embryo freezing) is often recommended before cancer treatment begins.
Endometriosis can damage ovarian tissue, particularly when ovarian cysts (endometriomas) develop. Repeated surgeries for endometriosis may also reduce healthy ovarian follicles.
Surgical removal of ovarian cysts or masses can unintentionally reduce ovarian reserve by removing healthy tissue along with the cyst.
Certain lifestyle and environmental exposures may contribute to accelerated ovarian aging:
Smoking
Excessive alcohol consumption
Exposure to endocrine-disrupting chemicals (plastics, pesticides, pollutants)
Conditions such as thyroid dysfunction or insulin resistance may indirectly impact ovarian health and reproductive hormone balance.
Many women with DOR have no noticeable symptoms until they attempt to conceive. However, possible signs may include:
Shorter menstrual cycles (less than 25 days)
Irregular periods
Poor response to ovarian stimulation during fertility treatment
Abnormal hormone test results
A fertility evaluation is essential for accurate diagnosis and early intervention.
Although DOR cannot be reversed, several approaches can help improve pregnancy chances.
Balanced, antioxidant-rich diet
Maintaining a healthy weight
Regular moderate exercise
Supplements such as CoQ10, Vitamin D, or DHEA (under medical supervision)
Ovarian Stimulation:
Medications like clomiphene or injectable gonadotropins may help recruit more eggs during a cycle.
In Vitro Fertilization (IVF):
IVF may improve success rates by retrieving multiple eggs and selecting viable embryos. Embryo banking can also be considered.
Egg Donation:
For women with severely diminished reserve, donor eggs significantly increase the likelihood of pregnancy.
Experimental treatments such as platelet-rich plasma (PRP) injections and stem cell therapies are currently under investigation. While promising, these approaches require further research before becoming standard practice.
Diminished Ovarian Reserve is a significant but manageable fertility challenge. Early testing and proactive planning are essential, especially for women over 35 or those with risk factors. With individualized treatment strategies and advances in reproductive medicine, many women with DOR can still achieve successful pregnancies. Consulting a fertility specialist is the most important step toward understanding options and creating a personalized fertility plan.