Recognizing and Treating Diminished Ovarian Reserve (+ Success Stories)
As you age, your ability to reproduce naturally decreases due to a lower egg count and decreased egg quality. This is known as diminished ovarian reserve (DOR) and can occur due to normal aging, but also due to genetic defects, surgery, injury, and radiation.
Your “ovarian reserve” refers to your reproductive potential based on the number of healthy, viable eggs left in your ovaries. Women are born with all the eggs they will ever have, and this number steadily decreases as you age. To put that into perspective, here are the numbers:
- The average woman is born with approximately 2,000,000 eggs
- By puberty, she has about 400,000 eggs left
- By her late 30s, she has approximately 27,000 eggs
- By the onset of menopause, about 1,000 eggs remain
While it’s not the most fun topic, the “biological clock” is a real thing for most women and understanding how to recognize and overcome diminished ovarian reserve is crucial for anyone looking to conceive later on in life.
What Is Diminished Ovarian Reserve?
As you age, the number of eggs in your ovaries steadily decreases. Some women do not follow this pattern and can begin to lose their reserve more quickly or stay fertile after 40. However, when diagnosing diminished ovarian reserve levels, yours are compared to population averages. If you have fewer eggs than other women your age, you are considered to suffer from DOR.
Everyone’s reserve is different, but on average each woman starts out life with around 2,000,000 eggs. As you age, you lose eggs naturally and by the time you enter puberty, you have around 400,000 remaining. By your late 30s, you have around 27,000 eggs left and this continues to decrease as you enter menopause. At the beginning of menopause, most women only have around 1,000 eggs remaining.
According to the Center for Human Reproduction, about 10% of women are diagnosed with DOR prior to the age of 40. If you have been diagnosed with DOR, know that there are treatment options available — and that there are plenty of success stories of women who have gotten pregnant despite DOR!
What Causes Diminished Ovarian Reserve?
Every woman loses eggs as she ages. However, some women lose eggs faster than the general population, leading to a diagnosis of DOR. Other causes of DOR, besides natural aging, can include:
- Cigarette smoking: The chemicals in cigarettes speed the loss of eggs. In general, the risk of fertility problems increases with the number of cigarettes smoked per day.
- Genetic abnormalities: Genetic disorders like Fragile X syndrome are associated with lower ovarian reserve.
- Pelvic infections: Untreated infections can cause pelvic inflammatory disease (PID), which decreases ovarian reserve.
- Autoimmune disease: Certain autoimmune diseases can attack any organ in the body. If they attack the ovaries, your ovarian reserve may become diminished.
- Chemotherapy and radiation: Cancer treatments like chemotherapy and radiation to the ovaries can decrease ovarian reserve, making it more difficult to get pregnant.
- Endometriosis: Both superficial endometriosis and endometriomas (“chocolate cysts”) can potentially decrease ovarian reserve.
- Pelvic surgery: If surgery requires the removal of large amounts of ovarian tissue, it could impact your ovarian reserve.
- Idiopathic: Unfortunately, not all cases of DOR have a clear cause — this is known as “idiopathic” DOR.
There is still a lot we don’t know about DOR, and there might be additional causes of DOR that don’t appear on this list. Thankfully, research is still being done on the condition and will hopefully provide more insight into causes and treatments in the future.
What Are The Symptoms of Diminished Ovarian Reserve?
DOR can be a hard condition to accurately diagnose. There are often no physical signs of diminished ovarian reserve, but there are a few symptoms that might hint at the possibility:
- Irregular or missed periods
- Heavy menstrual flow
- Difficulty conceiving
- Repeated miscarriages
Many women do not find out they have DOR until they undergo diagnostic fertility tests, such as a transvaginal ultrasound or hormone testing.
How is Diminished Ovarian Reserve Diagnosed?
The only way to accurately diagnose the condition of DOR is with lab testing.
Blood tests can measure the levels of FSH (follicle-stimulating hormone) and AMH (anti-mullerian hormone) to see if they point to DOR. Those with the condition experience elevated FSH and low AMH compared to others in their age group.
The Mira Fertility Tracker cannot officially diagnose diminished ovarian reserve, but it can give you an idea if your FSH might be higher than usual. Tracking your hormones at home with Mira can help you get to know your typical hormone curve and if your fertility hormones follow a normal pattern.
Doctors can estimate the number of eggs you have left based on these hormone levels, but it’s impossible to determine the exact number of eggs you have in reserve. It can, however, tell you your fertility potential and whether you have levels similar to others in your age group. If your numbers are lower than those of other women your age, your doctor may diagnose DOR.
What Are The Treatments for Diminished Ovarian Reserve?
It may come as a relief to learn that you can still get pregnant with DOR! Some women are able to conceive naturally, but more often, women with DOR conceive with the use of fertility treatments. Your best chance of getting pregnant is with early diagnosis and individualized treatment.
If you are trying to get pregnant naturally, it is important to know when your fertile window is. Fewer eggs available means you need to time intercourse with ovulation to improve the odds of conception (and ensure the quality of your eggs). Using a fertility tracker like Mira can help you track your cycle.
However, the majority of women with diminished ovarian reserve looking to get pregnant require fertility treatments to conceive. The most common treatments include:
- Fertility preservation is often the first step if DOR is caught early. This treatment includes retrieving eggs and freezing them for later in vitro fertilization (IVF).
- DHEA supplementation helps increase naturally diminishing levels of this androgen and increases the number and quality of eggs retrieved for IVF.
- Ovarian stimulation with injectable hormones is another treatment for increasing the number of eggs available for IVF.
- Use of donor eggs from a younger woman has the highest success rate for those with DOR.
It is important to note that DOR cannot be reversed with any treatment. Therefore, women who have fewer high-quality eggs still suffer more miscarriages even with IVF.
Each treatment option has its own set of risks and success rates. You should discuss all of your fertility options with your doctor to make the right choice for you and your family.
Can You Still Get Pregnant With Diminished Ovarian Reserve?
Yes, you can still get pregnant with diminished ovarian reserve! The good news is that while you may require fertility treatments to help you conceive, many women with DOR are still able to start their families. Some women require donor eggs or adopted embryos, but many are able to have biological children.
Having DOR might make the road to conception longer or more challenging for you, but it doesn’t mean that you cannot get pregnant.
Diminished Ovarian Reserve Success Stories
If you have a diagnosis of DOR, you might be worried about whether or not you’ll be able to get pregnant. It might make you feel better to know that many women have been able to successfully get pregnant despite a diagnosis of DOR.
Here are some stories of women like you who managed to conceive with diminished ovarian reserve.
Success Story #1: Bonnie
Bonnie and her husband Casey spent six years trying to get pregnant — and documenting the process on their YouTube channel. After a test showed she had low AMH, Bonnie was diagnosed with diminished ovarian reserve and underwent in-vitro fertilization (IVF). Eventually, after she became pregnant, she gave birth to not one baby but triplets!
Success Story #2: April
At 36, April was diagnosed with diminished ovarian reserve, with only 11 follicles available to become mature eggs. Her doctor told her the odds for a woman with her egg count to get pregnant were only around 20%. However, after over two years on her infertility journey, she successfully beat the odds and became pregnant with her daughter Nora. (Hot tip: she recommends the book It Starts with the Egg!)
Success Story #3: Christine
Christine’s infertility story was harder than most because both she and her husband had their own fertility issues. Not only did Christine have diminished ovarian reserve, but her husband also had bilateral varicoceles, a condition affecting his sperm quality. After going through both intrauterine insemination (IUI) and IVF, she was able to conceive and gave birth in February 2021.
As these success stories show, it’s definitely possible to get pregnant with diminished ovarian reserve! While many women require the help of IVF to get pregnant, a diagnosis of DOR does not mark the end of your journey toward starting a family.