How to Treat Diminished Ovarian Reserve

by Jul 21, 2020

Have you heard of the proverbial biological clock? While not one of our favorite topics it is a real thing for most women. 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.

woman's hand and pills

What is ovarian reserve?

Ovarian reserve is simply the term for the number and quality of eggs a woman has left in her ovaries. Everyone’s reserve is different, but on average each woman starts out life with around 2 million eggs. As you age, you naturally lose eggs. By the time you enter puberty you have around 400,000 eggs. By your late 30s you have around 27,000 eggs left and this continues to decrease as you enter menopause.

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 you are compared to population averages. If you have fewer eggs than other women your age you are considered to suffer from DOR.

According to the Center for Human Reproduction about 10% of women suffer diminished ovarian reserves (DOR) prior to the age of 40. If you have been diagnosed with DOR, know that there are treatment options and pregnancy is possible even with the condition.

What causes diminished ovarian reserve?

As you age you will experience some level of natural DOR. But there are also other factors that can accelerate or cause an early onset. These include:

  • Smoking
  • Pelvic infections
  • Autoimmune disorders
  • Radiation therapy
  • Chemotherapy
  • Endometriosis
  • Previous ovarian surgery
  • Mumps
  • Tubal disease
  • Genital tuberculosis
  • Genetic abnormalities

However, it is also possible to have diminished ovarian reserves at an early age and have none of these factors. Work is still being done on the condition and will hopefully provide more insight into causes and treatments in the future.

Symptoms and Diagnosis

Diminished Ovarian Reserve can be a hard condition to accurately diagnose. There are often no physical symptoms, but there are a few things that might hint at the possibility:

  • Irregular or missed periods
  • Heavy menstrual flow
  • Difficulty conceiving
  • Repeated miscarriages

The only way to accurately diagnose the condition is with lab testing. Blood tests will 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.

Measuring these hormone levels won’t tell you 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.

Fertility treatment options

It is possible to get pregnant with diminished ovarian reserve naturally or more commonly with fertility treatments. Your best chance of getting pregnant is with early diagnosis and individualized treatment.

If trying to get pregnant naturally it is important to know when your fertile window is. Fewer eggs available means you need to time intercourse 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.

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 those suffering from lower quality eggs still suffer more miscarriages even with IVF. Each treatment option has its own set of risks and average outcomes. Discuss all of your fertility options with your doctor to make the right choice for you and your family.

✔️ Medically Reviewed by Dr Roohi Jeelani, MD, FACOG and Lauren Grimm, MA

roohi jeelaniDr Roohi Jeelani is Director of Research and Education at Vios Fertility Institute in Chicago, Illinois. Dr Jeelani earned her medical degree from Ross University School of Medicine in Portsmouth, Dominica. She then completed a residency in Obstetrics and Gynecology and a fellowship in Reproductive Endocrinology and Infertility at Wayne State University, Detroit Medical Center, where she was awarded a Women’s Reproductive Health NIH K12 Research Grant. She is board certified in Obstetrics and Gynecology. Dr Jeelani has authored numerous articles and abstracts in peer-reviewed journals, and presented her research at national and international scientific meetings. A Fellow of the American College of Obstetrics and Gynecology, Dr Jeelani is a member of the American Medical Association, the American Society of Reproductive Medicine, and the American Association of Gynecologic Laparoscopists.

Lauren Grimm is Research Coordinator at Vios Fertility Institute in Chicago, Illinois. Lauren earned her bachelor’s degree from Loyola University Chicago, where she also completed her masters in Medical Sciences. Lauren has worked alongside Dr. Jeelani for the last 3 years, authoring a number of abstracts and articles in peer-reviewed journals, and presented her research at national and international scientific conferences. Lauren will be continuing her education this fall at Rush University Medical College in Chicago, IL as an MD candidate.

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