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Diminished Ovarian Reserve is one of the most common infertility diagnoses, so this week we're answering your questions about it.

What does Diminished Ovarian Reserve mean?

 

Your ovarian reserve refers to the number and quality of your eggs, called oocytes. To have a diminished ovarian reserve means that the number and quality of your oocytes is lower than expected for your age. This can result from a disease or injury, but most often it’s just a result of normal aging. DOR can make it difficult for you to get pregnant, and contribute to higher rates of pregnancy loss. According to the Center for Human Reproduction, this condition affects around 10% of women seeking fertility treatment. 

 

What causes Diminished Ovarian Reserve?

 

The most common cause is natural aging. Women are born with a set number of eggs, your reserves naturally decrease as you age. Natural fertility starts to diminish around 30, and accelerates as a woman approaches the age of 30. 

 

That being said, there are other factors that could contribute to a prematurely diminished ovarian reserve, including endometriosis, chemotherapy, smoking, pelvic inflammatory disease, autoimmune disorders, or genetic abnormalities like fragile X syndrome. 

 

In some cases there is no apparent cause, which is why it’s super important to check in with your healthcare provider if you think you might be suffering from this condition. 

 

Symptoms of Diminished Ovarian Reserve 

 

Here are some of the common symptoms of DOR:

  • Difficulty getting pregnant
  • Late or absent periods
  • Menstrual cycles that are shorter than 28 days
  • Heavy flow
  • Miscarriage

 

That being said, sometimes there are no physical symptoms of DOR, which is why it is important to talk to your doctor if you are having a hard time getting pregnant. 

 

How to tell if I have Diminished Ovarian Reserve? 

 

Diminished Ovarian Reserve is diagnosed by blood tests to measure hormone levels. More specifically, your doctor will measure your levels of follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH). These levels will then be compared against a baseline for your age. People with DOR will have higher levels of FSH and lower AMH compared to other women their age. 

 

All this to say, a DOR diagnosis usually depends on the results of a blood test and is defined by hormone levels, not actually counting the number of eggs you have, which can make the diagnosis confusing.

 

Is Diminished Ovarian Reserve over-diagnosed?

 

The research does indicate that DOR is over-diagnosed. This is largely due to the fact that medical professionals have not yet settled on a set criteria for diagnosis. As a result, Diminished Ovarian Reserve is sometimes used as a blanket diagnosis for a reduction in fertility or to explain a poor ovarian reserve, but it may not entirely describe the full situation. And again, since the tests for DOR do not involve actually going into your ovary and counting your oocytes one by one, the hormonal results from a blood test may indicate other issues as well. Not to mention, hormone levels are not always the best predictor of fertility (for more on this click here!). 

 

If you are trying to conceive and you have a history of irregular or painful periods, repeated miscarriages, endometriosis, pelvic inflammatory disease, you should get fertility testing early. If you are under 35 and TTC, you should see a doctor after a year of being unsuccessful. If you are over 35, see your doctor after 6 months of trying to conceive. 

 

Can I still get pregnant with Diminished Ovarian Reserve?

 

There are treatment options to manage DOR, and it is still possible to get pregnant. According to the Center for Reproductive Health, 33% of women are able to get pregnant with their own eggs after diagnosis. 

 

Once DOR is identified, some options are to either speed up your efforts to conceive, or preserve your eggs for future use. The most common treatment is the supplement dehydroepiandrosterone (DHEA). This is a form of androgen that is naturally produced in the body, but levels decrease with age. This supplement is thought to increase fertility. One study found that participants with Diminished Ovarian Reserve who took DHEA while undergoing IVF treatment had a 23.1% live birth rate, while those who did not take the supplement had a 4% live birth rate. However, the sample size of this study was only 33 people, more research is needed before we can definitively say that DHEA improves fertility levels. 

 

There are options other than supplementation:

  1. You can freeze your healthy eggs to preserve them and try IVF. 
  2. You can use donor eggs to get pregnant, fertilizing them through IVF and implanting them either in your uterus, a partner’s uterus, or a surrogate. 

 

Ultimately, treatment will be a personal decision that depends on what is right for you and your body, so it is important to make sure you discuss all your options with your doctor. 

 

If you are trying to conceive, we know how challenging infertility can be. As always, we are here to support you through your journey and answer any questions you may have. You can reach our trained healthcare professionals any time through the chat portal on our website!

 

Sources:

https://www-ncbi-nlm-nih-gov.proxy.library.upenn.edu/pmc/articles/PMC4560955/

https://www.columbiadoctors.org/condition/diminished-ovarian-reserve

https://www-ncbi-nlm-nih-gov.proxy.library.upenn.edu/pmc/articles/PMC4915288/

https://www-ncbi-nlm-nih-gov.proxy.library.upenn.edu/pmc/articles/PMC4560955/

https://www.healthline.com/health/diminished-ovarian-reserve

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