Diminished Ovarian Reserve: How Do You Know if You Have It?

If you’ve been struggling to get pregnant, you may be piling worries on top of questions on top of more worries. Questions like, “Is my body doing what it’s supposed to? How will I know if it isn’t? Do I even have any eggs left?” may be causing you anxiety. 

Seeking out information from expert sources or your medical team can help lessen some of this anxiety. The more information you have, the more you can understand your path forward. 

When it comes to ovarian reserve specifically, studies have shown that Diminished Ovarian Reserve impacts anywhere from 10-30% of women who are struggling to conceive. So what exactly is Diminished Ovarian Reserve, and how do you know if you have it? Let’s dive in.

What is diminished ovarian reserve?

Women are born with all of the eggs they’ll ever have – approximately 2 million – and that count reduces to about a couple hundred thousand eggs after puberty and continues to diminish further through adulthood.  

We spoke with Dr. David Nash, a Reproductive Endocrinologist & Infertility Specialist at Reproductive Gynecology & Infertility (RGI), a fertility clinic with several locations in Ohio, who explained: “Ovarian function decreases with age. This is normal. However, there are strict criteria for diagnosing Diminished Ovarian Reserve.”

He goes on to say, “When [fertility specialists] do ovarian reserve testing on day-3 of your cycle, it includes FSH, AMH, and an early-follicular antral-follicle count. An FSH level greater than 10 mIU/ml paired with an AMH of less than 1 ng/mL and a low antral-follicle count typically indicates Diminished Ovarian Reserve (DOR).”

The one caveat here is that AMH does depend on age. Dr. Nash explains, “‘Normal’ AMH levels for a 30-year-old should be around 2.5 ng/mL. At 40, it’s around 1 ng/mL. If your number is lower than that, we will definitely be concerned about ovarian function.” 

But how do you know what you don’t know? Diminished Ovarian Reserve often presents without symptoms, so if you’re under the age of 35 and have been trying to conceive for over one year – 6 months if you’re over 35 – it may be time to see an OB/GYN or fertility specialist for bloodwork and an ultrasound. 

Egg quantity vs. quality

One thing that is often misunderstood about Diminished Ovarian Reserve is that low ovarian reserve does not necessarily relate to egg quality. Rather, age is the most important factor when it comes to oocyte quality or the potential for the egg or embryo to result in a baby. 

According to Dr. Nash, “Ovarian function gradually decreases from 32-37. After 37, it’s much more dramatic, and after 40, it plummets.” 

Basically, a younger person with Diminished Ovarian Reserve has a better prognosis than an older person with DOR because the younger you are, the more high-quality eggs you have remaining. And while there’s not a ton you can do to improve egg quality, quitting smoking, reducing your alcohol and caffeine intake, and taking a prenatal vitamin are all encouraged if you’re trying to conceive. 

How is diminished ovarian reserve treated?

If you have been diagnosed with Diminished Ovarian Reserve, try not to panic. While there are minimally-invasive treatment options you can try – like a short course of oral agents like Clomid or Letrozole – IVF offers the highest success rate for pregnancy in women with DOR, especially if you’re over 40. 

When it comes to IVF with Diminished Ovarian Reserve, Dr. Nash says, “The goal is to stimulate the ovaries with high doses of medication and retrieve as many eggs as possible to give you the best possible odds for pregnancy,” keeping in mind that every patient and situation is unique. “At RGI, we look at a patient’s unique circumstances and develop a protocol that fits their situation and will give them the best possible chance of successfully meeting their family-building goals.”

Our recommendation is to find a fertility specialist that can come up with a protocol specifically tailored to your needs as a patient and who makes you feel comfortable and supported along the way.  

While, unfortunately, nothing can slow down or prevent ovarian aging, by no means is Diminished Ovarian Reserve a closed door to conception. If you suspect you may have DOR, reaching out to an OB/GYN or fertility specialist for ovarian reserve testing is a good place to start. Once you know what you’re dealing with, you can work with them to come up with a treatment plan that works for you. Remember, one day and one small step at a time. You’ve got this!  

If you would like to further your understanding of what might be impacting your ability to conceive, you can check out RGI’s monthly free fertility webinar. Hosted by a reproductive physician, these webinars are a great opportunity to learn more about the causes of infertility, available treatment options, and success rates, and have your personal questions answered by a doctor. Learn more and register here.