What is diminished ovarian reserve?

Written by: Dr. Amy Beckley, PhD, Founder and Inventor of the Proov test the first and only FDA-cleared test to confirm successful ovulation at home.

Written on: 11/2/21

what is diminished ovarian reserve

Keep reading to learn more about what exactly diminished ovarian reserve is and how Proov can help you test yours.

Here at Proov, we believe the more knowledge we have about our reproductive health, the better. There are so many things about our cycles and ovaries that we just aren’t taught in school.

One of the many terms we’ve learned after middle school sex ed is diminished ovarian reserve. Keep reading to learn more about what exactly diminished ovarian reserve is and how Proov can help you test yours.

What is diminished ovarian reserve?

Unlike men who produce new sperm every day, women are born with all the eggs they will ever have. We call this our ovarian reserve.

We’re each born with about 2 million immature eggs. Each cycle, our ovaries grow and prepare many eggs for ovulation, but only one egg will actually become mature enough to ovulate; the rest will disintegrate.

We’ll continue maturing and ovulating eggs each cycle until we run out of eggs, i.e. menopause. In menopause, we no longer have any viable eggs left.

However, as we know menopause doesn’t happen overnight; it takes years for our ovarian reserve to completely disappear. Along the way, we may notice signs that we’re running out of eggs. This is called diminished ovarian reserve (DOR).

Many of us will start to experience the effects of diminished ovarian reserve around ages 35-40. This is also known as the perimenopausal transition.

Diminished ovarian reserve is a natural process that comes with age; everyone with ovaries will experience it.

How does diminished ovarian reserve impact fertility?

Diminished ovarian reserve may impact fertility in one of a few ways, depending on how you try to conceive.

Since we are born with all the eggs we will ever have, as we age our eggs also get older. Since DOR usually occurs later in life, it’s natural that a lower number of eggs also coincides with a diminished egg quality.

The quality of an egg refers to the egg’s ability to produce a healthy baby. As we age, our eggs display increased chromosomal abnormality, which means they are less and less capable of fertilizing and producing a healthy embryo.

To put it simply, as we age and our ovarian reserve diminishes, the chances of releasing a healthy egg each cycle diminishes as well. A healthy, 30-year-old woman has about a 30% chance of conceiving naturally each cycle. Just 10 years later — when we’re 40 or older— the odds of conception drop as low as 5% each natural cycle.

However, not every couple can conceive naturally. In the cases of assisted reproductive technologies, DOR can also impact chances of conception, especially in in-vitro fertilization (IVF).

Each IVF cycle, the patient will take medications and hormone supplements to stimulate the ovaries to produce more than one egg (which would be produced in a natural cycle). The more eggs produced and retrieved during an IVF cycle, the higher the rate of success, i.e. successful pregnancy.

Patients with DOR do not have many eggs left. Because of this, they may not respond to the stimulating medications and, regardless of how aggressive the stimulation protocol is, will not be able to produce more than a few eggs.

what is diminished ovarian reserve

Patients with DOR do not have many eggs left.

What are the symptoms of diminished ovarian reserve?

As we mentioned, the transition from a normal ovarian reserve to DOR doesn’t happen overnight. While the age of 35 serves as a common threshold, the reality is that a decline in ovarian reserve and ovarian function happens gradually and may stretch over many years.

The first hormone to change is the anti-mullerian hormone (AMH). AMH reflects how many eggs you have left, as it’s produced by immature follicles waiting to be recruited for ovulation.

A rather recent finding, AMH was initially considered to be a marker of fertility. Later research found AMH serves as a good marker for predicting response to ovarian stimulation treatments, but doesn’t play much of a role in natural conception.

In the last 5-10 years before menopause, as our ovarian reserve depletes, our ovaries struggle more and more to produce an egg each month. The results in an increase in follicle stimulating hormone (FSH) levels, as the brain offers increased support to stimulate follicular growth.

But sometimes, even this isn’t enough, and anovulatory cycles become more frequent. When we don’t ovulate each cycle, we may experience a hormonal imbalance or irregular cycles. This can lead to symptoms such as:

  • Hot flashes
  • Mood changes
  • Intermenstrual bleeding
  • Bloating
  • Lack of libido
  • Fatigue
  • Insomnia

It’s important to note that one single symptom or biomarker alone doesn’t indicate DOR. For the best overall assessment of your ovarian health, we recommend consulting your doctor for further testing.

How do I know if I have diminished ovarian reserve?

Regardless of your age and if you are having symptoms or not, the only way to know for sure if you have DOR is to assess your fertility.

The standard approach — which we definitely recommend discussing with your doctor — is cycle day (CD) 3 blood tests. Typically, CD 3 tests include blood tests for FSH, LH, estrogen, AMH, and an ultrasound to count the number of immature follicles that cycle.

Before getting your blood drawn (ouch, needles!), you can try an at-home test, like Proov Assess FSH tests, to get a better idea of where you stand. Testing your FSH levels on cycle days 5, 7, and 9 can give you a better idea of if DOR impacts your chances at conception.

Since hormones can fluctuate from one cycle to the next, you may want to test over several cycles to get a clearer picture of your results. We recommend using Proov FSH tests alongside the Proov Insight app to take your results one step further with numerical results, info on what they mean, and personalized action plans.

what is diminished ovarian reserve

We recommend using Proov FSH tests alongside the Proov Insight app.

If you have any questions or concerns about your ovarian reserve, we recommend consulting your doctor.

What should I do if I have diminished ovarian reserve?

What you should do depends on your goals. If you are trying to conceive, you may want to discuss your options with your doctor and take necessary steps so that you don’t waste any time.

On the other hand, if you are no longer TTC and may be in perimenopause, there is nothing you need to do about DOR — it’s just a natural effect of aging. You may want to continue to monitor and keep your hormones in balance to improve your wellbeing and perimenopausal transition.

Diminished ovarian reserve occurs naturally in anyone with ovaries. The more you know about DOR, the better prepared you can be for DOR, depending on your specific goals.

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“Hormone balance plays a huge role in fertility, and understanding what’s going on with your hormones doesn’t have to be such a mystery.

It’s actually way easier than most people realize.” 

— Amy Beckley, Proov Founder