What Is Diminished Ovarian Reserve and What Does It Mean for Your Fertility?
If you’ve recently heard the term diminished ovarian reserve—or DOR—you might be feeling overwhelmed or unsure about what it means for your ability to get pregnant. At Tennessee Fertility Institute (TFI), we’re here to help you understand the science behind your fertility and the options available to you.
Here’s what you need to know about DOR: what it is, how it’s diagnosed, and how we can support you through it.
What Is Diminished Ovarian Reserve?
Diminished ovarian reserve means that the quantity and sometimes the quality of your remaining eggs is lower than expected for your age. All people with ovaries are born with a set number of eggs, and that number naturally declines over time—but for some, it declines faster than average.
DOR doesn’t mean pregnancy is impossible—but it can make conceiving more difficult, especially without medical support.
What Causes DOR?
There’s no single cause of diminished ovarian reserve—and in many cases, there’s no clear explanation at all. That said, several known factors can contribute to a lower-than-expected number of eggs:
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Age: Age is the most common cause. People with ovaries are born with all the eggs they’ll ever have, and egg quantity and quality naturally decline over time. This process accelerates in the mid-30s and becomes more pronounced after age 40.
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Genetics or Family History: Some people are genetically predisposed to experience early egg loss. If your mother or sister went through menopause early (before age 40), your fertility may follow a similar pattern.
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Autoimmune Disorders: Conditions like lupus, rheumatoid arthritis, or autoimmune thyroid disease can sometimes damage ovarian tissue or disrupt hormone regulation, leading to decreased ovarian reserve.
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Cancer Treatments: Chemotherapy and radiation—especially treatments involving the pelvic area—can harm the ovaries and rapidly reduce egg quantity. In some cases, surgical removal of ovarian tissue (for cancer or endometriosis) can also lower egg count.
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Ovarian Surgery: Repeated ovarian surgeries, such as for endometriomas (ovarian cysts caused by endometriosis), can inadvertently remove healthy ovarian tissue, reducing the number of eggs remaining.
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Endometriosis: This condition can lead to inflammation and damage to the ovaries, and as noted above, treatments for endometriosis can sometimes further reduce ovarian reserve.
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Environmental and Lifestyle Factors: Smoking, exposure to environmental toxins, certain medications, and long-term stress may all play a role in accelerating egg loss, though more research is ongoing in these areas.
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Chromosomal Abnormalities or Genetic Conditions: Conditions like Turner syndrome, Fragile X premutation carriers, and other chromosomal changes can lead to reduced or absent ovarian function at an early age.
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Idiopathic Causes (Unknown Reasons): In many cases, diminished ovarian reserve occurs without a clear cause. It can happen in people who are young, healthy, and otherwise show no risk factors—which is why proactive fertility testing can be helpful if you’re planning for future parenthood.
How Is DOR Diagnosed?
Your fertility specialist may run a few tests to assess ovarian reserve:
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AMH (Anti-Müllerian Hormone): A hormone produced by the follicles in your ovaries. Lower levels can suggest fewer remaining eggs.
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AFC (Antral Follicle Count): A transvaginal ultrasound to count the small follicles in your ovaries at the beginning of your cycle.
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FSH (Follicle-Stimulating Hormone): High FSH levels on day 3 of your cycle may indicate that your body is working harder to stimulate the ovaries—another possible sign of DOR.
It’s important to note: these tests don’t predict whether you’ll get pregnant naturally—they help us understand how your body may respond to fertility treatment.
What Are the Symptoms of DOR?
Most people with diminished ovarian reserve don’t have noticeable symptoms, especially in the early stages. However, signs may include shorter menstrual cycles (i.e., less than 26 days), lighter or irregular periods, and difficulty getting pregnant.
How Is DOR Treated?
While there’s currently no way to reverse diminished ovarian reserve or increase the number of eggs in the ovaries, there are still several effective treatment options that can help maximize your chances of success based on your goals, age, and reproductive timeline. Here’s how each approach can help:
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IUI (Intrauterine Insemination): For patients who are still ovulating regularly and have some healthy follicles, IUI can be used in combination with ovulation-stimulating medications to help ensure that sperm reaches the egg at the optimal time. This approach may be appropriate in early-stage DOR or in cases where time is a factor and patients wish to try a lower-intervention option first.
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IVF (In Vitro Fertilization): IVF is often the most effective treatment for DOR because it allows us to stimulate the ovaries to produce as many eggs as possible in a single cycle—even if that number is still lower than average. The eggs are then retrieved and fertilized in the lab, where we can closely monitor embryo development. IVF also gives us the option to freeze embryos for future use and perform genetic testing to identify the healthiest embryos before transfer.
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Embryo or Egg Freezing: If you’re not ready to conceive now but know you may want children in the future, freezing eggs or embryos while your ovarian function is still active can help preserve your fertility. This proactive approach is particularly useful if DOR is diagnosed at a younger age, or if you’re planning to delay parenthood for personal or medical reasons.
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Donor Eggs: In cases where egg quality is significantly compromised or egg supply is extremely low, donor eggs may offer the highest chance of a successful pregnancy. Using donor eggs from a young, healthy donor can bypass many of the limitations that come with DOR and result in excellent success rates. This option is often recommended when multiple IVF attempts with a patient’s own eggs have not been successful.
What If I’ve Been Diagnosed with DOR?
A diagnosis of diminished ovarian reserve can feel discouraging, but it doesn’t define your future. Many of our patients with DOR go on to have healthy pregnancies—with or without fertility treatment.
We encourage you to ask questions, explore your options, and remember that support is available—every step of the way.
Ready to Take the Next Step?
If you’ve received a DOR diagnosis—or if you’re simply curious about your fertility health—our team at TFI is here to help. Whether you’re ready to start treatment or just want a clearer picture of your options, we’re here to provide answers, guidance, and hope. Request an appointment today!