Diminished ovarian reserve means having fewer and lower quality eggs in the ovaries than is normally typical for females of the same age. While a person with diminished ovarian reserve may have difficulty getting pregnant, it is not impossible.
Assistive reproductive technologies, such as in vitro fertilization (IVF), can help a person conceive. Depending on the severity of the diminished ovarian reserve, a fertility doctor may recommend using donor eggs to conceive.
A healthcare professional may also recommend other assistive reproductive technologies such as egg freezing and ovarian superovulation. Ovarian superovulation uses drugs to stimulate the ovary to produce more eggs within a cycle.
Read on to learn about diminished ovarian reserve, the symptoms and causes, treatment options, and more.
This article will use the terms “female” and “male” to refer to a person’s sex assigned at birth. However, it is important to note that transgender men can also get pregnant.
Diminished ovarian reserve is also known as “low egg count” or “low ovarian reserve.” It means having
A female is born with all of their eggs, and the number of eggs in the ovaries naturally decreases with age. Females with diminished ovarian reserve experience this sooner than typically expected.
Under typical circumstances, a female reaches peak fertility between the late teens and late 20s. Fertility begins to decline by age 30, with the decline speeding up during the mid-30s.
The American Society for Reproductive Medicine says females normally start losing their ovarian reserve before they become infertile and stop menstruating.
A female is born with all of their eggs. This is different from males, who can produce more sperm during the course of their life. Age is the factor most likely to determine how many and the quality of eggs a person has.
According to the American College of Obstetricians and Gynecologists (ACOG), a female has the following number of eggs throughout their life:
- birth: 1,000,000–2,000,000
- puberty: 300,000–500,000
- age 37: 25,000
- age 51: 1,000
Fertility gradually but significantly declines from around the age of 32, with this decline speeding up after the age of 37.
A female with diminished ovarian reserve may not have any symptoms until they try to get pregnant. If they experience other symptoms, they may include a shortening of the menstrual cycle, for instance, from 28 to 25 days.
To determine the number of eggs a person has, a doctor needs to carry out an ovarian reserve test.
Most people only find out they have diminished ovarian reserve following diagnostic testing. This includes transvaginal ultrasound to check for the number of small resting follicles, which correlate with ovarian reserve. They will also carry out hormone level tests, including:
- Follicle-stimulating hormone (FSH): This is an indicator of fertility and response to ovulation stimulation.
- Estradiol: This is a form of estrogen that is also an indicator of fertility and response to ovulation stimulation.
- Anti-Müllerian hormone: This indicates fertility potential and the number of eggs a person has left.
There may be no obvious cause for diminished ovarian reserve. However, the condition can have links to a person’s genes or medical treatments they have had.
- smoking tobacco
- genetic variants, such as fragile X syndrome
- aggressive medical treatments, such as radiation therapy for cancer
- ovarian surgery, such as for endometriosis
People with diminished ovarian reserve may find it more difficult to get pregnant because they have fewer and lower-quality eggs. However, a successful pregnancy only requires one viable egg, so it is not impossible.
Age and the number and quality of eggs are not the only factors influencing female fertility. Other affecting factors include:
- body weight
- lifestyle, such as alcohol, smoking, and drug use
- previous pregnancy
- sexual activity
- medication use
- medical conditions, such as thyroid problems, vitamin D deficiency, polycystic ovary syndrome, or endometriosis
- hormonal abnormalities, such as high prolactin levels or insulin resistance
- ovulatory problems
- tubal blockage
- uterine abnormalities
While there is no way to cure or reverse diminished ovarian reserve, a person with this condition has options to increase their chances of pregnancy. The course of action they choose will depend on factors such as their age, when they want to have children, and how many they wish to have.
Assisted reproductive technologies
Taking these factors into account, a person may choose:
- Fertility preservation: This involves IVF to stimulate egg growth, retrieving those eggs from the ovaries, and freezing them. They could also choose to combine them with sperm to create embryos and freeze them for future use.
- Ovarian superovulation: This technique uses medications, such as pills or injectable hormones, to induce the growth of multiple eggs. Doctors can trigger ovulation and deliver sperm via intrauterine insemination, where they place sperm into the uterine cavity using a thin, flexible catheter.
- IVF with donor eggs: For a person with a low ovarian reserve who may not be able to produce their own eggs or have low egg quality, their donor eggs can combine with sperm to create embryos.
Additionally, vitamins and supplements may be beneficial in supporting fertility and pregnancy.
It is important to start taking prenatal vitamins 1–3 months before conceiving to help prepare the body for pregnancy. Folic acid is an important supplement that helps minimize the risk of neural tube defects.
Docosahexaenoic acid (DHEA) helps support the baby’s development. Researchers have also shown vitamin D can benefit both fertility and pregnancy. Additionally, coenzyme Q10 is an antioxidant that
Supplemental DHEA, a mild androgen that the body produces naturally, may also help with fertility. However, as with most medications, DHEA can have side effects and risks. It is important to speak with a fertility doctor about these risks when choosing a supplement.
Diminished ovarian reserve occurs when a female has lower than typical numbers and quality of eggs for their age. Often, they do not experience any symptoms and only find out following diagnostic testing after being unable to get pregnant naturally.
Its causes may have links to genetics, medical treatments, or smoking. However, assisted reproductive technologies and supplements may help a person conceive.