What is Diminished Ovarian Reserve?

Diminished ovarian reserve for reproduction is a term used to describe ovaries that no longer contain eggs that can reliably produce a successful pregnancy. It is usually, but not always, associated with advanced reproductive age (female >35 years old).

Here is a good article that talks more about FSH, ovarian reserve and egg quality. Good Eggs, FSH levels and Ovarian Reserve: The Egg Factor by David Sable, MD

Why do we test for diminished ovarian reserve?

Diminished ovarian reserve is associated with much of the infertility and miscarriages experienced by women in their 30’s and 40’s. It is important to know if this condition exists, because there are no medicines that can help the ovaries of women with diminished ovarian reserve produce a pregnancy. Other methods of family building can be suggested.

How do we test for diminished ovarian reserve?

The diagnosis of diminished ovarian reserve is made using a combination of items considered singly and together. If any one of the following conditions exist, a woman has diminished ovarian reserve for reproduction:

• any cycle day 2 or 3 FSH > 10 mIU/ml
• any cycle day 2 or 3 estradiol > 80 pg/ml
• any abnormal FSH or estradiol value on a Clomiphene Citrate Challenge Test
• failure to recruit more than two mature eggs from a woman of any age with unexplained infertility who is on normal doses of injectable fertility medications

Additionally, the following factors are also highly associated with diminished ovarian reserve for reproduction:

• transvaginal ultrasound determination of less than six visible small egg follicles in each ovary in the early part of the menstrual cycle
• a change in menstrual cycle interval from a previous history of regular cycles to a somewhat shortened interval. For example; a woman with cycles every 28-30 days for most of her life now has cycles that are every 25-27 days
• age > 35

The diagnosis of diminished ovarian reserve is confirmed if any of the conditions listed above exists and:

• the woman has normal ovulation
• she has open tubes
• her partner has normal sperm

Recent studies have shown that even though these FSH and estradiol levels may vary from month to month, the highest value for FSH is most predictive. For this reason, your provider may ask you to repeat these tests more than once.

What are the causes of diminished ovarian reserve?

Advanced age is the most common cause of diminished ovarian reserve. As a woman gets older, the quality of the eggs remaining in her ovaries is not as good as when she was younger. An egg must be strong enough to support the earliest stages of fertilization and embryo growth. When a woman is older there are more breaks in the egg’s DNA and the egg’s repair mechanism is less accurate. This results in fewer healthy eggs being produced for fertilization.

Other reasons for diminished ovarian reserve include chemotherapy, radiation therapy, autoimmune diseases and certain genetic conditions.

How is diminished ovarian reserve treated?

There are no medications that will reverse this condition or improve pregnancy success in a woman with diminished ovarian reserve if she is relying on her own eggs. However, as long as her uterus is normally shaped, the opportunity to carry a baby is certainly possible by using either donor eggs with in vitro fertilization, or embryo adoption. As long as a woman is having normal cycles and regular sexual intercourse, there is always the chance she will become pregnant. However, in women with diminished ovarian reserve, these chances are low (less than 5% per cycle) and are the same whether or not fertility medication is used. Because of the biology associated with this condition there is a low pregnancy success rate, regardless of the treatment approach. Consideration must also be given to the risks of medication, inconvenience and costs. Fertility medication is not considered a good treatment for women with diminished ovarian reserve.