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DOR – Diminished Ovarian Reserve

Ovarian reserve refers to a woman’s ability to conceive and deliver a live birth. Perhaps the strongest predictor of ovarian reserve is a woman’s age.  A woman is born with a finite number of eggs, typically one to two million. By the time puberty is reached the number of eggs is reduced to approximately 400,000. From puberty (around age 12) to menopause (around age 51) there is a progressive depletion of egg number and quality in the ovaries, and therefore a decrease in ovarian reserve and reproductive potential.

In addition to advancing age, a woman’s medical/surgical and family history may suggest other factors which can negatively impact on her ovarian reserve. Such factors may be genetic, autoimmune, exposure to certain chemotherapeutic agents/radiation treatment, pelvic infection, ovarian surgery, severe endometriosis, smoking, and unexplained etiologies.

At the California Center for Reproductive Health, a routine part of the infertility evaluation includes comprehensive testing for ovarian reserve in order to determine a treatment course and to predict the likelihood of pregnancy with any specific treatment protocol. Multiple tests are available including cycle day 3 hormonal (FSH, estradiol, inhibin, AMH) and transvaginal ultrasound evaluations (antral follicle count, ovarian volume testing), as well as dynamic tests such as the clomiphene citrate challenge test. Ovarian reserve may also be determined by the outcome of ovarian hyperstimulation with gonadotropin hormones.

Unfortunately, to date, no “magic potion” solution to reduced ovarian reserve has been found. However, emerging recent data on the use of various over-the-counter and prescribed supplements (DHEA, CoQ10, Isositol, Melatonin, L-Arginine, transdermal testosterone…) suggest that ovarian reserve, in some patients diagnosed with diminished ovarian capacity, may actually improve).

Women diagnosed with diminished ovarian reserve have hope!  Reduced reproductive potential does not necessarily mean absent reproductive potential! The California Center for Reproductive Health provides women with diminished ovarian reserve with safe, practical, yet aggressive customized treatments aimed at achieving a healthy pregnancy using their own eggs.