Potential signs and symptoms of diminished ovarian reserve

Medically reviewed by Neka Miller, PhD on July 15, 2021. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


Women are born with about 1 to 2 million eggs. That number does not go up at any point in their lifetime. In fact, by the time you have your first period during puberty, your total egg count is about 300,000 on average. As you go through your natural menstrual cycles, you gradually lose eggs until you hit menopause. Based on a variety of factors, you may have even fewer eggs than someone your age should. Learn more about diminished ovarian reserve, its symptoms, and whether or not you should consider ovarian reserve testing below.

Everlywell

What is Diminished Ovarian Reserve?

Your ovarian reserve refers to the number of eggs that you have remaining in your ovaries, as well as their quality. If you have a diminished ovarian reserve, your egg count and quality are lower than what is normally expected for your age. For example, you may be in your mid-20s but have an ovarian reserve that is more similar to someone in their 40s.

What Causes Diminished Ovarian Reserve?

Diminished ovarian reserve can be caused by several factors, including:

  • Aggressive therapies, including chemotherapy and radiation therapy
  • Any form of ovarian surgery, like removing an ovarian tumor or ovarian cyst)
  • Genetic mutations that disrupt regular ovarian function
  • Endometriomas, a condition that is characterized by the formation of cysts due to endometriosis

Some experts believe that untreated sexually transmitted infections can potentially spread to reproductive organs, resulting in a diminished ovarian reserve. However, many cases of diminished ovarian reserve are idiopathic, meaning there is no apparent cause.

Signs and Symptoms of Diminished Ovarian Reserve

While symptoms are the best way to determine the presence of any condition, diminished ovarian reserve doesn’t actually present any noticeable symptoms in most people. Some women with DOR may experience:

  • Difficulties getting pregnant
  • Miscarriage
  • Heavy menstrual flow
  • General changes to menstrual cycles, like a late or absent menstruation or menstrual cycles that are shorter than usual

Diagnosing Diminished Ovarian Reserve

Have you ever wondered, “How fertile am I?” Due to the lack of any noticeable symptoms, the best way to know for sure that you have a diminished ovarian reserve is with a diagnostic test. Generally, you shouldn’t need to get tested for fertility issues until you have been actively trying to get pregnant for at least a year.

There are a variety of diagnostic tests available. A transvaginal ultrasound provides your doctor with a look at your ovaries and reproductive system. The ultrasound can also help to determine your ovarian antral follicle count. This is essentially the number of potential eggs in your ovaries.

Your doctor may also use certain blood tests to determine the state of your ovarian reserve. An FSH test looks at the levels of follicle-stimulating hormone in your system. The Follicle Stimulating Hormone (FSH) is the hormone that normally signals the ovaries to release a mature egg (a process known as ovulation) during the menstrual cycle. While women have a high FSH level during ovulation, the hormone level naturally subsides during the rest of the month. Consistently elevated FSH secretion levels may point to DOR or other issues.

Your doctor can also test for anti-Müllerian hormone, which is made by cells surrounding each egg. Your AMH levels can actually provide an estimate of how many eggs you have in your ovaries.

There is no treatment for diminished ovarian reserve, but having a low egg count and getting pregnant is still possible. A fertility treatment specialist may recommend alternative pregnancy methods rather than traditional ways to increase fertility, like IVF or intrauterine insemination.

Diminished ovarian reserve rarely presents symptoms, but you can take a test to know for sure if you have diminished ovarian reserve. If you are having trouble getting pregnant or wondering why getting pregnant is difficult sometimes, consider the Everlywell Ovarian Reserve Test, which tests FSH levels to determine if you have adequate egg quantity and quality.


"How fertile am I?"


References

1. Infertility FAQs. Centers for Disease Control and Prevention. URL. Accessed July 15, 2021.

2. Jirge PR. Ovarian reserve tests. J Hum Reprod Sci. 2011;4(3):108-113. doi:10.4103/0974-1208.92283

3. Transvaginal ultrasound. Mayo Clinic. URL. Accessed July 15, 2021.

Everlywell makes lab testing easy and convenient with at-home collection and digital results in days. Learn More