Vasiliki A. Moragianni, MD, MS, FACOG is an award-winning reproductive endocrinologist and infertility specialist at Fertility Solutions. Dr. Moragianni is passionate about providing individualized, state-of-the-art fertility care to individuals and couples who wish to build a family. Dr. Moragianni currently sees patients in Dedham, MA and Providence, RI.

It is an honor to be invited again this year to speak at the Annual Resolve New England Conference, about a topic that so many women are struggling with, oftentimes without being aware of it.

What is Ovarian Reserve?

Women are born with all the eggs (oocytes) we will ever have and as we go through life (from birth to menopause) we are constantly losing eggs. As a result, our chance of releasing a healthy egg (ovulating) and thus getting pregnant progressively decreases with age. Ovarian reserve refers to the fertility potential, or the relative “egg supply” that a woman has at any given time.

What is considered Diminished Ovarian Reserve (DOR)?

Diminished ovarian reserve (DOR) means that the “egg supply” is less than what would be predicted based on a woman’s age. There is no way to tell the exact number or quality of eggs that a woman has remaining in her ovaries but a relative assessment can determine whether the supply is decreased or not.

How can I find out what my Ovarian Reserve is?

There are several tests, some more reliable than others, that physicians utilize to assess a woman’s ovarian reserve. These include blood tests (FSH and estradiol) or vaginal ultrasound tests (antral follicle count) that are performed during the first few days of the cycle, as well as blood tests (AMH) that can be performed at any time in the cycle. Another source of information about a woman’s ovarian reserve is her response to fertility medications, such as Clomid or injectable gonadotropins.

It is important to note that normal or abnormal tests of ovarian reserve do not determine who will or will not conceive. These tests are never interpreted alone, your fertility specialist will correlate them with your age and reproductive history.

What causes DOR?

There are many factors that can affect a woman’s ovarian reserve, including but certainly not limited to:

  • age
  • history of previous surgery (including surgery for ovarian cysts, such as endometriomas)
  • exposure to toxins, such as smoking, chemotherapy, or radiation
  • stress
  • genetic predisposition
  • unexplained

Does having DOR mean that I cannot get pregnant, or that I have to use donor eggs?

Absolutely not! As mentioned above, these are relative test results and need to be interpreted in the context of a patient’s whole health history. No single test or value can predict whether a woman can get pregnant. Instead, these values can be used to guide treatment plans and establish expectations for treatment success.

What can I do to improve my Ovarian Reserve?

There is very little that a woman can do to improve her ovarian reserve. What we can do is minimize harmful exposures, such as smoking, and seek professional consultation with a reproductive endocrinologist who can perform and interpret the tests, as well as provide treatment.

What are available treatment options for women with DOR?

The treatment of DOR should be individualized for each woman. A few supplements have been studied in relation to DOR and show promise in selected cases. More importantly, women with DOR can benefit from carefully-designed, individualized fertility treatment protocols that will stimulate their ovaries and lead to pregnancy. If these strategies are not effective the option of donor eggs is available as well.

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