The term "ovarian reserve" refers to the number and quality of your eggs, also known as oocytes. If you have diminished ovarian reserve, this means that the number and quality of your eggs is lower than expected for your age.
Diminished ovarian reserve can affect people of all ages. About 10 percent of people with uteruses experience it according to the Center for Human Reproduction, a fertility center in New York City.
Treatments do exist for diminished ovarian reserve, however, and it's possible to get pregnant despite having the condition.
The "average" number of eggs in your ovarian reserve depends on age.
Your own eggs were formed while you were still in utero. In other words, you're born with all the eggs you'll ever have. From there, your egg reserve decreases over time.
According to the American College of Obstetricians and Gynecologists, these are the average number of eggs you have at each age:
- 20 weeks of gestation: 6 to 7 million oocytes
- birth: 1 to 2 million oocytes
- puberty: 300,000 to 500,000 oocytes
- around age 37: roughly 25,000 oocytes
- around age 51, the average age of menopause in the United States: roughly 1,000 oocytes
While those with diminished ovarian reserve have fewer eggs than those who without, there's no clear consensus on the average number of eggs for those with the condition.
As pointed out in a 2015 paper, diminished ovarian reserve is generally defined by hormone levels and not by the number of eggs in the ovarian reserve, which makes the definition of the condition confusing.
Since diminished ovarian reserve is diagnosed by blood tests measuring hormone levels, and not by counting eggs, it’s hard to determine the average number of eggs of someone who has the condition.
Aging naturally reduces your egg reserves. However, a number of other factors can cause diminished ovarian reserve. These include:
- tubal disease
- prior ovarian surgery
- radiation therapy
- pelvic infection
- autoimmune disorders
- genetic abnormalities such as fragile X syndrome
However, sometimes there's no apparent cause of the condition.
There aren't many noticeable symptoms of diminished ovarian reserve. However, those with the condition might experience any of the following symptoms:
- difficulty getting pregnant
- late or absent menstrual periods
- shorter menstrual cycles than average, with the average being 28 days
- heavy menstrual flow
That said, these symptoms aren’t always present. This is why it’s important to talk to your doctor if you’re having difficulty conceiving.
According to Mayo Clinic, it’s important to get fertility testing early if you’re trying to conceive without success or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis. Early diagnosis means that you have a better chance of successful treatment.
If you’re under 35 years of age, you should see a doctor if you’ve been trying to get to conceive for a year. If you’re over 35, see a doctor after six months. If you’re over 40 and you’re trying to conceive, it’s best to talk to your doctor right away.
Diminished ovarian reserve is diagnosed through a few blood tests that measure follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels. Both of these hormones play an important role in menstruation and reproduction.
It’s natural for FSH levels to increase and AMH levels to drop as you age, so it’s important to assess these hormone levels against a baseline of your age. Those with diminished ovarian reserve will have higher FSH levels and lower AMH levels compared to others their age.
It's still possible to get pregnant with a diminished ovarian reserve. According to the Center for Reproductive Health, 33 percent of their patients with diminished ovarian reserve are able to get pregnant with their own eggs after receiving treatment. However, the center emphasizes that early diagnosis is important, as it gives you a better chance of conceiving.
One of the most common treatments for diminished ovarian reserve is supplements like dehydroepiandrosterone (DHEA), a mild androgen. DHEA is produced naturally in the body, but levels of DHEA decrease with age. DHEA supplements can increase fertility.
Another study looked at 77 participants with diminished ovarian reserve, and found that those who took DHEA were significantly more likely to get pregnant spontaneously — that is, without additional medical intervention.
However, a 2012 review of studies notes that more research is needed before we can confidently say that DHEA improves fertility levels.
Other than DHEA supplements, there are a few ways to get pregnant if you have this condition. If diminished ovarian reserve is diagnosed soon enough, it’s possible to freeze healthy eggs for future use. Your doctor might even suggest trying IVF immediately.
Another option is using donor eggs to get pregnant. In this case, eggs will be retrieved from a donor. The eggs will then be fertilized through IVF and implanted in your own uterus, your partner’s uterus, or the uterus of a surrogate.
The treatment you pursue will depend on your personal situation, so it’s important to talk about all your options with a fertility specialist.
Being told you have a diminished ovarian reserve can be discouraging, but it’s completely possible to get pregnant with your own eggs or donor eggs if you have the condition.
If you suspect you have a diminished ovarian reserve, or if you're having difficulty with conceiving, speak to your doctor.