Diminished ovarian reserve is seen in patients who have had surgery on the ovaries for ovarian cysts, removal of endometriosis, ovarian tumours or autoimmune issues. Low ovarian reserve can also be caused by chromosomal anomalies like Turner Syndrome, where the woman does not have two X chromosomes or gene abnormalities.

Diminished ovarian reserve is diagnosed by blood tests, which is a routine part of our infertility evaluation. Multiple tests are available including cycle day 2/3 hormonal follicle-stimulating hormone (FSH) and anti-mullerian hormone (AMH) testing, and transvaginal ultrasound to see your antral follicle count. The FSH level should be less than 10-12miu/ml. An FSH greater than 18 miu/ml suggests a significant reduction in ovarian reserve, which decreases your chances of achieving a pregnancy. In the early stages of DOR, there are some menstrual cycles that are still normal and the patient could conceive on her own. If the patient is a candidate for IVF, we need to look for those “normal” menstrual cycles in order to have a good response to the administration of fertility drugs.