Diminished Ovarian Reserve (DOR)

DOR is diagnosed when ovarian reserve markers — AMH, AFC, and/or day-3 FSH — fall below age-adjusted expected values. It does not mean a woman cannot conceive, but it does mean she has fewer eggs available per stimulated cycle and may progress to menopause earlier than average. The condition can occur at any age and is sometimes idiopathic.

Common causes include prior ovarian surgery, endometriosis, autoimmune conditions, genetic factors (e.g., FMR1 premutation), and chemotherapy. Treatment focuses on optimizing the IVF approach — selecting the best stimulation protocol, considering adjuncts like DHEA or CoQ10 (modest evidence), and counseling about realistic prognosis. Donor egg IVF offers high success rates when a patient's own eggs are insufficient.