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Diminished Ovarian Reserve (DOR) is when your ovaries have fewer or less mature eggs than is usual for a person your age. This doesn’t stop you from having a family, but your path to getting there may differ. On the bright side? With help from proper tests, advice, and healthcare experts, you can take steps that may improve your odds of getting pregnant. Also DOR does not always cause infertility, it also doesn’t require immediate intervention unless you are actively trying to conceive.
What Is Diminished Ovarian Reserve?
You're born with a finite number of eggs; over time, both quantity and quality naturally decline. However, in some cases, this decline begins earlier than expected, when Diminished Ovarian Reserve (DOR) becomes a concern.Having diminished ovarian reserve (DOR) means your ovaries may produce fewer good-quality eggs than is typical for your age. This can affect your chances of conceiving naturally and may also influence how well you respond to fertility treatments. It’s important not to confuse DOR with premature ovarian insufficiency (POI), which is a different condition that can lead to early menopause. With DOR, your menstrual cycles often remain regular, but your likelihood of getting pregnant may be lower than it once was.
Why Does It Happen Before 35?
There isn’t always a clear cause, but several factors can contribute to early diminished ovarian reserve:- Genetics: If your family experienced early menopause, you might be at higher risk.
- Autoimmune conditions: Certain autoimmune diseases can cause the body to attack ovarian tissue.
- Medical treatments: Chemotherapy, radiation, or pelvic surgeries may damage ovarian function.
- Endometriosis: This condition can affect ovarian tissue and egg quality.
- Environmental toxins: Exposure to harmful chemicals or pollutants may accelerate egg loss. Please note that there is still ongoing research in this area, and the results are not confirmed yet.
- Unexplained cases: Sometimes, no specific cause is found; your body ages differently.
Early Signs to Watch For
DOR is not always easy to detect, so it can sometimes surprise you. There are some things your body can show you before you notice a drop in ovarian reserve.You might notice:
- Shorter menstrual cycles (less than 26 days)
- Lighter periods than usual
- Difficulty conceiving after 6–12 months of trying
- Hot flashes, sleep disturbances, or mood changes (in more advanced cases)
- Poor response to ovarian stimulation during fertility treatments
How Ovarian Reserve is Tested
A fertility specialist will likely test your ovarian reserve right away after you talk about your concerns. They do not require surgery, and they help your doctor understand your ovaries better.1. Anti-müllerian Hormone (AMH) test
This test is a dependable way to measure your ovarian reserve. Your ovaries produce AMH. If your AMH level is low compared to what’s normal for your age, it may mean there are fewer remaining eggs.2. Follicle-stimulating Hormone (FSH) and oestradiol
Your doctor will measure these hormones on days 2 or 3 of your cycle. When your FSH and oestradiol levels are high, it usually means your body is working harder to stimulate the ovaries, which can be a sign of diminished ovarian reserve (DOR).3. Antral Follicle Count (AFC)
This method involves a transvaginal ultrasound to see and count the small follicles in your ovaries when your period begins. A lower number of eggs is usually a sign of fewer eggs than usual.What do Your Test Results mean?
It’s important to remember that these tests measure quantity, not necessarily quality. Even with a diminished ovarian reserve, you can still conceive, especially if you’re ovulating regularly and have no other fertility challenges.However, the lower reserve may mean:
- You have fewer eggs available for fertilisation each month
- You may not respond as strongly to fertility medications
- You might need to consider assisted reproductive technologies sooner rather than later.
Treatment Plans for DOR in Your 20s or Early 30s
If you’ve been diagnosed with diminished ovarian reserve, your treatment will be personalised based on your age, overall health, and whether you’re trying to conceive now or later.1. Trying to conceive now
If you’re actively trying, your doctor may suggest:- Ovulation induction with timed intercourse or IUI: Stimulating your ovaries to release one or more eggs, then timing intercourse or performing intrauterine insemination (IUI).
- In Vitro Fertilisation (IVF): Although you may respond to stimulation with fewer eggs, IVF can still be effective, especially with tailored protocols.
- Embryo freezing: If you create multiple embryos during IVF, freezing them gives you more chances for future attempts.
2. Not ready to conceive yet
If you’re not planning a pregnancy immediately, fertility preservation becomes a smart option:- Egg freezing: You can freeze your eggs now, when quality is higher, and use them later when you’re ready.
- Lifestyle changes: Focus on preserving ovarian health with a balanced diet, stress reduction, and avoiding smoking or environmental toxins.
Emotional Support and Mental Health
Receiving a Diminished Ovarian Reserve (DOR) diagnosis before the age of 35 can be emotionally challenging for anyone, regardless of gender. It’s completely natural to feel grief, anxiety, or frustration, especially when it seems like your peers are facing very different life experiences. Your emotions are valid, and you don’t have to face them alone.Seeking support from a counsellor, joining a community group for individuals navigating fertility challenges, or speaking with a therapist who specialises in reproductive health can make a meaningful difference. Fertility isn't just a physical journey—it's deeply emotional too, and taking care of your mental well-being is just as important.
Having a diminished ovarian reserve early can be challenging, but it doesn’t stop you from having children if you address it soon, learn more, and find supportive care. If you see the symptoms, ask for testing, and learn about options, you remain in control of your reproductive future.
Even though diminishing ovarian reserves are common, many women with this condition can have healthy pregnancies. Regardless of how you achieve fertility, you still have plenty of opportunities. The main thing is to look after yourself and choose a medical team you trust for support.
FAQs on Diminished Ovarian Reserve Before 35: Signs, Tests, and Treatment Plans
- Can I still get pregnant naturally with diminished ovarian reserve?
Yes, it's possible. Diminished ovarian reserve doesn’t mean you’ve stopped ovulating. While your chances may be lower, natural conception can still occur, especially if you're under 35 and otherwise healthy. - Should I freeze my eggs if I have DOR and don’t want children yet?
Freezing your eggs early gives you more options later. Even with DOR, if you still have viable eggs, fertility preservation can be a proactive way to protect your future fertility. - How fast does ovarian reserve decline once it’s diminished?
The rate of decline varies. Some people experience a gradual decrease, while others may see a faster drop in egg quantity or quality. Regular monitoring and consultation with your fertility specialist are key.
