What Is Diminished Ovarian Reserve?

By: Ervin E. Jones, MD, PhD, FACOG Reproductive Endocrinologist

Diminished ovarian reserve is a term used to describe a woman's potential for successful pregnancy--the desired end-point of all fertility investigation and treatment. In order for a pregnancy to occur, a normal egg must be available. The presumed ability of a woman to produce normal eggs underlies all so-called tests of ovarian reserve. There is no single test or group of tests capable of answering this question directly. All tests of ovarian reserve are indirect nonnumeric estimates of a woman's ability to produce normal eggs and of how many normal eggs remain in her ovaries. Such endocrine tests include, but are not limited to, cycle day 3 follicle-stimulating hormone and estradiol levels, the clomiphene citrate challenge test and measurements of other endocrine substances such as Inhibin-B and anti Müllerian hormone. These tests are often combined with what is referred to as the antral follicle count, i.e., the number of small follicles that can be seen on ultrasound during the early follicular phase.

Tests of ovarian reserve should be viewed as global estimates of ovarian competence. No test of ovarian reserve is completely predictive of a woman's ability to have a child. Instead, tests of ovarian reserve are used for counseling, decision making with respect to choice of treatment, and for inclusion and exclusion criteria. A normal test of ovarian reserve does not insure a woman's ability to produce normal eggs and embryos and an abnormal test of ovarian reserve does not always predict for failure. If they do not achieve pregnancy with their own eggs, women with significant diminished ovarian reserve often find that donor egg is a great option for achieving pregnancy.