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Diminished Ovarian Reserve (DOR)

An age-inappropriate decline in ovarian reserve is a major cause of infertility, and timely diagnosis affects success in assisted reproduction.

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Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Diminished Ovarian Reserve (DOR)?

DOR is a follicle pool and oocyte count below the age-expected level. Assessment uses anti-Müllerian hormone (AMH), day-3 FSH and estradiol, antral follicle count (AFC), and sometimes the clomiphene challenge test.

DOR is not the same as primary ovarian insufficiency (POI); in POI menstrual function has stopped, while in DOR cycles can continue. Genetic (Fragile X premutation), autoimmune, iatrogenic (chemotherapy, radiotherapy, surgery), and environmental factors may contribute.

Pregnancy planning should be expedited; options include natural conception, ovulation induction with clomiphene/letrozole, IVF (ideally with the patient's own eggs at younger age), and donor oocytes. Prognosis worsens markedly with advancing age.

Symptoms

Shortening of menstrual cycles (23-25 days)
Irregular menses
Anovulatory cycles
Inability to conceive over a year
Family history of early menopause
Hot flashes and night sweats (early)
Vaginal dryness

Risk Factors

Advanced maternal age (≥35)
Family history of early menopause
Prior oophorectomy or ovarian surgery
Chemotherapy or pelvic radiotherapy
Smoking
Endometriosis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Inability to conceive for one year (six months if over 35)
  • Noticeable shortening of menstrual cycles
  • Family history of early menopause warranting evaluation
  • Fertility preservation before chemotherapy
  • Reserve assessment after pelvic surgery

Treatment Methods

01
Evaluation with AMH, FSH, estradiol, and AFC
02
Lifestyle adjustments (smoking cessation, optimal weight)
03
Ovulation induction (clomiphene, letrozole, gonadotropins)
04
IVF protocols (microdose flare, antagonist, mini-IVF)
05
Donor oocyte IVF in severe DOR
06
Fertility preservation: oocyte/embryo cryopreservation

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.