What is ovarian reserve?
Ovarian reserve refers to the quantity and quality of remaining eggs in your ovaries. Every woman is born with a fixed number of follicles — about 1 to 2 million at birth, declining steadily through childhood and into adult life. By menopause, the pool is essentially exhausted.
Diminished ovarian reserve (DOR) means having fewer eggs than expected for your age. It's not the same as menopause — cycles often continue, ovulation usually happens — but the per-cycle chance of conception drops, and response to fertility medications may be poor.
How ovarian reserve is measured
AMH (anti-Müllerian hormone)
A blood test that measures hormone produced by small developing follicles. AMH is relatively stable across the cycle and is the most commonly used reserve test. Reference ranges vary by lab and assay.
Antral follicle count (AFC)
A transvaginal ultrasound performed in the early follicular phase to count the small (2–10 mm) follicles in both ovaries. Direct, real-time measurement. Both AFC and AMH should align; if they disagree, repeat tests are needed.
FSH and oestradiol on cycle day 2 or 3
Elevated baseline FSH (above 10–12 mIU/mL) is a marker of reduced reserve. Less sensitive than AMH but useful when interpreted alongside.
What "low" means at different ages
AMH declines with age. What's considered low depends on context:
- Under 35: AMH below 1.0 ng/mL is often considered low for age.
- 35–40: Below 0.7–0.8 ng/mL.
- Over 40: Below 0.5 ng/mL.
These are rough thresholds. The interpretation matters more than the number alone — a 32-year-old with AMH of 0.8 is in a different situation than a 42-year-old with the same number.
Causes of DOR
- Age — the most common cause.
- Premature ovarian aging — unexplained, may be genetic.
- Prior ovarian surgery — cystectomy, particularly bilateral.
- Chemotherapy or pelvic radiation.
- Severe endometriosis with endometriomas.
- Genetic conditions — fragile X premutation, Turner mosaicism.
- Autoimmune disorders — rare but identifiable.
- Idiopathic — no identifiable cause in many women.
Effect on fertility
DOR affects fertility by:
- Fewer eggs per cycle in stimulation cycles.
- Higher cycle cancellation rates due to poor response.
- Time pressure — reserve continues to decline; cycles delayed lose options.
However, DOR does not mean infertility. Many women with low AMH conceive, especially younger women with reasonable egg quality.
Treatment options
Don't delay — act
The single most important strategic move with DOR is to move quickly. Months of "trying naturally" cost ovarian reserve that won't come back.
Mild stimulation IVF
Lower doses of stimulation aiming for fewer but possibly better-quality eggs. Particularly useful when standard high-dose protocols have produced poor response.
Supplement protocols
DHEA (75 mg/day for 12 weeks before stimulation), CoQ10 (200–600 mg/day), and antioxidants may modestly improve egg yield and quality in some women. Evidence is mixed but the safety profile is good.
Ovarian PRP
Emerging therapy with preliminary evidence. May benefit some women with DOR before committing to donor eggs.
Donor eggs
The most reliable path when own-egg IVF has repeatedly produced poor results or when AMH is severely low and age is advanced.
Realistic expectations
Honesty matters here more than anywhere. A 32-year-old with low AMH has very different prospects from a 42-year-old with the same number. Per-cycle live-birth rates with own-egg IVF in DOR vary widely. We project realistic expectations based on age, AFC, AMH, FSH, and any prior cycle response.
How I work with DOR
Three principles:
- Speed matters. Don't waste months on low-yield approaches when reserve is declining.
- Tailor protocols. Standard high-dose stimulation isn't best for every woman with DOR.
- Talk about donor eggs early. Not because it's the first move — but so the option doesn't feel like a last resort when it eventually becomes the right move.
Concerned about your AMH?
A consultation gives us a full reserve workup and a realistic plan.
Book at KIMS Fertility (opens in a new tab)Frequently asked questions
The questions patients ask me most often about low ovarian reserve.
What does my AMH actually mean?
AMH reflects how many follicles your ovaries are recruiting — a proxy for remaining egg quantity. Measures quantity, not quality. Low AMH means fewer eggs than average for age. One number among several; never interpret alone.
Can I improve my AMH?
Not really. Supplements like DHEA and CoQ10 may modestly improve stimulation response but don't meaningfully raise the underlying number. Lifestyle changes important for health but don't reverse low reserve. We work with what you have.
How is DOR different from POI?
DOR: fewer eggs than expected for age, periods usually still happening, ovulation occurs. POI: ovarian function failing before 40, periods often stop or become irregular, FSH markedly elevated. POI is the more advanced end of the spectrum.
Should I go straight to IVF?
For DOR, the case for IVF sooner is real. Each cycle loses reserve. If trying to conceive with low AMH, especially over 35, long natural-cycle stretches not advised. Active IUI with stimulation or moving toward IVF more efficient.
What protocol is best for DOR?
Antagonist protocols with higher-dose stimulation are most common. Mild stimulation alternative for very poor responders. Individualised based on prior cycles, AMH, AFC, FSH.
Should I freeze eggs if my AMH is low?
If not trying now but wanting to preserve options, worth considering — though yields lower per cycle, may need multiple cycles. Fewer cards to play later, but more than zero. Discuss expectations realistically.
Is donor egg my only option?
No — one option, not only. Many women with low AMH conceive successfully with own-egg IVF, particularly younger. As AMH drops below ~0.5 ng/mL with age, donor eggs become more efficient.
Will my children inherit DOR?
Familial component, especially with strong family histories of early menopause or POI. Daughters may have increased risk. Awareness lets younger relatives consider fertility planning earlier.