Beneath the Surface: The Enigmatic Diagnosis of Diminished Ovarian Reserve

By: Erica Ferraro

Diminished Ovarian Reserve (DOR) holds a special place in my heart, as it became a part of my life soon after I turned 30. It was during the infertility blood work at my fertility clinic that I received this diagnosis. I remember eagerly awaiting the call from my doctor, hopeful that with answers, we could find a solution to all our struggles in trying to conceive. Little did I know what awaited me.

DOR is a condition where there are fewer eggs in the ovaries compared to others of the same age. It can make getting pregnant more challenging, but it doesn’t mean it’s impossible. Fertility treatments offer hope, but the chances of success vary for each person. In my case, I was told I had a 5%-10% chance of success with IVF using my own eggs. The odds depend on factors like age, genetics, and sometimes, luck. As we age, our egg count naturally decreases, but for some, like me, it happens earlier than expected, leading to DOR. It is believed that my egg quantity and quality was destroyed through years of pelvic inflammation due to my undiagnosed endometriosis. Endometriosis is one of the leading cause of DOR amongst women of varying ages.

Doctors diagnose low ovarian reserve through ovarian reserve testing. However, having diminished ovarian reserve doesn’t mean you can’t get pregnant; it just means it might be more difficult, and fertility treatment could be considered.

Women are born with a set number of eggs, and age is the most significant factor in determining egg supply. On average, the number of eggs throughout life looks like this:

• At birth: 1 to 2 million eggs
• At puberty: 300,000 to 400,000 eggs
• At age 40: 25,000 eggs
• At menopause: less than 1,000 eggs

These numbers can vary from person to person, and only a healthcare provider can estimate the number of eggs based on ovarian reserve testing.

I discussed in my article, Female Cycles, in Plain English, how women “dump” multiple eggs each month, as part of the natural culling process that occurs during each menstrual cycle. Understanding this process helps us see how we “run through” our eggs naturally, aside from medical diagnoses.

Despite the challenges, it’s important to know that pregnancy is still possible with diminished ovarian reserve. Only one egg is needed for conception, and getting pregnant relies on various factors, including egg quality, sperm quality, and the overall function of the reproductive organs. While some individuals with DOR may also have issues with egg quality, it’s not true for everyone. It’s crucial to consult with a doctor who can assess your specific situation.

For DOR patients, the journey through IVF treatments can be uniquely stressful because the success rates often depend on the quantity of eggs retrieved. With fewer eggs available, the hope lies in their quality, which can vary among individuals. This has led to numerous supplement and product companies marketing solutions for improving egg quality to target the vulnerabilities of DOR patients.

Symptoms of DOR are often absent, except for the inability to conceive after months or years of trying. Some may notice a consistently shorter menstrual cycle, experience hot flashes or vaginal dryness, which can resemble early menopause.

While aging is a common cause of low ovarian reserve, sometimes there is no clear cause, which can be frustrating for patients seeking answers. Genetic disorders, radiation or chemotherapy treatments, endometriosis, ovarian surgeries, autoimmune conditions, and primary ovarian insufficiency are among the known causes of diminished ovarian reserve.

Finally, it’s important to acknowledge that some individuals are born without eggs, have fewer eggs, or have poor-quality eggs. Understanding this reality and acknowledging that not everyone can have biological children is crucial. Just as some men are born without sperm or with poor-quality sperm, it’s essential to recognize that reproductive challenges can affect people of all ages and genders.

Take Control of Your Fertility: Assess Your Egg Reserve with These Steps

1. Request Infertility Blood Work & Sonogram: Discover your egg reserve status by reaching out to a fertility clinic and requesting infertility blood work. Enhance your understanding further by scheduling a sonogram at the fertility clinic. This procedure allows the assessment of Anticle Mullerian Hormone (AMH) levels alongside a visual examination of the number of follicles on each ovary. This crucial step will provide valuable insights into your fertility potential.
2. Interpret the Results: Once the blood work and sonogram are complete, consult with the experts at the fertility clinic. They will interpret the results, providing you with a comprehensive understanding of your egg reserve status.
3. Take Informed Action: Armed with this knowledge, you can make informed decisions about your fertility journey. Whether you choose to explore fertility treatment options or focus on proactive fertility preservation techniques (egg freezing), you hold the power to take action towards achieving your reproductive goals.
4. Empower Yourself: By actively participating in assessing your egg reserve status, you empower yourself to make proactive choices and navigate your fertility journey with confidence. Remember, knowledge is the first step towards empowering yourself on the path to parenthood.

It would have been critical in my youth, for someone to impart the truth that not all women possess the genetic blueprint for bearing children, just as some men are bereft of sperm. Knowing this information earlier in life would have helped me mentally prepare for the possibility of such a diagnosis. Having someone encourage me to test my egg reserve potential sooner, may have resulted in the freezing of my eggs, or, my endometriosis being diagnosed and addressed earlier before it destroyed my egg quality. Understanding that not all women can have genetic children due to various reasons would have been invaluable and pushed me to take action.

Hence why I share the tale of Diminished Ovarian Reserve—an intimate saga of hope and despair, of embarking upon a path strewn with uncertainty. It is a story that calls us to traverse uncharted territories, confront our vulnerabilities head-on, and to seek solace in the wisdom of others in this very niche community. Through the haze of confusion, we strive to unravel the enigma and to transform this journey from one of darkness to one of resilience and newfound understanding.

Erica was diagnosed with DOR in 2021. If you’d like to connect, follow or message on her personal Instagram page.