Diminished ovarian reserve (DOR) means fewer eggs remain in the ovaries. It is characterized by low AMH, a reduced antral follicle count and/or elevated baseline FSH. There is no way to actually increase ovarian reserve, but optimizing egg quality and specific IVF strategies can maximize results.
AMH is the best test available for assessing ovarian reserve: it directly reflects the number of follicles left in the ovaries and can be drawn on any day of the cycle. The antral follicle count is a transvaginal ultrasound between day 2 and day 5 that counts the small follicles (2 to 10 mm) in each ovary. Baseline FSH is drawn between day 2 and day 4; when it is elevated this early, the body is having to “shout” louder to get a response.
| Test | Normal or ideal | Sign of reduced reserve |
|---|---|---|
| AMH | Under 30: 1.5 to 4.0 ng/mL 30 to 40: 1.0 to 3.0 ng/mL | Diminished: below 1.0 ng/mL Severely reduced: below 0.5 ng/mL |
| Antral follicle count | 8 to 25 follicles in total | Reduced: below 7 |
| Baseline FSH | Below 10 mIU/mL (10 to 15 is borderline) | Elevated: above 15 mIU/mL |
Reference values as given in the book's chapter on advanced tests. Your doctor reads them together, in the context of your case.
Fertility statistics by age are population averages, not individual predictions. There are 38-year-olds with the ovarian reserve of a 28-year-old, and 28-year-olds with reduced ovarian reserve. Ovarian assessment tests are what give you information about you.
The book also lists situations in which you should see a specialist before the standard timeline, including previous cancer (especially with chemotherapy), previous pelvic surgery and a family history of early menopause (before 40). And ovarian reserve doesn't pause: for women between 35 and 40, every additional 6 months of waiting can mean a measurable drop in the success rate of future treatments.
There is no way to actually increase ovarian reserve. What the book describes is working on what can still change, always with your specialist:
A diagnosis of ovarian insufficiency is also one of the situations in which the book considers a second opinion good medical practice: ask for copies of all your results and present the case to another specialist neutrally.
Diminished ovarian reserve is diagnosis number 6 in Chapter 33 of Map to the Positive, in Station IV (Signs). The same station explains each advanced test, the age cutoffs for seeking help, and the treatments with IVF success rates by age. Station III (Optimization) covers the advanced supplements and the 90-day timing that egg quality depends on.
Take 30 days. If it does not give you more clarity than everything you have read for free so far, ask for a refund and you get every cent back. We cannot promise you a pregnancy. We can promise you will not be guessing.
References: ASRM Practice Committee. Testing and interpreting measures of ovarian reserve, 2020.