What is Diminished Ovarian Reserve?
This blog post is meant to be for educational purposes only. It is not meant to be used as a treatment plan.
Has your fertility practitioner told you that you have diminished ovarian reserve (DOR) after doing a fertility workup? If so, you're probably wondering what it means and how it affects your overall chances of conceiving.
What is Diminished Ovarian Reserve?
By definition, diminished ovarian reserve is when you either have a low follicle count, your AMH levels are low or below optimal and when your FSH is too high. Essentially, what DOR means is that you have a lower than expected egg supply (your pool of ovarian follicles, or fluid-filled sacs that contain eggs, are decreasing). Having DOR can mean you may have a harder time getting pregnant naturally.
Markers for Diminished Ovarian Reserve
Low Antral Follicle Count (AFC), via ultrasound
AFC is a follicle count that's done using transvaginal ultrasound between cycle day 2 and 5. The number of follicles seen on an ultrasound is reflective of how many follicles are left in your ovarian reserve. If you have a low follicle count, you may be diagnosed with diminished ovarian reserve.
Low Anti-Müllerian Hormone (AMH), via blood test
Anti-Müllerian Hormone is a hormone secreted by your ovarian follicles. Your AMH level is a reflection of the number of ovarian follicles in the early stages of maturing. The more follicles you have, the higher your AMH level. Your AMH levels can change based on other factors and is NOT a stand alone evaluative tool. For example, PCOS can cause high AMH levels. Below 0.7 ng/mL is considered low.
High Follicle Stimulating Hormone (FSH), via blood test
Follicle Stimulating Hormone is a hormone secreted by the pituitary gland in your brain. It stimulates your ovaries to grow follicles in preparation for ovulation. FSH is checked around Day 3 of your menstrual cycle. As we get older and our ovarian reserve declines, we naturally produce more FSH. Normal is less than 10 mIU/mL. Above 10-15 is considered high.
The Good News about Diminished Ovarian Reserve
Your AMH level and FSH level does NOT predict whether or not you can get pregnant naturally. DOR is not a be-all and end-all diagnosis and does NOT mean infertility. A recent 2022 study has found that women with a diagnosis of "diminished ovarian reserve" (low AMH levels and high FSH levels) were able to conceive with similar rates as women with normal ovarian reserves.
What researchers found in this study of over 300 women between ages 30-44 was that the women with diminished ovarian reserve did not have a harder time getting pregnant compared to women who had normal ovarian reserve markers. They conclude that, "Diminished ovarian reserve is not associated with reduced future reproductive capacity." The researchers also state that women should be cautioned about using common reproductive biomarkers (such as AMH and FSH) as predictors of their future ability to conceive.
DOR is typically discovered when a fertility test is done due to difficulty conceiving or if someone is interested in preserving their fertility. Often the results you receive after a fertility workup are used to assess how effective fertility treatment might be or how you might respond to fertility medications. According to Dr. Eric Forman, Reproductive Endocrinologist at Columbia University's Fertility Center, these fertility tests aren't meant to test your fertility or ability to conceive naturally and a diagnosis of DOR does not equate to infertility.
Holistic and Vitalist Approaches to Nourish Egg Health
So, how can you support your fertility despite having DOR? You can implement nutritional and lifestyle changes that can help optimize your ovarian reserve while nourishing your overall hormonal health. Below are some diet and lifestyle changes you can start integrating into your daily routine:
Increase blood flow to ovaries. Consider getting acupuncture or gyno-visceral manipulation such as Mayan Abdominal Massage or Mercier Therapy; have a consistent and regular movement/exercise routine.
Get deep, restorative sleep often. Getting enough deep sleep is critical for hormone balance and thus fertility.
Incorporate herbal medicine to help modulate immune system, reduce inflammation, improve implantation, reduce free radicals, etc.
Eat food and supplement with essential nutrients for egg development.
CoQ10 - reduces oxidative damage to ovaries
Omega-3 fatty acids (DHA and EPA) - improves egg quality, embryo morphology, and birth outcomes
Vitamin A (retinol) - essential for the normal growth and development of oocytes (eggs). It is required to initiate the cell division process that allows you to release a healthy and fully mature egg each time you ovulate. Best obtained from food sources. Liver is the best source of vit A (retinol).
Vitamin D - plays an important role in ovarian function and follicular development
Antioxidants (vitamin C, vitamin E, selenium, folate, zinc) - reduces oxidative damage and thus improves egg quality
Eat nutrient-dense warming foods and avoid raw, cold foods. For example, instead of raw greens (like salads), eat cooked greens; instead of pizzas or burgers, eat soups/stews/curries that are warming and easy to digest and absorb.
Add in more chicken, eggs, lamb. These types of protein improves egg maturation, helps the body recruit more follicles for ovulation every cycle.
Balance blood sugar. Reduce processed sugar consumption and "never eat carbs naked" (always pair carbohydrate-rich foods with a fat and protein, like eating crackers or bread with hummus or cheese and a deli meat, or eating apples with peanut butter, etc.)
Find ways to reduce stress. If you have chronic stress, ask yourself what the root cause may be and how you can reduce the load of stress on a day-to-day basis. Chronic stress can cause immune dysfunction, inflammation, thyroid suppression, and oxidative stress.
Reduce exposure to xenoestrogens (endocrine disruptors). Avoid plastics, personal care products or household cleaning products with BPA, fragrance (parfum), phthalates, pesticides, etc.
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References:
Burns, C. (Host). (2022, February 23). Strategies for Diminished Ovarian Reserve [Audio podcast episode]. In Fertility In Focus.
Harris, B. S., Jukic, A. M. Z., Truong, T., Nagle, C. T., Erkanli, A., & Steiner, A. Z. (2023). Markers of ovarian reserve as predictors of future fertility. Fertility and Sterility, 119(1), 99–106. https://doi.org/10.1016/j.fertnstert.2022.10.014
Hendrickson-Jack, L. (Host). (2023, April 14). Does Low AMH Mean You Can't Conceive Naturally? (Ep. 464) [Audio podcast episode]. In Fertility Friday.
Hendrickson-Jack, L. (2019). The fifth vital sign: master your cycles & optimize your fertility. Fertility Friday Publishing Inc.
Hendrickson-Jack, L. (Host). (2018, November 9). Premature Ovarian Failure and Diminished Ovarian Reserve (Ep. 229) [Audio podcast episode]. In Fertility Friday.
