Diminished Ovarian Reserve (DOR) is a diagnosis given when a woman has fewer eggs than expected for her age.
A female fetus has 6-7 million eggs at 20 weeks gestation and approximately 1-2 million at birth. At puberty there are about 300,000 eggs remaining, and every month hundreds are lost even though usually only one is ovulated. Menopause occurs when there are no more eggs in the ovaries, but long before menopause, the egg number can be low enough to cause difficulty becoming pregnant.
Women in their 40’s will almost always have DOR, but it occurs in some women at a much younger age. There are several ways to evaluate ovarian reserve, including an ultrasound in the early part of a menstrual cycle for antral follicle count (AFC). In general, when Including both ovaries, 10-15 antral follicles are normal, > 20 is associated with PCOS, and <5 is typically associated with DOR. A clomiphene citrate challenge test or a blood test for anti-mullerian hormone (AMH) may also be helpful.
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