Diminished Ovarian Reserve (DOR)

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated May 13, 2026

Diminished Ovarian Reserve (DOR) is a reduction in the quantity and, often, the quality of the remaining egg supply in the ovaries relative to what is expected for a woman's age. DOR is most commonly age-related, but it can occur prematurely due to prior ovarian surgery, autoimmune conditions, endometrioma, genetic factors, or prior gonadotoxic treatment. It does not make pregnancy impossible. It makes it more urgent to act, and more important to understand why reserve is low.¹

DOR is assessed through three markers used together, not in isolation: serum anti-Müllerian hormone (AMH), antral follicle count (AFC) on ultrasound, and cycle day 3 FSH. No single marker is definitive. A 2017 JAMA study found that AMH and AFC did not predict natural conception rates in older reproductive-age women as precisely as commonly assumed, underscoring the importance of individualized evaluation over thresholds alone.²

In RRM, a DOR diagnosis prompts investigation, not resignation. Clinicians evaluate for treatable contributors: autoimmune activity, endometrioma, thyroid dysfunction, oxidative burden, and nutritional deficiencies. Where modifiable factors exist, they are addressed. See Ovarian Reserve for interpretation of reserve markers in clinical context and DHEA supplementation for one studied supportive strategy in DOR.³

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.