Diminished Ovarian Reserve (DOR)

The ovaries contain a fixed pool of eggs from birth — this reserve declines naturally with age, but in women with DOR it declines faster than expected. The result is fewer follicles available for recruitment each cycle, lower peak estrogen levels during stimulation, and often fewer mature eggs at retrieval. AMH (anti-Müllerian hormone) and antral follicle count (AFC) are the most reliable predictors of ovarian response; elevated baseline FSH is an older marker that adds limited additional information. DOR reduces fertility primarily through reduced egg quantity, not necessarily quality — this distinction is important for prognosis.

Women with DOR who pursue IVF typically retrieve fewer eggs per cycle than the national average, which reduces the probability of obtaining multiple high-quality embryos for selection or banking. Poor responders (defined by the POSEIDON criteria as < 4 oocytes retrieved) have lower per-cycle success rates, but cumulative success rates across multiple cycles can still reach 40–60% for women under 38. Aggressive protocols (maximum FSH doses, mini-IVF, natural cycle IVF) are all used, with evidence supporting individualized approaches rather than one-size-fits-all stimulation.