Decreased ovarian reserve is a decrease in the quantity or quality of oocytes, leading to impaired fertility.

Ovarian reserve may begin to decrease at age 30 or even earlier and decreases rapidly after age 40. Ovarian lesions also decrease reserve. Although older age is a risk factor for decreased ovarian reserve, age and decreased ovarian reserve are each independent predictors of infertility and thus of a poorer response to fertility treatment.

Diagnosis

• FSH and estradiol levels, sometimes after stimulation with clomipheneSome Trade Names
  CLOMID
  Click for Drug Monograph
  

Testing for decreased ovarian reserve is considered for women who are ≥ 35, who have had ovarian surgery, or who have responded poorly to treatments such as ovarian stimulation with exogenous gonadotropins. Follicle-stimulating hormone (FSH) levels > 10 mIU/mL or estradiol levels of < 80 pg/mL on day 3 of the menstrual cycle suggest the diagnosis. Diagnosis can also be made by giving the woman clomipheneSome Trade Names
CLOMID
Click for Drug Monograph
100 mg po once/day on days 5 to 9 of the menstrual cycle (clomipheneSome Trade Names
CLOMID
Click for Drug Monograph
citrate challenge test). A dramatic increase in FSH and estradiol levels from day 3 to day 10 of the cycle indicates decreased reserve.

Treatment

If women are > 42 or ovarian reserve is decreased, assisted reproduction using donor oocytes may be necessary.

Last full review/revision November 2008 by Robert W. Rebar, MD

Content last modified November 2008