DOR: Diminished Ovarian Reserve
DOR stands for Diminished Ovarian Reserve, a condition characterized by a reduced quantity of ovarian follicles and eggs remaining in the ovaries compared to what is expected for a woman's age. 1
Definition and Diagnostic Criteria
DOR is defined by abnormal ovarian reserve testing, specifically:
- Anti-Müllerian hormone (AMH) levels < 0.5-1.1 ng/ml 2
- Antral follicle count (AFC) < 5-7 follicles 2
- Elevated basal follicle-stimulating hormone (FSH) > 10 IU/L 2
The condition represents a loss of normal ovarian reproductive potential that affects fertility, though it must be distinguished from premature ovarian failure (POF) and poor ovarian responders (POR). 2, 3
Clinical Significance in Fertility Context
Women with DOR face specific reproductive challenges:
- Reduced response to ovarian stimulation with fertility medications 4
- Lower success rates with medically assisted reproduction (MAR) 5
- Approximately 35% increased relative risk of miscarriage compared to women with normal ovarian reserve 6, 7
- The absolute miscarriage risk increases from approximately 20% to 27% in women with low AMH 6, 7
This association between DOR and miscarriage may reflect both quantitative and qualitative aspects of ovarian reserve, potentially related to higher rates of aneuploid embryos. 1
Important Clinical Considerations
DOR affects approximately 10% of women seeking fertility treatment and represents a major challenge in reproductive medicine. 5 Women with DOR typically maintain regular menstrual cycles despite having reduced follicle quantity. 4
The condition impacts more than just fertility—52.2% of women with DOR report significant mental health impacts, highlighting the need for comprehensive support beyond reproductive treatment. 5