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Understanding Poor Ovarian Reserve: Causes, Diagnosis, and Options

Infertility is a deeply personal and often challenging journey for many couples. Among the various factors that affect female fertility, poor ovarian reserve (POR) is one of the most critical. It refers to a condition where the ovaries lose their normal reproductive potential, leading to a reduced quantity and quality of eggs. For women trying to conceive, this diagnosis can feel overwhelming — but understanding it is the first step toward finding the right options.

What Is Ovarian Reserve?

Ovarian reserve refers to the number and quality of eggs (oocytes) a woman has at a given age. Every woman is born with a finite number of eggs, and this number declines naturally with age. However, in some women, this decline occurs earlier or more rapidly than expected, leading to poor ovarian reserve.

When ovarian reserve is low:

• The number of available eggs is fewer than average.
• The quality of eggs may be reduced, lowering the chances of fertilization and healthy embryo development.

Causes of Poor Ovarian Reserve

Several factors can contribute to reduced ovarian reserve:

1. Age – The most significant factor. After age 35, ovarian reserve declines more rapidly.
2. Genetics – Some women may inherit a predisposition to early ovarian aging.
3. Medical conditions – Endometriosis, autoimmune diseases, or chromosomal abnormalities can accelerate egg depletion.
4. Medical treatments – Chemotherapy, radiation, or ovarian surgery may damage ovarian tissue.
5. Lifestyle factors – Smoking, poor nutrition, and environmental toxins may impact egg health.
6. Idiopathic (unknown causes) – In some cases, no clear reason is found.

How Is Poor Ovarian Reserve Diagnosed?

Doctors use a combination of medical history, physical exams, and specialized tests to assess ovarian reserve:

• AMH (Anti-Müllerian Hormone) Test: Measures hormone levels secreted by ovarian follicles. Low AMH suggests fewer eggs.
• AFC (Antral Follicle Count): An ultrasound count of visible follicles in the ovaries.
• FSH (Follicle Stimulating Hormone) Test: Elevated FSH levels on day 2–3 of the cycle indicate reduced ovarian function.
• Age & menstrual history: Shorter or irregular cycles can signal diminished reserve.