Diminished Ovarian Reserve: what can you do about it?

Diminished ovarian reserve Dr Agnes Ryu

Desperation ensues when there is a realisation of the plummeting of fertility rates as women enter the perimenopausal years, which is when many women are just starting to try to achieve a pregnancy, while they are often confused by how normal and “young” they feel. They discover they have FSH hormone elevation which signals a significant decline in ovarian reserve and the ability to conceive with one’s own eggs. Patients often have to face challenging decisions and choices.

Caring for my patients who are typically in their late 30’s and early 40’s, desperately trying to achieve a healthy pregnancy, can be very challenging as patients come to understand the concept of ovarian reserve.

The Ovarian Reserve


The model of establishment and decline of human primordial follicle population from conception to the menopause that has the best fit to data from 325 ovaries of varying ages. 


The concept of ovarian reserve (OR) measures female reproductive potential as a function of the number and quality of oocytes. A good ovarian reserve is responsible for producing high-quality oocytes and successful pregnancy.


  • Ovarian reserve tests have appeared to be fairly accurate in predicting the response to ovarian stimulation in the assisted reproductive technology (ART) setting.
  • However, the ability to predict the likelihood of spontaneous pregnancy or pregnancy after ART appears very limited.

Diminished Ovarian Reserve (DOR)

A diminished ovarian reserve (DOR) indicates that some women of childbearing age, whilst having normal menstrual cycles, have ovarian stimulation responses or fertility that is lower than other women of the same age. There are many factors that affect the ovarian reserve, such as age, endometriosis, living conditions, ovarian surgery, heredity and mutation, immune system defects, radiation and chemotherapy, each of which could directly or indirectly result in a decline in a woman’s oocyte quantity and quality.

The American Centers for Disease Control ART (assisted reproductive techniques) success Report stated that Diminished Ovarian Reserve was the second most common reason (32%) for ART treatment, exceeded only by male factor infertility (33%).

Although ART has developed rapidly in recent years, the low clinical pregnancy rates and low live birth rates for patients with DOR are becoming a bottleneck that limits its further development.

Infertility caused by DOR has been treated with Oriental Medicine in the East for several thousand years. It has been shown that time-tested composite medications could effectively improve endometrium receptivity in patients with infertility, increase retrieved oocyte numbers in patients with DOR, improve the quality of oocytes and embryos, and improve the pregnancy rate among such patients.


Dr Ryu’s Articles:

A devastating diagnosis – High FSH

Ovarian reserve test: it’s not the be-all and end-all

Premature Ovarian Failure, Is there any hope? 

What causes Premature Hormone Decline 

How Old is ‘Too Old’ to have children?  

Luteal Phase Defect: Can I get pregnant?



Herbal medicine treatment for Diminished Ovarian Reserve:

Advancement in the treatment of diminished ovarian reserve by traditional Chinese and Western medicine (Review)

Treatment of declining in ovarian reserve by shen-reinforcing and menstrual cycle-regulating therapy combined with western medicine: a clinical observation

Progress of study on improving the development of follicle with Chinese herbal medicines for enriching kidney

Treatment of premature ovarian failure patients by bushentiaojing recipe combined hormone replacement therapy: a clinical observation

Treating premature ovarian failure with Chinese medicine

A general description for Chinese medicine in treating premature ovarian failure.


Acupuncture treatment for Diminished Ovarian Reserve

Electroacupuncture for reproductive hormone levels in patients with diminished ovarian reserve: a prospective observational study

Agnes Ryu

Agnes Ryu

Dr. Ryu is a clinician and biochemist specializing in integrative medicine. Her clinical interests include fertility, hormones, metabolism, healthy ageing, menopause, and natural breast cancer care. As an integrative practitioner, Dr. Ryu aims to uncover the root causes of health issues and strives to empower patients with the knowledge and tools to take charge of their own health.

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