What is diminished ovarian reserve?
Diminished ovarian reserve (DOR) refers to a reduced quantity of eggs remaining in the ovaries relative to age-based expectations. It is a quantity measure, not a quality measure, though the two often track together. ASRM defines DOR as a clinical category in which a woman's response to ovarian stimulation, or her testing, indicates fewer remaining oocytes than would be expected for her age.
The most commonly used measures of ovarian reserve are anti-Müllerian hormone (AMH), antral follicle count (AFC) on ultrasound, and basal follicle-stimulating hormone (FSH) with estradiol. ASRM's Practice Committee notes that no single test is definitive and that ovarian reserve testing is best interpreted alongside age, prior response to stimulation if any, and clinical context. Importantly, low ovarian reserve does not equal infertility — many women with low AMH conceive — but it is a key planning input for IVF.
How common is it among IVF patients?
Diminished ovarian reserve is reported as a contributing diagnosis at 446 of 458 US clinics in the most recent CDC data, with an estimated 227,527 IVF cycles annually citing DOR as a diagnosis. It is one of the two most commonly reported diagnoses overall, alongside male factor.
The high prevalence reflects three trends. First, the average age of women undergoing IVF in the United States has increased over the past two decades, and ovarian reserve declines naturally with age. Second, AMH testing is now routinely performed in fertility evaluations, leading to identification of DOR earlier than in prior decades. Third, women with mild DOR who would not have been classified as such using older criteria are now identified by AMH thresholds.
How DOR affects IVF outcomes
The two main IVF effects of DOR are lower egg yield per retrieval and a higher rate of cycle cancellation due to insufficient response. Live birth rates per intended retrieval are generally lower for DOR patients than for those without DOR, particularly in older age groups, but the relationship is complex: a 32-year-old with low AMH typically has better outcomes than a 42-year-old with normal AMH, because age affects egg quality (chromosomal normalcy) more than AMH does.
Multiple retrievals are common with DOR. Cumulative success across two or three retrievals can substantially exceed single-cycle outcomes when banking is used to accumulate embryos before transfer. ASRM has noted that for DOR patients, success metrics that capture cumulative outcomes are often more informative than per-cycle metrics.
Donor egg IVF achieves substantially higher live birth rates than own-egg IVF for patients with DOR, particularly those over 38. The choice between continued own-egg attempts and donor egg is highly personal and depends on factors no clinical metric can capture.
What treatments are commonly discussed
Approaches that reproductive endocrinologists may discuss for DOR patients include:
- Stimulation protocol selection. Several protocols are used for poor responders, including mild stimulation, antagonist protocols, agonist flare protocols, dual stimulation (DuoStim), and luteal phase stimulation. The evidence base for any single protocol's superiority is mixed.
- Adjuvant medications. DHEA, CoQ10, growth hormone, testosterone priming, and androgen pretreatment have all been studied for poor responders, with variable evidence. ASRM has reviewed these and notes that high-quality evidence supporting most adjuvants is limited.
- Embryo banking. Multiple retrievals to accumulate embryos before transfer can increase cumulative success when single-cycle yields are low.
- PGT-A consideration. Preimplantation genetic testing for aneuploidy is sometimes discussed for older DOR patients but the per-retrieval cost-benefit calculation differs from younger patients.
- Donor egg IVF. Often discussed as a comparison option, particularly when cumulative own-egg outcomes have been poor or when age is significantly advanced.
Decisions about protocol, adjuvants, and donor egg are individualized. The right approach depends on age, prior response, embryo quality from any prior cycles, and patient preferences.
Questions to ask your fertility specialist
If DOR is part of your diagnosis, the following questions can help structure the conversation:
- What does my AMH and AFC tell us, given my age?
- What stimulation protocol are you recommending and why? What is the trade-off versus other protocols for my situation?
- What is your typical retrieval yield for patients with my AMH and age?
- How do you think about cumulative outcomes across multiple retrievals versus a single cycle?
- If we proceed and have low yield, what are our decision points along the way?
- At what point would you suggest considering donor egg as a planning option?
- If I want to bank embryos before transfer, what does that pathway look like at this clinic?
US fertility clinics with the highest reported dor cycle volume
The list below ranks US fertility clinics by estimated annual cycles citing dor as a diagnosis, derived from each clinic's CDC-reported total cycle count multiplied by the percentage of cycles citing this diagnosis. Volume is a signal that a clinic regularly treats this diagnosis. It is not a measure of success rate or quality. CDC does not publish per-diagnosis success rates at the clinic level, so a "best clinic for dor" cannot be derived from this dataset alone.
How we computed these numbers
The clinic-level numbers on this page come from the CDC's National ART Surveillance System (NASS), specifically the 2022 ART Surveillance Report, which is the most recent dataset available. CDC publishes these reports on a two-year lag.
Estimated annual cycles for this diagnosis are computed by multiplying each clinic's total reported cycles by the percentage of cycles in which dor was cited as a diagnosis. The CDC reports these percentages but does not publish absolute cycle counts per diagnosis, so the figures here are estimates.
A single IVF cycle can have multiple diagnoses recorded. A patient with both male factor and diminished ovarian reserve would have both diagnoses counted, which is why the percentages reported by clinics often sum to more than 100%. The "share of all CDC IVF cycles" stat above is therefore an approximation of how often this diagnosis appears in any cycle's record, not a percentage of cycles where it is the sole cause.
Editorial content on this page was last reviewed on April 30, 2026. We aim to update each diagnosis page when major guidelines from ASRM, ACOG, AUA, the Endocrine Society, or related professional bodies are revised.