Diminished Ovarian Reserve (DOR) represents one of the more common causes of infertility and recurrent pregnancy loss and due to delayed childbearing, this has become a more prevalent condition in fertility patients.  Simply stated, this process represents premature aging of the ovary.   Women are born with their entire complement of eggs.  When these are gone, menopause ensues.  Each individual has a particular time line of ovarian function which may not always match chronologic age.  We will often evaluate ovarian function if there are signs of problems or in patients over 35 years of age.  Signs include, short cycle interval (<28 days), Mother's age at menopause < age 46, or recurrent pregnancy loss.  In our practice we are now underway with a study which will likely link endometriosis and DOR.  Currently, we test patients for DOR if they have a history of endometriosis. 

The Clomiphene Challenge Test is the gold standard test for the diagnosis of DOR.  We give Clomid, the oral ovulation drug for a cycle and measure the hormonal response (blood testing) across the cycle and perform a mid cycle ultrasound to evaluate the number of follicles (eggs) produced.  From these tests we can get an idea of where a person fits in the age and ovarian function spectrum.