Diminished ovarian reserve and premature ovarian failure: A review

Diminished ovarian reserve (DOR) is defined as reduced capacity of the ovaries to produce oocytes; the oocytes produced are of poorer quality leading to the formation of poor quality embryos. The most severe form of DOR can be represented as premature ovarian failure (POF). There are various reasons leading to DOR, the most important factor being increasing age, others being endometriosis and surgeries on the ovary. POF can be due to chromosomal aberrations or secondary to chemotherapy, radiotherapy, infections, or surgeries involving the ovaries. Patients with DOR may present with infertility and menstrual cycle abnormalities; patients with sudden onset POF may also present with hot flushes and vaginal dryness. There are various tests for finding out ones's ovarian reserve, the most widely used being follicle-stimulating hormone (FSH), anti-Mullerian hormone, and antral follicle count. It is important to know a patient's ovarian reserve before recruiting her for in vitro fertilization. Various modalities have been tried to improve the outcome in candidates with DOR undergoing assisted reproductive technology. This includes high-dose FSH treatment, luteinizing hormone supplementation, GnRH antagonist cycle, and use of adjuvant treatments such as estrogen priming, growth hormone, L-arginine, and dehydroepiandrosterone. Patients who are planned for chemotherapy or radiotherapy may undergo oocyte or embryo cryopreservation before the cancer treatment. To conclude, patients with DOR and POF should be provided with good counseling and emotional support.