Alborzi S, Madadi G, Samsami A, Soheil P, Azizi M, Alborzi M, Bakhshaie P

While diminished ovarian reserve (DOR) predicts decreasedovarian response to stimulation, it does not necessarily foretellabout the fecundity cycle. According to Bologna's criteria laiddown by the European Society of Human Reproduction andEmbryology, old age, abnormal ovarian reserve tests such asantral follicle count (AFC) and anti-mullerian hormone (AMH)as well as prior suboptimal response to stimulation are themain factors representing DOR. Unfavorable response to maximalstimulation on two previous occasions may also representDOR. Among the ovarian reserve tests, AMH and AFC are themost predictive values for DOR. Factors which may give rise toDOR include environmental factors, autoimmune or metabolicdisorders, infections, genetic abnormalities, and iatrogeniccauses (such as smoking, chemotherapy, radiation and gynecologicsurgeries). Besides, studies have proposed endometriosisas a key contributor to DOR and hence emphasized on itsproper management to prevent additional damages leading tocompromised fertility. In summary, DOR is found to be a clinicalchallenge in the practice of fertility care with controversialcountermeasures to prevent or treat the condition. Nevertheless,some promising measure such as: oocyte, embryo and tissuecryopreservation, ovarian transplantation, dietary supplementationand the transfer of mitochondria have offered hopes towardsameliorating the burden of DOR. This review attempts todiscuss DOR from different perspectives and summarize someexisting hopes in clinical practice.