1. Age of the patient – Age 40 or older are at the most risk for low egg count.

2. Abnormal ovarian test results – On Day 3 of the cycle, a doctor will perform a blood test and an endometrial biopsy to determine ovarian health. DOR presents itself in a few ways:
    

   1. A high amount of follicle-stimulating hormone (FSH) – Levels above 12 mIU/mL are considered elevated and levels about 15 mIU/mL are cause for concern. The high levels are due to the brain having to send a stronger signal to create eggs due to low response.[1]

   2. Estradiol (E2) levels – E2 is the natural form of estrogen in the body. E2 levels must be in the normal range of 15-350 pg/ml. If this number is low or high, this could signal another issue and not DOR. If they are normal, this indicates that the FSH level is correct.[2]

   3. A low Anti-Mullerian Hormone (AMH) level – AMH correlates to the number of eggs in the body. Normal levels of AMH are between 1.0-3.0 ng/ml. Low-normal levels are 0.7-0.9 ng/ml, low levels are 0.3-0.6 ng/ml, and very low levels are <0.3 ng/ml.

   4. Antral Follicle Count – The doctor will examine the ovaries via transvaginal ultrasound to see the number of visible follicles. If the number is low, this is another sign of DOR. If it is normal or high, this could mean that ovarian function is normal despite other results.[3]

3. Poor response to previous treatment – if the woman has tried previous infertility treatment (such as Clomid) and had poor response, this is a further sign of DOR.

To be diagnosed with DOR, women usually need 2 out of 3 of these factors.[4]

Additionally, your doctor may order a clomiphimine citrate challenge test (CCCT). In this test, the woman will be checked on day 3 of their period, take 100mg of the ovulation inducing drug Clomid for days 5-9, then be re-checked on day 10. A low follicle response and a high FSH level are said to have failed the test. The CCCT is an added expensive however and may not be ordered. However, for woman with borderline DOR levels, it may be a good indicator.[5]