Diminished Ovarian Reserve: A Narrative Review of Etiologies and Possible Therapeutic Approaches

Diminished ovarian reserve (DOR) occurs unintentionally during treatment or spontaneously. Despite its significant clinical manifestations, such as infertility and early menopause, and its high prevalence, most studies on DOR have focused on premature ovarian insufficiency, and reviews specifically addressing DOR remain scarce. This narrative review aims to provide insight into the diverse etiologies of DOR while discussing promising therapeutic approaches. Iatrogenic DOR can occur during chemotherapy, pelvic radiation, and ovarian surgery. Spontaneous DOR may result from ovarian tumors as well as idiopathic or genetic causes. DOR also inevitably occurs during ovarian fragment transplantation. Stem cell transplantation, in vitro activation, and platelet-rich plasma injection have shown some positive results as therapeutic approaches to DOR; however, more high-quality studies are needed to establish their broader applications in clinical practice.