Abstract
Patients with diminished ovarian reserve (DOR) often exhibit depression, which may aggravate the disease by affecting spontaneous regional activity in the brain. However, the differences of brain activity between DOR patients with and without depression are unclear. Eighty-five DOR patients including 42 depressive and 43 non-depressive patients, as well as 44 healthy controls (HC), were enrolled. Resting-state functional magnetic resonance imaging data were obtained and preprocessed to calculate the measures of fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo), evaluating the differences of spontaneous regional brain activity between groups. In addition, relationships between fALFF, ReHo values of altered brain regions and scores of 17-item Hamilton Depression Rating Scale (HAMD-17) were evaluated. Receiver operating characteristic (ROC) curves were also used to explore the suitability of the altered brain regions as potential neuroimaging biomarkers for evaluating the level of depression in DOR patients. Compared with HC, DOR patients with depression showed decreased intensity and concordance of regional brain activity especially in the frontal regions while DOR patients without depression exhibited decreased brain activity in the frontal, parietal regions and increased concordance of activity in the parietal, temporal regions. In addition, compared with non-depressive DOR patients, depressive patients displayed decreased brain activity in the frontal, temporal and parietal regions. DOR patients with moderate depression demonstrated decreased brain activity in the frontal and parietal regions when compared to patients with mild depression. Moreover, negative relationships were found between HAMD-17 scores and fALFF values of the right opercular part of inferior frontal gyrus, precuneus and postcentral gyrus, as well as ReHo values in the right middle cingulate gyrus and supplementary motor area. Moreover, ROC analysis revealed that both altered fALFF and ReHo values of impaired regions might be helpful for evaluating the level of depression in DOR patients. The accompanied depression in DOR patients might be associated with decreased intensity and concordance of brain activity in the frontal, temporal and parietal regions. In depressive DOR patients, the worse depression might be related to decreased brain activity in the frontal and parietal regions. These findings might provide new insights into the pathological mechanism underlying DOR with depression. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-026-41986-2.