Usually when we have satisfactory ovarian reserve according to the age group, mainly what we are trying to do is to try with low doses of medication to achieve the number of the follicles in order to increase the chances to find the normal embryos and good quality embryos. Basically, all the women, with satisfactory ovarian reserve they can have mild stimulation in order to be able to create more than one embryo and increase the success rate in one only IVF cycle. When the ovarian reserve decreases and we start to go to a lower level, then of course the mild stimulation is not possible anymore because lower ovarian reserve needs higher doses of medication and perhaps this higher dose of medication will lead to more abnormal eggs. Basically, when we have decreased ovarian reserve, the next thing that we need to assess to a woman is if the cycles are regular. If the FSH is normal (it is not so increased) in order for us to take advantage of natural selection, basically a woman with low ovarian reserve, her chances will be through natural approach because the body cannot produce more than one or two eggs even with stimulation. So, all the women, even if they have decreased ovarian reserve, if they still have regular cycles which means that they are not in perimenopausal stage yet, they have the possibility to create at least one embryo per cycle.
The prognosis will depend on how low the ovarian reserve is. At this point we have to tailor the treatment to the patient we have in front of us. The lower it is the worse it is. It will depend on how low it is. Sometimes it is suitable for IVF procedures and sometimes when ovarian reserve is too low, the best way to get pregnant is through a donor egg programme. I understand that this is a tough decision to make.
