Shifting paradigms in diminished ovarian reserve and advanced reproductive age in assisted reproduction: Customization instead of conformity

Beverly G. Reed, Samir N. Babayev, Orhan Bukulmez

Research output: Contribution to journalArticle

10 Scopus citations


As women are increasingly delaying childbearing into their 30s and beyond, diminished ovarian reserve (DOR) and advanced reproductive age (ARA) patients are bound to become a large proportion of all assisted reproductive technology practices. Traditional controlled ovarian stimulation (COS) protocols for DOR and/or ARA have had some limited success, but pregnancy rates are lower and cycle cancellation rates are higher than their younger counterparts with normal ovarian reserve. Though many physicians have a selection of favorite standard protocols that they use, patients with DOR may require closer monitoring and customization of the treatment cycle to address the common problems that come with low ovarian reserve. Frequent issues that surface in women with DOR and/or ARA include poor follicular response, premature luteinizing hormone surge, and poor embryo quality. Limited published evidence exists to guide treatment for DOR. However, use of minimal or mild doses of gonadotropins, avoidance of severe pituitary suppression, and consideration for luteal phase stimulation and a freeze all approach are possible customized treatment options that can be considered for such patients who have failed more traditional COS protocols.

Original languageEnglish (US)
Pages (from-to)169-178
Number of pages10
JournalSeminars in Reproductive Medicine
Issue number3
StatePublished - May 4 2015



  • advanced reproductive age
  • diminished ovarian reserve
  • luteal phase stimulation
  • minimal stimulation
  • poor responder

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Physiology (medical)
  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this