plastic female reproductive anatomy used during consultation

Diminished Ovarian Reserve (DOR): Possible Treatments to Lead to Successful Outcomes

By: Mira Aubuchon, MD

Frequently, we care for patients with diminished ovarian reserve (DOR), low egg numbers, with IVF. This is a challenging situation because the egg supply does not increase, and eventually over the years the supply will be exhausted. A number of approaches have been described to treat diminished ovarian reserve with varying degrees of success- these have been summarized nicely in a series of articles in April 2022 Fertility and Sterility.

Taking certain medications or supplements prior to starting the IVF stimulation may be helpful depending on the circumstances; these include dhea, testosterone, growth hormone (Omnitrope for example), coq10, letrozole (Femara), leuprolide (Lupron), cetrorelix (Cetrotide) or ganirelix, oral contraceptives, and estradiol.

During stimulation, growth hormone and clomiphene citrate (Clomid) may promote higher egg numbers and quality, dual triggers using a combination of Lupron plus HCG may improve egg maturity, and in select cases calcium ionophore applied to retrieved eggs may improve fertilization and embryo development. 

While not every one of these treatments would benefit every patient, judicious use as determined by the fertility physician may allow patients to have a successful outcome.  However, some strategies that were seemingly promising ultimately were found to be unhelpful; these include minimal or “mini” stimulation (mini IVF), injections of platelet rich plasma into the ovaries, and surgical ovarian fragmentation.

In the end, use of one’s own eggs may simply not be possible, and in that case biological families may be achieved with a high rate of success using egg or embryo donors

Myths and misperceptions are widely publicized with respect to this issue; we encourage a visit with one of our physicians to understand the realities and the options. To schedule your initial visit contact us today.