Poor Ovarian Reserve: How Can It Be Treated?

Poor ovarian reserve (POR), also called diminished ovarian reserve (DOR), means the ovaries contain fewer eggs than expected for a woman’s age. It’s tied primarily to aging and can’t be reversed. Treatment doesn’t bring eggs back. It works with what’s left: IVF using high-dose FSH or mini-IVF, supplements like DHEA and CoQ10 to support what egg quality remains, and donor eggs when own-egg cycles aren’t giving results.

According to Dr. Prajna Shetty, an experienced fertility specialist in Nerul, Poor ovarian reserve means we’re working with a smaller window, but a smaller window isn’t a closed one the right protocol and timing make a real difference to what’s retrievable.

Several things can drive reserve down, and age isn’t always the culprit.

• Age-related decline: Egg count drops naturally through the thirties and forties, but some women hit this earlier than expected because of genetics or conditions that speed up follicle loss well before they’d typically appear.
• Autoimmune factors: Sometimes the immune system attacks ovarian tissue directly. It’s not common, but when it happens, follicles can deplete fast, even in women in their late twenties with no other obvious issues.
• Past surgeries: Ovarian procedures, especially those for endometriomas or cysts, can take out more functional tissue than intended. AMH often drops measurably in the months after, and that loss doesn’t come back.
• No clear reason: Quite a few patients don’t fit neatly into any category. Their numbers are low, but there’s no identifiable cause. Frustrating, yes. But it also means their actual response to stimulation sometimes beats what the blood test suggested.

If you’ve been through multiple failed cycles or you’re seeing consistently low AMH on repeated tests, getting an ovarian reserve evaluation is the clearest next step.

Options vary significantly depending on how low the reserve is and what else is going on clinically.

• High-dose FSH or mini-IVF: Standard stimulation doesn’t work well for poor responders. High-dose FSH pushes harder to recruit what follicles are available, while mini-IVF takes the opposite approach, using lower doses to collect fewer but potentially better-quality eggs from a depleted pool.
• DHEA and CoQ10: Both are backed by decent evidence for poor ovarian reserve specifically. DHEA supports androgen levels that follicles need to mature, and CoQ10 targets mitochondrial function inside the egg itself. Most doctors run these 12 weeks before an IVF cycle to get the full benefit.
• PRP ovarian rejuvenation: Platelet-rich plasma gets injected into ovarian tissue under ultrasound guidance to try to wake up dormant follicles. It’s still an emerging technique. Not every patient qualifies, and results vary, but some women with very low reserve have seen follicle activity that wasn’t there before.
• Donor eggs: When own-egg cycles keep failing or AMH is critically low, donor egg IVF is often the most practical path. Success rates are consistently higher than own-egg IVF in poor responders, and the process uses eggs from a screened, matched donor.

Our blog on low AMH and natural pregnancy is worth reading if you want to understand where natural conception sits as an option before going straight to IVF.

Dr. Prajna Shetty has 15+ years in reproductive medicine, an FNB in Reproductive Medicine, and is an active member of ESHRE and ISAR. Her clinical work centres on the harder cases: poor ovarian reserve, recurrent IVF failure, RPL, and oncofertility. That focus shows in how protocols actually get built here, not off a template.

What patients consistently mention is the specificity. Not a general overview of their situation, but a real conversation about what their AMH number, follicle count, and stimulation history actually mean for the options in front of them. That clarity matters when you’re making decisions this significant.

References:

1. Diminished Ovarian Reserve — Clinical Overview — National Library of Medicine
2. Poor Ovarian Response Guidelines — ESHRE