Poor Ovarian Reserve

Highly personalised stimulations tailored to each patient's hormonal patterns

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    What is poor ovarian response?

    Ovarian response is understood as the number of mature oocytes obtained after an ovarian stimulation process. Generally, and while there is no consensus among the different scientific societies, the Bologna diagnosis criteria from the ESHRE (European Society of Human Reproduction and Embryology) adhered to by the Spanish Fertility Society establish that a woman is a low responder or has a poor ovarian response (POR) when at least two of the following circumstances concur, or when this poor response occurs after two maximum stimulation processes.

    • Maternal age ≥ 40 years, or any other risk factor for PR (surgery, endometriosis, chemotherapy, having only one ovary, etc.)
    • Poor ovarian response in a previous cycle. Specifically, having obtained three or fewer oocytes after conventional ovarian stimulation.
    • Ovarian reserve test with altered results indicating a low ovarian reserve such as an antral follicle count equal to or less than 5-7 or producing an Anti-Mullerian hormone blood value of less than 5 – 1.1 ng/ml).

    The Equipo Juana Crespo considers poor ovarian response to be when the result obtained from the ovary after ovarian stimulation is lower than expected, both in oocyte quantity and quality. Therefore, as specialists in highly complex reproductive medicine, we work with stimulations in highly controlled and personalised fashion, focusing on both quantity and quality.

    What is poor ovarian reserve?


    Ovarian reserve is the number or quantity of eggs a woman has in her ovaries.

    A woman is born with a finite number of eggs or ovarian reserve that is progressively reduced with each menstruation. The relationship between ovarian reserve and age is a determining factor in achieving pregnancy. Generally, the best age to become a mother is around 20 years old. From the age of 30 onwards, female fertility begins to decrease and, from the age of 35 onwards, this decrease becomes extremely pronounced. By 40, the chance of a natural pregnancy is only 5% in each cycle.

    Causes of Poor Ovarian Response

    The main cause of poor ovarian response is having a poor ovarian reserve mainly due to age. However, this is not the only cause. 

    • Age
    • Poor ovarian reserve due to genetic causes
    • Women with reduced ovarian mass due to chemotherapy, ovarian cysts, etc.
    • Endometriosis
    • Genetic causes
    • Lifestyle habits (smoking, alcohol, high exposure to toxic substances, etc.)

    Highly personalised stimulation strategy

    Although one of the main causes of poor ovarian reserve is age, some women are born with a lower number of oocytes or their loss is accelerated for reasons external to the ovary, such as surgery, infections, endometriosis, autoimmunity, etc.

    In any case, the result is that the biological age does not correspond to the ovarian age. Finding a fertility clinic able to establish the reason for the poor reserve, and its therapeutic approach and management, is not always easy.

    Equipo Juana Crespo works with the leading specialists to determine the most appropriate diagnosis. Only after doing so, are we able to develop and apply highly personalised stimulation strategies that make the difference. Our goal is to select the optimum cycle to ensure the best results.

    What does the ovarian stimulation strategy involve?

    We define a unique and exclusive treatment strategy for each patient, tailored to their causes and personal circumstances. 

    Identify the cause

    The first step in the strategy involves determining the cause. This may be due to different factors.

    Age and ovarian reserve are inversely related factors. Women are born with a genetically predetermined and fixed number of eggs that decreases throughout reproductive life with each menstrual cycle. Therefore, pregnancy rates decrease considerably with maternal age, as does the success rate of ovarian stimulation in assisted reproduction treatments.

    Immunity is a highly complex defence system of the organism against any type of aggression. On certain occasions, immunity is altered, attacking the ovary as if it were a foreign organ and creating autoantibodies against various parts of the female gonad, generating “early ovarian ageing”.

    This is a chronic and progressive disease that affects 10-15% of women of childbearing age. There is a positive association between endometriosis and infertility, which has multifactorial origins. This compromises the fertilization process. However, personalised stimulation treatments are designed for each of the mechanisms altered in endometriosis and, in addition to improving the number and quality of eggs, they offer an improvement in the general condition thanks to the special preparation focused on reducing the local and systemic inflammatory environment.

    Other less frequent causes include genetic, metabolic, infectious and even environmental, which could be associated with a decrease in a woman’s ovarian reserve.

    Once the cause has been identified, a strategy can be established to achieve the desired pregnancy.

    High complexity strategy and treatment.

    We are experienced in resolving cases considered impossible and/or highly complex. Our techniques are based on fully personalised diagnosis, treatments and even technology. Whether your case is complicated or simple, we will develop an action plan and medical guidelines tailored exclusively to you and your treatment.

    Unique procedures and protocols for each patient

    To achieve the desired result in poor responders, the Equipo Juana Crespo focuses on diagnosis, which provides detailed information concerning the patient’s case.

    We follow a personalised stimulation protocol to establish the most appropriate time to retrieve the eggs. The hormonal determination at the beginning of the menstrual cycle together with the ultrasound assessment of the ovary allows us to identify the pattern that the cycle will follow and to make the decision to start treatment only if optimal.

    Not all embryos are the same and the Equipo Juana Crespo knows that each embryo requires special care in the culture media.

    Fully personalised and can be performed in natural or replacement cycle. Endometrial preparation is one of the key factors for achieving pregnancy with poor ovarian reserve. It involves optimally preparing the woman’s endometrium so that its thickness, appearance, vascularisation, and other factors are adequate for the embryo to implant.

    Treatment for poor ovarian response

    Our strategy for treating poor ovarian response is based on different treatments. Depending on each case, we will recommend one of the following techniques:

    Revitalize is a medical procedure developed by Equipo Juana Crespo that improves egg quality and ovarian functionality. For women with poor ovarian reserve, it is especially indicated as it promotes the transition from primordial follicles (each woman’s innate ovarian reserve) to antral follicles (those susceptible to stimulation) and, therefore, facilitates the production of mature eggs.

    Consists of planning several cycles of highly personalised stimulation for the patient until an optimal number of oocytes is obtained, resulting in excellent quality embryos. These embryos are vitrified while the endometrium is prepared for embryo transfer.

    This strategy sees the patient undergo several ovarian stimulations but only one embryo transfer.

    Through this procedure and due to vitrification, patients can obtain enough embryos to perform a PGT in case of medical indication or even for a second pregnancy.

    Frequently Asked Questions

    Can ovarian reserves be increased?2023-01-12T11:00:50+02:00

    No. Unfortunately, a woman’s ovarian reserve cannot be increased. What can be improved through fertility treatments is the woman’s ovarian response. Specifically, the ovaries can be stimulated to obtain the highest number of mature eggs in the same menstrual cycle.

    Can I get pregnant even if I suffer from poor ovarian response?2023-01-12T11:01:10+02:00

    Poor ovarian response is not a synonym of infertility. While the odds are reduced, it doesn’t mean you can’t get pregnant.

    Is PGD useful for solving poor ovarian response?2023-01-12T11:01:26+02:00

    PGD is a test generally focused on detecting genetic abnormalities in embryos. It is not directly related to addressing the conditions conducive to poor ovarian response.

    What is the likelihood of successful pregnancy when facing poor ovarian reserve?2023-01-12T11:01:43+02:00

    Although ovarian reserve is not a determining fertility indicator, it is sometimes related to a woman’s chances of getting pregnant: generally, when the ovarian reserve is normal or high, the chances of a natural pregnancy are higher, while with a poor ovarian reserve, achieving a natural pregnancy is usually more complicated. A poor reserve diagnosis requires fertility planning.

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