Waiting for a good oocyte
Diminished ovarian reserve (DOR) is characterized by poor fertility outcomes even when assisted reproductive techniques (ART) are used and represents a major challenge in reproductive medicine. Although consensus exists on the concept of DOR, its definition remains blurry[8]. As a most popular theory on follicle recruitment and development, a foundation of ovarian stimulation is that FSH threshold determined number of antral follicles growing to mature follicle, by increasing the dosage of gonadotrophin, the recruit window of follicles has been enlarged [11], allowing more oocytes to be harvested in one cycle. But this may not be the case in DOR women because there are very few antral follicles to begin with, even less ones with good quality oocytes, the recruitment of a good quality oocyte in DOR patient is inconsistent, random and occasional. If heavy ovarian stimulation still can’t achieve expected number of follicles, down low the gonadotropins might be same. Keeping retrieval with minimal stimulation for several cycles, “waiting for a good oocyte (Graph 3)” strategy is acceptable.