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.