Introduction: The scope of the problem with diminished ovarian reserve

The observation throughout the recorded human history confirmed that the fecundability and the fecundity rates decline with advancing female age. It seems that fertility decline in females may start as early as the late 20s to early 30s. Female age is the most important factor for achieving live birth with assisted reproductive technologies. Many women also postpone pregnancy due to various factors as evidenced by the registry data that the age of first birth in women is increasing around the globe. Hence, many such women are attempting conception during their reproductive years when steep fertility decline is expected. This fertility decline with aging is commonly associated with diminished ovarian reserve (DOR) and diminished oocyte/embryo quality. Since the controlled ovarian stimulations became a norm in assisted reproductive technology (ART) cycles, it has been realized that some women just do not respond well to ovarian stimulation. Therefore, poor ovarian response (POR) generalization has been proposed in order to unify such criteria for relevant studies. The Bologna criteria is based on response to maximum dose conventional stimulation, advanced reproductive age at or above 40, somewhat wide ranges of ovarian reserve markers, and prior history of POR. Recently, another POR criteria was proposed by POSEIDON group bringing somewhat more individualization, focusing on prognosis. Many such women are in fact suffering from DOR and show various prognoses.