Low ovarian reserve in assisted reproduction

Reduced antral follicle count and low AMH in a woman preparing for IVF or other assisted reproduction. Stimulation prognosis is worse: fewer oocytes, higher cycle cancellation rate. ESHRE 2019 lists DHEA as a conditional add-on in confirmed DOR – evidence quality is low, the reproductive specialist decides on an individual basis.

ICD-10 E28.31 drug

Also known as: Diminished ovarian reserve (DOR), Low AMH in IVF, Poor ovarian response

Drugs used for this condition

CDehydroepiandrosterone (DHEA, prasterone)Add-on therapy · Endogenous C19 steroid precursor; an EU prescription drug for adrenal insufficiency and a vaginal form (Intrarosa); a freely available supplement in the United StatesDHEA is a conditional add-on in low ovarian reserve before IVF. ESHRE 2019 permits 75 mg/day for 6–12 weeks before stimulation in women with confirmed DOR (low AMH, low AFC). Evidence quality is low: Cochrane 2015 noted moderate increases in oocyte yield and clinical pregnancies, but study bias remains high. The reproductive specialist decides individually. Self-prescribing DHEA «for fertility» without confirmed DOR is not justified: the drug converts to testosterone and may worsen acne and hirsutism.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit