One of the most challenging problems in assisted reproduction today involves cases in which the use of medications designed to trigger the release of multiple eggs at once does not seem to be effective. The final number of eggs retrieved remains low, and uncertainty about the next steps grows. This poor ovarian response, as it is termed in medical terminology, is associated with a diminished egg reserve and occurs more frequently with advancing age.

The likelihood of IVF success depends largely on the number of mature eggs retrieved during egg retrieval and, ultimately, on the likelihood of forming at least one blastocyst with a normal number of chromosomes.

Various methods have been used to increase the number of oocytes in these cases, either by modifying ovarian stimulation protocols, by adding medications to stimulate follicle maturation, or, finally, by intervening in the ovarian microenvironment.

A recent literature review* examined the effectiveness of the methods used to improve the number of eggs retrieved. It evaluated the data available to date but did not identify any benefit from the strategies described. The sole exception is egg retrieval from consecutive cycles and multiple egg retrievals, a proven strategy for managing this challenging situation.

Specifically, the researchers found that neither increased medication dosages nor the supplemental use of androgenic hormones, such as DHEA and testosterone, helped increase the final number of eggs retrieved during oocyte retrieval, while the strategy of dual egg retrieval within the same cycle—also known as “duo stimulation”—although useful for collecting eggs in a shorter period of time, did not appear to offer any benefit in terms of the final outcome.

Also significant was the finding that intra-ovarian injection of platelet-rich plasma (PRP), also known as ovarian rejuvenation, did not lead to improved ovarian function or a higher likelihood of pregnancy. Although the number of eggs sometimes improved in consecutive egg retrievals, the study attributed these changes to possible cycle-to-cycle variations, or even to the stimulation process itself, regardless of any other accompanying procedures.

Collecting oocytes from consecutive cycles with the goal of accumulating a sufficient number of fertilized oocytes remains the only effective strategy for managing cases of low oocyte reserve, with a poor response to ovarian stimulation. To date, the generation of new oocytes, the mobilization of dormant follicles, and, more generally, efforts to reverse ovarian decline remain areas of intense research, but without proven benefits from their application in clinical practice.

*Horton M, Beccar Varela J, Kopcow L. Possible therapeutic options for enhancing the number of oocytes in poor ovarian responders. Fertil Steril. 2026;126(2):230–236. doi:10.1016/j.fertnstert.2026.06.025