Poor Ovarian Response in IVF: 7 Critical Facts to Know Before Your Next Cycle

1. Poor ovarian response is not exactly the same as low AMH

AMH is frequently discussed before IVF because it gives doctors useful information about the pool of follicles that may be available to respond to stimulation.

However:

low AMH ≠ no eggs

low AMH ≠ poor egg quality

low AMH ≠ zero chance of pregnancy

AMH is primarily an ovarian reserve marker.

ESHRE’s 2025 guideline specifically recommends AMH or AFC for predicting low and high responses to stimulation. It does not recommend AMH as a predictor of pregnancy or live birth.

This distinction matters enormously when discussing poor ovarian response in IVF. A patient may produce fewer eggs, yet one of those eggs may still form a viable embryo.

2. Why did only a few follicles grow despite a high dose of injections?

This is one of the most common questions after a disappointing stimulation cycle.

A higher medication dose does not necessarily make an unlimited number of follicles appear. IVF medications mainly stimulate follicles that are biologically available to respond during that cycle.

Factors potentially associated with a lower response include ovarian reserve, previous ovarian surgery, endometriosis involving the ovaries, prior chemotherapy or radiotherapy, removal of one ovary and individual differences between cycles.

Previous response to ovarian stimulation is therefore extremely useful information for your fertility specialist.

Sometimes the first IVF cycle also functions as a real-world assessment of how your ovaries respond.

3. Does poor ovarian response mean poor egg quality?

Not necessarily.

Egg quantity and egg quality are related concepts, but they are not identical.

Ovarian reserve describes mainly the number of remaining eggs and the expected ovarian response.

Egg quality is more closely associated with an egg’s ability to complete maturation, fertilise normally and support embryo development. Maternal age becomes particularly important here.

A person may retrieve relatively few eggs but still obtain mature eggs and embryos.

Conversely, someone with a high egg yield may still experience problems with maturity, fertilisation or embryo development.

This is why reviewing an IVF cycle should not stop at:

“How many eggs did I retrieve?”

It should examine the entire sequence:

follicles → eggs retrieved → mature MII eggs → fertilisation → Day 3 embryos → blastocysts → embryo quality/genetic status where applicable.

4. What should be reviewed after a poor-response IVF cycle?

After poor ovarian response in IVF, the next consultation is an opportunity to analyse what actually happened rather than simply repeating the same protocol.

Useful questions include:

How many follicles were seen before stimulation?

Compare this with the final number recruited.

What was the starting AFC?

What was the AMH?

How many follicles reached an appropriate size?

How many oocytes were retrieved?

How many were mature?

Was the response similar on both ovaries?

Was there previous ovarian surgery or an endometrioma?

How did you respond during previous IVF cycles?

Your fertility specialist can then decide whether changes to medication type, dose, stimulation protocol or timing should be considered.

There is no single “best IVF protocol” for every patient with a lower response.

5. Can lifestyle or supplements make the ovaries produce more eggs?

This needs a careful answer.

There is currently no diet, supplement, acupuncture protocol or herbal medicine that has been proven to restore the ovarian reserve or manufacture a new supply of eggs.

Be especially cautious of claims that something can “increase AMH dramatically”, “reverse ovarian ageing” or guarantee more eggs.

That does not mean health before IVF is irrelevant.

Preparing for treatment may still reasonably include addressing smoking, alcohol intake, sleep, nutrition, metabolic health, underlying medical conditions and significant deficiencies after discussing these with your healthcare team.

But these should be viewed as optimising overall health around fertility treatment, not as a promise that ovarian reserve can be reversed.

6. Where can TCM and acupuncture fit?

For patients experiencing poor ovarian response in IVF, TCM should be positioned as complementary care rather than a replacement for reproductive medicine.

At EMW TCM, fertility care may include an individual TCM assessment, acupuncture and, where appropriate, Chinese herbal medicine after reviewing the patient’s fertility history and current IVF timeline.

The goals should be realistic.

We do not claim that acupuncture creates new eggs, reverses diminished ovarian reserve or guarantees additional follicles.

Instead, some patients choose complementary TCM care while preparing for IVF to support their broader health, menstrual wellbeing, sleep and stress regulation alongside their fertility specialist’s medical treatment.

Patients undergoing IVF should always tell both their fertility doctor and TCM physician about medications and supplements they are using.

7. When should you discuss poor ovarian response with your fertility specialist?

You don’t necessarily need to wait until several unsuccessful cycles.

A detailed discussion may be particularly useful if:

your first stimulation produced substantially fewer follicles than expected, your AMH or AFC suggests diminished ovarian reserve, you have had ovarian surgery, you have endometriosis involving the ovaries, one ovary is absent or significantly smaller, you previously received chemotherapy/radiotherapy, or repeated IVF cycles show a similar low response.

ASRM also highlights factors such as chemotherapy, radiation and other conditions associated with diminished ovarian reserve as reasons fertility evaluation may need to begin without delay.