IVF in women with low ovarian reserve or response

In vitro fertilisation (IVF) has revolutionised infertility treatment and offers each year hope to millions of couples worldwide. Embryo freezing has become an increasingly prominent part of the treatment. While initially used for the storing of excess embryos after fresh embryo transfers, the so called freeze-all strategy has now become part of IVF, where no fresh transfer and all suitable embryos are frozen for transfer in subsequent menstrual cycles. In a linked research paper, Wei and colleagues (doi:10.1136/bmj-2024-081474) studied the effectiveness of this strategy in women who have a poor prognosis of IVF treatment success (defined as nine or fewer oocytes retrieved or a poor ovarian reserve).1

One benefit of the freeze-all method is the ability to reduce the risk of ovarian hyperstimulation syndrome; although, this risk is generally low in women with poor prognosis owing to a low ovarian response. Another rationale for the freeze-all strategy is to improve pregnancy outcomes by avoiding potential negative effects of ovarian stimulation on endometrial receptivity. …