As women age, their response to ovulation induction is progressively diminished due to the continuous depletion of primordial follicles and to changes in the ovarian endocrine/paracrine microenvironment. While many couples faced with the reality of a diagnosis of low functional ovarian reserve may turn to the use of donor gametes to achieve a pregnancy, some still feel the need to try on their own, despite a poor prognosis. For such women careful preparation and hormonal priming in the months prior to beginning an IVF cycle can increase their chance of a successful outcome. Optimal treatment of these patients differs from the usual treatment of women with normal ovarian reserve in every aspect and needs to be highly individualized.

Because studies of older and, otherwise, unfavorable patients going through in vitro fertilization (IVF) treatments with own (autologous) oocytes are sparse, we here present to a large degree the subjective experience of only one fertility center in New York City, which as of this point contributed a majority of published studies on this subject. As US national IVF data registries by the Center for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technologies (SART) demonstrate, this center serves the by-far oldest patient population among over 500 reporting US IVF centers and, therefore, likely the oldest patient population of any IVF center in the world. While the median age of all US centers reporting to the CDC in 2016 was 36 years, this center’s median age was 42 years in 2016 and 43 years in 2017 and 2018. Over 90 percent of the center’s new patients in recent years reported prior failed IVF cycles, often at multiple centers. Over half of the center’s patients are so-called long-distance patients from outside the larger New York City Tri-State area, many from Canada and overseas. Finally, in excess of 95 percent of the center’s patients suffer from LFOR, which means that even younger patients usually demonstrate abnormally high age-specific follicle-stimulating hormone (FSH) and abnormally low anti-Müllerian hormone (AMH). This center, thus, overall, likely, serves the poorest-prognosis patient population of any IVF center in the world.