Low Ovarian Reserve & PRP Treatment at Yaal Fertility Centre, Chennai

Every woman is born with a fixed, non-renewable supply of eggs, and that supply declines throughout life — most rapidly in the years leading up to menopause. Diminished ovarian reserve describes a supply lower than typically expected for a given age, identified through two main tests.

AMH (Anti-Müllerian Hormone) is a blood test that correlates with the number of small follicles remaining in the ovaries, and can be taken on any day of the menstrual cycle. Antral follicle count is a direct count, on ultrasound, of the small follicles visible in the ovaries at the start of a cycle. Used together, these give a reasonably reliable picture of remaining egg quantity.

It is important to separate quantity from quality. A lower reserve means fewer eggs are available to work with in any given cycle, and often a lower response to the medications used to stimulate multiple eggs to develop. It does not automatically mean the eggs that remain are of lower quality — though quality, like quantity, does decline with age, and the two effects can compound in older women with a diminished reserve.

Once diminished ovarian reserve is identified, the evaluation looks for a cause, because the cause can affect both prognosis and the conversation about options.

• Age-related decline is confirmed simply by the pattern being consistent with what is expected at that age, and is by far the most common finding.
• Genetic testing may be considered, particularly where reserve is significantly reduced at a younger age than expected, since certain genetic factors are associated with earlier decline.
• History of ovarian surgery — for endometriosis, an ovarian cyst, or other conditions — can reduce reserve, since ovarian tissue is inevitably affected during such procedures.
• History of chemotherapy or radiotherapy is reviewed, since these treatments can be directly toxic to the remaining egg supply.
• Idiopathic diminished ovarian reserve — where no cause is found despite investigation — is common, and does not change the practical management, only the counselling around it.

Where a woman with diminished ovarian reserve chooses to proceed with IVF using her own eggs, the approach to ovarian stimulation is typically adjusted specifically for a lower expected response. This can include a different choice or higher dose of stimulation medication, a different protocol timing, or, in some cases, strategies that combine eggs collected across more than one stimulation cycle before proceeding to fertilisation, in order to build up a workable number of eggs.

The realistic goal in this situation is often different from a standard IVF cycle: rather than aiming for a large number of eggs, the aim is to retrieve as many good-quality eggs as the reserve realistically allows, and to give each one the best possible chance in the laboratory. This is also why timing matters more here than in many other fertility situations — because reserve continues to decline, delay itself has a cost, and this is generally discussed candidly rather than left unsaid.

Even with an optimised protocol, IVF success with a significantly diminished reserve is, on average, lower per cycle than IVF with a normal reserve, particularly in older women where reduced reserve and reduced egg quality often occur together. This is a difficult reality, and it is exactly why the full range of options — including donor eggs — is part of an honest conversation rather than a last resort raised only after repeated disappointment.

For some women — particularly those with a very significantly reduced reserve, an early or premature reduction at a younger age, or repeated cycles yielding few or no usable embryos — donor eggs offer a materially better chance of success than continuing with their own eggs. This is because donor eggs come from young, screened donors with a normal reserve and good egg quality, which removes the limiting factor entirely.

This is rarely an easy conversation, and it is not one we introduce lightly or use to discourage a woman from trying with her own eggs where that remains reasonable. But when the evidence from testing and, sometimes, from a prior cycle points clearly in this direction, we believe an honest conversation early is a kindness rather than a discouragement — it allows a woman to make a fully informed decision about her own path, on her own timeline. Our donor programs page covers this option, including the screening process and the legal framework, in full.

Platelet-Rich Plasma (PRP) ovarian therapy — sometimes called ovarian rejuvenation — involves injecting a concentrated preparation of a woman’s own platelets, derived from her blood, directly into the ovarian tissue. The proposed idea is that growth factors released by the platelets might stimulate remaining follicles or improve the ovarian environment, potentially improving egg yield or quality in a subsequent IVF cycle.

It is important to be direct about where the evidence currently stands. Intraovarian PRP is not, at this time, an established, first-line, or universally evidence-backed treatment for diminished ovarian reserve. The research published so far is limited in scale, varies significantly in method, and reports mixed results — some studies suggest a possible benefit in follicle count or response in certain women, while others show no meaningful effect. Long-term safety data and large, well-designed trials confirming genuine benefit for live birth rates are not yet available. Major reproductive medicine bodies generally describe ovarian PRP as experimental or investigational rather than as a proven therapy, and it should be discussed and understood in exactly those terms — as a possible option under active study, not a reliable fix for a low ovarian reserve.

If PRP is something you are considering, the right questions to ask any clinic offering it are: what evidence supports it for your specific situation, what outcome can realistically be expected, what the procedure and any risks involve, and how it compares honestly against simply proceeding with an optimised IVF cycle or considering donor eggs. Any recommendation for PRP should come with those honest caveats attached, not as a substitute for that conversation.