Received April 04, 2013
Accepted May 26, 2013

Objective:We observed the menstrual cycle pattern of patients with low ovarian reserve in order to distinguish different stages of ovarian insufficiency. Once we were able to describe the different stages, we developed new treatment approaches for each patient group based on natural Cycle IVF. Methods:the menstrual cycle pattern of 10patients with AMH<1.0nmol/L were observed. Patients were 22–42 years old. Blood samples were drawn to determine AMH, FSH, LH, E2 and transvaginal ultrasound scans were performed on different days of the cycle. Depending on the cycle pattern of each patient, we offered individualized treatment approaches based on natural Cycle IVF using Clomifen citrate to control ovulation, GnRH agonists to induce ovulation and either Ethinyl-Estradiol or combined oral contraceptive pills to regulate the cycle. Embryos were vitrified in day 2stages and transferred later in artificial cycles. Patients were informed about off label use of the medication and informed consents were signed. Results:We could describe four different stages of ovarian insufficiency. We were able to perform oocyte retrievals and embryo transfers in all 10patients. A total of 33natural cycles were initiated. Premature ovulation occurred in 3 cycles(9.0%) and no retrieval was attempted. Among the attempted 30oocyte retrievals, 21(70.0%) were successful. Out of those 21oocytes 11(36.6%per/retrieval) were mature and 10 (33.3%per/retrieval) were immature. ICSI resulted in 8fertilizations (72.7%per/mature oocyte). Out of 8transfers, 3(37.5%) resulted in biochemical pregnancy. Two patients delivered(25.0%), one patient had a miscarriage at 8weeks of pregnancy. Conclusion:Our experience shows that ovulation can successfully be controlled by the use of Clomiphene citrate and does not necessarily require GnRH analogues for pituitary suppression.