Received November 16, 2013
Accepted November 16, 2013

OBJECTIVES: Patients with low ovarian reserve are difficult to manage and have a relatively poor prognosis. METHODS: In 2012, the menstrual cycle pattern of 10 patients with AMH<1.0 nmol/L was observed. Patients were 22 – 42 years old (average 39.3). Blood samples determined AMH, FSH, LH, E2 and transvaginal ultrasound scans were performed on different days of the cycle. Depending on these patterns, we offered individualized treatment based on Natural Cycle IVF using Clomifen citrate, GnRH agonists and either EE or COC to regulate the cycle. Embryos were vitrified on day 2 and transferred later in artificial cycles. RESULTS: We found 4 different stages of ovarian insufficiency and performed oocyte retrievals and embryo transfers in all patients within 33 natural initiated cycles. Premature ovulation occurred in 3 cycles (9.0%) with no attempted retrieval. Among the 30 retrievals, 21(70.0%) were successful. Out of those 21 oocytes, 11(36.6% per retrieval) were mature and 10(33.3%) immature. ICSI resulted in 8 fertilizations (72.7% per mature oocyte). Out of 8 transfers, 3(37.5%) resulted in biochemical pregnancy. Two patients delivered (25.0%), one patient had a 8-weeks pregnancy miscarriage. CONCLUSION: These patients can successfully be controlled by Clomiphene citrate and not necessarily require pituitary suppression. This opens space for alternative protocols before egg donation.