Oocyte quality in women with diminished ovarian reserve: not as poor as assumed

How does diminished ovarian reserve (DOR) affect euploid blastocyst rates, and how many embryos need to be biopsied for women with or without DOR to achieve one euploid embryo?

A retrospective study was conducted at a single reproductive centre, involving 694 women (126 with and 568 without DOR) undergoing 803 preimplantation genetic testing for aneuploidies (PGT-A) cycles from 2016 to 2024. DOR was defined as a concentration of anti-Müllerian hormone below 1.1 ng/ml and/or an antral follicle count of less than 7. Participants were stratified by age into three groups: <35, 35-39 and >39 years. Euploidy rates and pregnancy outcomes were compared between the DOR and non-DOR groups. Cumulative euploid embryo acquisition was analysed.

DOR patients showed comparable euploidy rates to their non-DOR counterparts. The number of embryos required to obtain a euploid embryo was a: for age <35 years, a mean of 1.6 embryos for the DOR group and 1.7 for the non-DOR group; for age 35-39 years, a mean of 1.9 and 2.3 embryos, respectively; and for age >39 years, a mean of 7.2 and 4.2 embryos, respectively. In women over aged 39 years, the mean number of euploid embryos obtained remained low even after two retrievals for both groups. Pregnancy outcomes after euploid embryo transfer were similar between the two groups.

Participants with DOR had similar euploidy rates and pregnancy outcomes to non-DOR patients. Limited embryo quantity, rather than inferior oocyte quality, thus remains the predominant challenge for individuals with DOR.