Hi Dr. Ramirez,

I am 32 y.o. woman and have been trying to conceive for 3 years. All testing was normal, although FSH was 8.7.

My first IVF on a long protocol produced only 2 eggs and only 1 fertilized. I was diagnosed with DOR at that time (31 years old). I had 2 other failed IVF that produced 6-7 eggs but only 2-3 by day 3. I had a miscarriage after the second one.

My question is, are there any tests you would recommend for someone my age with DOR and failed IVF x 3? I never have enough embryos to get to day 5 blastocyst so I am not able to do PGD. Also, would you suggest a laparoscopy for unexplained DOR? I have a family history of endometriosis, but I have been told that a laparoscopy might further decrease my ovarian reserve. Thank you so much for your time, it is greatly appreciated!

Heidi from Ontario

Hello Heidi from Canada,

Certainly based on the numbers you have provided, your ovaries have not stimulated well.  This could be "decreased ovarian reserve" and we also call you a poor responder.  However, before giving you that title, I would need to see what kind of stimulation protocol you were one.  Often the stimulation will be proportionate to the amount of medication taken.  So if you were on a lower protocol, you would not get many follicles or eggs, whereas, if you were on a high protocol then you would have gotten more unless you were a low responder due to decreased ovarian reserve.

There are no other tests that I would suggest or recommend.  If you puruse the internet, you will see tests such as AMH and Antral follicle count but these would only confirm what you already know, that your ovaries don't respond well to stimulation (again I am assuming you were on a high protocol).  Laparoscopy will do nothing for you whether or not you had endometriosis.  Endometriosis does not lead to poor ovarian reserve.

I'm a little baffled by your result of stimulation, however, because you are so young and your FSH is not that high.  I'm wondering if maybe your doctor just didn't give you a high enough protocol?

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at if you are interested in continuous access to me.


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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