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The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
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InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
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Obstetrics and Gynegology2026№10

Comparative analysis of the effectiveness of assisted reproductive technology protocols in patients with low ovarian reserve: strategies, efficiency and a personalized approach

DOI
https://dx.doi.org/10.18565/aig.2025.378

Karmazina A.A., Sulima A.N.

Order of the Labor Red Banner Medical Institute named after S.I. Georgievsky, V.I. Vernadsky Сrimean Federal University, Simpheropol, Russia

Low ovarian reserve is recognized as one of the key prognostic markers for reduced success rates in assisted reproductive technology (ART) cycles. A comparative analysis of controlled ovarian stimulation protocols demonstrates that there is no universal algorithm for this heterogeneous cohort of patients. A protocol based on gonadotropin-releasing hormone (GnRH) antagonists is the gold standard for most patients due to the low risk of ovarian hyperstimulation syndrome (OHSS) and the optimal balance of manageability and efficacy. However, for patients with extremely low ovarian reserve (anti-Müllerian hormone <0.5 ng/ml), a minimal stimulation strategy or a modified natural cycle aimed at the selective retrieval of single oocytes under conditions of minimal exogenous hormonal exposure is associated with a comparable live birth rate when used repeatedly, but with significantly lower pharmacological and financial burden.
Conclusion. The choice of stimulation protocol in low ovarian reserve should be strictly individualized based on a range of parameters: age, ovarian reserve, medical history, and reproductive status. The current paradigm is shifting away from standardized, aggressive stimulation with high doses of gonadotropins towards a series of sequential, less invasive cycles, the ultimate aim of which is not to maximize the number of oocytes, but rather the quality and accumulation of euploid embryos, which statistically significantly increases the likelihood of achieving a live birth in this group of patients.

Authors’ contributions. Sulima A.N. – developing the concept and design of the study, editing the article; Karmazina A.A. – collecting and processing the material, writing the text.
Conflicts of interest. Authors declare lack of the possible conflicts of interests.
Funding. The work was carried out without financial support. 
Generative Artificial Intelligence. No generative artificial intelligence technologies were used in the preparation of this article.
For citation: Karmazina A.A., Sulima A.N. Comparative analysis of the effectiveness of assisted reproductive technology protocols in patients with low ovarian reserve: strategies, efficiency and a personalized approach.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (10): 12-19 (in Russian)
https://dx.doi.org/10.18565/aig.2025.378

Keywords

low ovarian reserve
controlled ovarian stimulation
assisted reproductive technologies
in vitro fertilization
adjuvant therapy
strategies
effectiveness
approaches
Full text (in Russian)

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Received 19.12.2025

Accepted 11.09.2026

About the Authors

Alexandra A. Karmazina, PhD student at the Department of Surgery No. 2, Department of Obstetrics, Gynecology and Perinatology No. 1, Order of the Labor Red Banner Medical Institute named after S.I. Georgievsky of V.I. Vernadsky Сrimean Federal University, Ministry of Higher Education and Science of the Russian Federation,
295051, Russia, Simferopol, Lenin Blvd., 5/7, +7(978)750-01-98, sasha.potemka@mail.ru, https://orcid.org/0009-007-0987-2840
Anna N. Sulima, Dr. Med. Sci., Professor at the Department of Obstetrics, Gynecology and Perinatology No. 1, Order of the Labor Red Banner Medical Institute named after S.I. Georgievsky of V.I. Vernadsky Сrimean Federal University, Ministry of Higher Education and Science of the Russian Federation, 295051, Russia, Simferopol, Lenin Blvd., 5/7, +7(978)764-82-00, gsulima@yandex.ru, https://orcid.org/0000-0002-2671-6985
Corresponding author: Anna N. Sulima, gsulima@yandex.ru

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