(1) women that strongly prefer using their own eggs over Donor Egg IVF,
(2) women with decreased ovarian reserve,
(3) older women, and
(4) women with a prior poor response to ovarian stimulation medication.
A woman’s ability to develop multiple follicles and multiple mature eggs in response to the administration of ovarian stimulation medication appears to be related to the overall number of viable eggs (eggs capable of resulting in a pregnancy) remaining within her ovaries; which are often referred to as her “ovarian reserve.”
Women are born with all of their eggs already contained within their ovaries (meaning that additional eggs are not produced over a woman’s lifetime), these viable eggs are “used up” throughout the reproductive years, and when the viable eggs have been exhausted then menopause approaches and occurs. Women with diminished or decreased ovarian reserve can still produce mature viable eggs capable of resulting in a pregnancy, however, their menstrual cycles may become increasingly irregular (difficult to predict) and their response to ovarian stimulation medication may be limited.
Women with a decreased ovarian reserve, older women and women with a history of poor response to ovarian stimulation medication will generally not respond well to the very high doses of stimulation medication that are used in conventional IVF. The IVF center’s usual response to this (in the USA) is to insist that the woman undergo donor egg IVF (using a different woman’s eggs) if she wants to undergo IVF. It seems that these women are generally not given a chance at IVF with their own eggs largely because (1) women with decreased ovarian reserve and/or poor responders have a reduced chance of successfully becoming pregnant with their own eggs when compared to other available age matched IVF candidates; and (2) the pregnancy and live birth rates (per IVF cycle start, per egg retrieval and/or per embryo transfer) for an IVF center are commonly used variables to compare and evaluate different IVF centers in the USA (so most IVF centers are very protective of their success rates).
In several other countries around the world there is less of an intense mono-focus on pregnancy success rates and more of a focus on patient interests, cost containment, risk reduction, and development of new medication protocols that accomplish these goals while offering acceptable pregnancy and live birth success rates. Mild (minimal stimulation) IVF protocols have been developed that reportedly have similar or improved pregnancy success rates in this group of women compared to conventional IVF, often at a much lower overall cost to the patient. This also allows a woman to use her own eggs for conception, which is very important for many couples.