There is an increasing proportion of older couples seeking fertility help worldwide. It is estimated that 20% of ART cycles currently performed in Europe and USA are in women 40 years and older. More than half of all treatments in Australia are in women above 35 years of age. With this trend, ART practitioners are facing more couples with low ovarian reserves and poor ovarian response during the ART treatments. Since the introduction of the Bologna criteria for poor ovarian responders (POR) it has helped clinicians to identify this group of challenging patients. It has also improved standardizations and terminology for research which previously were of small sample sizes and of heterogeneous populations. A brief review of some of the currently practiced strategies that may be of benefit for POR which include minimal stimulation with Clomiphene, “mixed Gonadotrophin” protocols and the additions of Growth Hormone. Newer strategies that have been proposed include Dual Stimulation and Dual Ovulation Trigger strategies. Principles of management of the couple with futile prognosis will also be presented.

Future trends to preserve the fertility of women at risk of premature menopause such as Elective Oocyte Freezing have been proposed. Ground-breaking research into “recharging” mitochondria of poor-quality oocytes, In-Vitro Activation of dormant .ovarian follicles and production of oocytes from pluripotent stem cells may bring hope in the future for women at/near the end of their reproductive period.

Conclusion: Woman of increasing age and lower egg reserves represent the majority of Poor Ovarian Responders (POR) which in turn have a poor prognosis of achieving conception and livebirths. This is clinically challenging as current data into strategies for POR is both lacking and confusing. Future more robust studies with larger study cohorts are needed before they can be of clinical usefulness. Exciting progress is being made in experimental techniques to extend a woman’s reproductive opportunities.