Ovarian responsiveness to gonadotropins: The influence of ovarian ageing and genetics

A central theme emerging from this thesis is that ovarian ageing and ovarian responsiveness are the result of a complex interplay between follicle quantity, oocyte quality, endocrine regulation, and genetic variation. While ovarian reserve tests inform expectations regarding stimulation outcomes, they do not solely determine reproductive potential. Similarly, although genetic variants in FSHR modulate ovarian sensitivity, they do not significantly influence live birth outcomes nor justify routine dose escalation. The studies presented in this thesis further demonstrate that diminished ovarian reserve does not equate to a lack of functional ovarian responsiveness. Overall, the findings support a cautious, individualized, and evidence-based approach to ovarian stimulation, in which age, ovarian reserve, and biological variability are jointly considered, rather than relying on single biomarkers or empiric dose escalation.