When individuals or couples wish to build a family but face decreased ovarian reserve, the severity of this condition is first quantitatively assessed. This evaluation typically involves blood tests, including anti-mullerian hormone (AMH) and follicle-stimulating hormone (FSH), alongside an ultrasound to count antral follicles in the ovaries. Treatment recommendations are tailored to the degree of decrease and the patient's age. For a mild reduction, intrauterine insemination (IUI) may be suggested. If the decrease is more severe, or if the patient is older, in vitro fertilization (IVF) might be recommended as a more aggressive option, requiring an individualized discussion. In instances of very advanced age, generally over 45, or extremely severe ovarian reserve depletion, egg or embryo donation are discussed as family-building alternatives.