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BACKGROUND: There is no consensual definition of diminished ovarian reserve and the best therapeutic strategy has not yet been demonstrated. METHODS: We performed a retrospective study to evaluate outcomes following a first in-vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycle in young women with diminished ovarian reserve. Women with tubal factor, endometriosis or previous stimulation cycle were excluded. We defined diminished ovarian reserve as women ≤38 years with an AMH ≤1.1 ng/mL or antral follicular count ≤7. RESULTS: Among 59 IVF/ICSI cycles (40% IVF/60% ICS1), the pregnancy rate was 17% (10/59) and live birth rate 8.5% (5/59). Miscarriage rate was 50%. Baseline characteristics and IVF outcomes of the pregnant and not pregnant women were compared. No differences in age, antral follicular count, AMH, protocol used or number of harvested oocytes were found between the groups. A higher gonadotropin starting dose in the pregnancy group (397.5±87 IU vs. 314.8± 103 IU; P=0.02) and a trend to a higher total dose received (4720± 1349 IU vs. 387U1367 IU; P=0.07) were noted. CONCLUSIONS: The present study confirms that women with diminished ovarian reserve have low live birth rates after a first IVF-ICSI cycle and that a higher gonadotropin starting dose might be associated with better outcomes. [ABSTRACT FROM AUTHOR]