Diminished ovarian reserve (DOR) is defined as a decrease in the number, quality, and quantity of oocytes. It is used to describe women of reproductive age whose response to stimulation or fecundity is reduced compared to women of comparable age. It is associated with poor ovarian response to ovarian stimulation, higher cycle cancellation rates, and lower pregnancy rates during IVF. The ovarian reserve tests (ORTs) should not be used as a sole criterion to deny Assisted Reproductive Technology (ART) or other treatments to any patients. If ORTs indicate a diminshed ovarian reserve, it means that pregnancy is less likely but not impossible. Various treatment regimens have been designed to manage the patients with DOR and include high dose of gonadotropins, natural and modified natural cycles, estrogen priming, supplementation with LH, luteal antagonist and letrozole co-treatment, use of adjuncts like androgens, growth hormone, melatonin, and aspirin, as well as oocyte donation and assisted hatching. The newer approaches in poor responders include ovarian transplantation, mitochondrial transfer and stem cell based neo-oogenesis, but more research is needed to establish the role of these approaches. Pregnancy rates are, however, poor and often these patients require oocyte donation. The one thing certain about DOR is that it is irreversible and that these women are at risk of poor ovarian response to ovarian stimulation in ART. It is one of the leading causes of infertility in women today. However, many women with DOR may conceive with their own oocytes, if they are given individualized treatment that is tailored for their profile.