The management and treatment of women with poor ovarian reserve (POR) is a challenging clinical situation with prevalence estimated to be between 9 and 24%. Importantly, egg quantity and quality seem to be compromised in this POR population. The aged oocytes tend to give rise to errors in cell division, leading to higher rates of aneuploidy and congenital malformations. The remedy to resultant infertility is either in-vitro fertilization (IVF) treatment with donor oocyte or adoption. 

Off-late attempts to rejuvenate ovarian function are being made and are under investigation to avoid these events. The use of Autologous Bone Marrow-derived  Mononuclear Stem Cells (ABMMSC) is one such modality, which might prove promising in these cases. Bone marrow-derived mononuclear cells (MNCs) form a promising option of cell therapy for regenerative medicine because they can be rapidly isolated from patients after a bone marrow aspiration, do not require culture, and therefore permit autologous applications. The available data on the efficacy of stem cells primarily come from preclinical studies and a few observational clinical studies. Autologous platelet-rich plasma is another novel, regenerative approach for enhancing ovarian function and folliculogenesis with ample evidence. 

With this background, this study is being proposed to explore the efficacy of autologous bone marrow-derived stem cells for the rejuvenation of ovaries in females with POR in terms of restoration of ovarian function by improved folliculogenesis, steroidogenesis, menstrual function, and fertility status. This non-inferiority RCT will assess and compare the two approaches for managing Poor Ovarian reserve. 

This might provide a potential treatment option for infertile females with poor ovarian reserve (POR) by providing them with an opportunity for improvement in hormonal profile, symptomatic relief in menstrual symptoms and above all possibility to have their biological offspring.