Purpose: To determine the relative confounding effect of diminished oocyte reserve on the chance of successful pregnancy in nonin vitro fertilization-embryo transfer (IVF-ET) cycles. Materials and Methods: Matched controlled study comparing pregnancy outcome in women aged ≤ 37 years with severely decreased oocyte reserve as manifested by a day 3 serum follicle stimulating hormone (FSH) ≥ 15 mIU/ml compared to women with normal oocyte reserve (serum FSH ≤ 8 mIU/ml). Couples were excluded if they did not have tubal patency or a semen analysis that required IVF-ET. Only couples that tried at least three natural cycles (unless pregnancy occurred first) were included. Results: The live delivered pregnancy rates within a maximum of five cycles of luteal phase support with progesterone (P) or at most mild FSH stimulation, or intrauterine insemination for mild male factor or cervical factor was 33.3% (8/24) with increased day 3 FSH and 62.5% (16/24) for the normal group (p = 0.08, Fisher’s exact test). Conclusion: Women with marked oocyte depletion are half as likely to conceive with assisted reproductive techniques compared to women with normal oocyte reserve.