The poor responder in assisted conception poses specific challenges to clinicians particularly as the aetiology remains poorly understood and there is, as yet, no consensus on the definition. Studies on this subject are very heterogeneous and therefore there is a lack of any good evidence base on how to deal with this difficult group of patients. As a result, much controversy exists on how to manage a poor responder in assisted conception and every new suggestion has proved contentious. The aim of this review is to provide an update and evaluation of the current evidence on the approach to management of the poor responder in assisted conception and to comment on the methods that have been suggested.