IVF in patients with low ovarian response, a great challenge for assisted reproduction

Do you know what it means to have a low ovarian response (POR)? This term refers to the low number of eggs obtained in the follicular puncture phase of the In Vitro Fertilisation treatment, and is suffered by between 7 and 24% of patients who come to an assisted reproduction clinic.

Low ovarian response should not be confused with a woman's low response to hormonal drugs. Many women may suffer from this problem, but, through the hormonal stimulation carried out in ART, they achieve a good response. In fact, when a woman has a poor response to hormonal drugs, it is because of factors such as age, pelvic infections or genetic factors. As for reproductive age, it may not be similar to biological age. Some women are born with a smaller number of eggs than others, and some women produce a larger number of follicles than others.

THERE IS NO DOUBT THAT OVARIAN STIMULATION MUST BE CARRIED OUT IN A PERSONALISED MANNER FROM THE BEGINNING OF TREATMENT.

When is a woman considered to have a low ovarian response?

There are some factors that help us to detect when a woman suffers from this problem:

• When the number of follicles in the ovary that can be seen by transvaginal ultrasound is less than 5.
• According to the SEF (Spanish Fertility Society), when a woman has 3 or less oocytes after follicular stimulation, the following is the case
• If after an FSH dose of less than 3,000 Ul and an oestradiol concentration of less than 500 pg/ml (on the day the hCG injection is given), a low number of eggs are retrieved.

What tests can be performed prior to stimulation to detect whether the patient may have a low response?

In order to know whether a woman requires assisted reproductive treatment due to low ovarian response, it is important to perform some tests beforehand, which will predict whether or not a low ovarian response is present.

• After having had a previous cycle with a low response.
• Depending on age, as mentioned above.
• When a basal ultrasound shows less than 5 follicles between both ovaries.
• When the antimüllerian hormone is found to be less than 1 ng/ml. This hormone provides information to assess the fertility of the patient. This indicator also provides information on the most appropriate assisted reproduction treatment.
• Having a basal FSH greater than 10 Mui/ml. This is a data that informs us that, on the one hand, there will be a low response and, on the other hand, that there is a poor oocyte quality.
• Basal oestradiol greater than 50 pg/ml.
• Inhibin B levels below 45 pg/ml. A very important piece of information: premature ovarian ageing.

What can cause a low ovarian response in a woman?

• Age is a factor that determines the success of pregnancy in most fertility-related issues. In this case, the older you get, the fewer eggs there will be and the response to ovarian stimulation will progressively get worse and decrease.
• When there has been premature ageing of the ovary.
• Due to an autoimmune problem, which generates antibodies, causing an endocrine blockage.
• Endometriosis is one of the diseases that cause a low ovarian response.

Benefits of IVF facing a low ovarian reserve

When a woman cannot get pregnant due to a low ovarian response, she can resort to assisted reproduction treatments such as In Vitro Fertilisation that will help her to fulfil her dream. Thanks to methods such as this, a much more controlled ovarian stimulation is achieved, obtaining a greater number of eggs in order to obtain embryos that can be transferred to the mother's uterus.

Therefore, thanks to IVF, many more eggs will be obtained than those that would develop in the woman's natural cycle and it will be possible to choose those of higher quality, since a lower follicular response is also associated with poorer egg quality.

But which treatments or processes can be performed during IVF to increase the patient's ovarian response? Pre-treatment with androgens, for example, can be a good option to achieve this. Normally, they are carried out with transdermal testosterone or DHEA, the hormone produced by the adrenal gland in our body.

Several cycles can also be carried out in order to accumulate a greater number of eggs and, therefore, increase the chances of creating a quality embryo or embryos. Therefore, the eggs that are extracted from each cycle must be vitrified and then fertilised in the laboratory using the ICSI technique.

Reproclinic, fertility clinic that will help you combat low ovarian reserve

At Reproclinic, we undoubtedly carry out an individualised assisted reproduction treatment for each woman. Only by analysing and solving any problems or difficulties will we be able to help the patient realise her dream of becoming a mother.

If you have any doubts, do not hesitate to contact us. And remember that at Reproclinic, we currently offer a promotion that includes a free medical consultation with a gynaecologist specialising in infertility and a discount on your treatment, our Repro Plus Double Pack.