Poor responders in IVF
Poor responders patients are the most challenging in IVF. Also, they are patients who respond less than expected during ovarian stimulation.
We know that pregnancy IVF rates are directly related to the number and quality of embryos being transferred. The more eggs produces a woman in ovarian stimulation, the more embryos will be developed. From these, they select the best ones and transfer them. This means the embryos that have a better potential for achieving pregnancy.
For this reason, women who respond well to ovarian stimulation and produce several eggs will eventually have a better chance of getting pregnant.
What we usually observe is how ovarian function depends on age: as the woman grows older, the ovarian response decreases.
Each girl is born with a large number of eggs in the ovaries. But it gradually decreases as the woman grows, ie the oocyte “stock” is reduced. That’s why the gynecologist wants to know how the patient’s ovaries work and how many eggs there are.
One way to find out the ovarian reserve is to do a blood test. On the 2nd day of the cycle we measure levels of follicle stimulating hormone (FSH), estradiol and the antral follicular count (AFC). If the FSH levels are high, it means that the ovarian reserves are poor. If the levels are too high (more than 20 mIU / ml) then we are talking about ovarian failure (the ovaries do not function normally). Finally, if the FSH is high, it does not mean that a woman can not get pregnant. The chances of getting pregnant decrease, though. This happens because the eggs she produces are of poor quality.
Why are FSH levels high in women with reduced ovarian function?
The pituitary gland produces FSH, a gland in the brain. it is responsible for the development of the eggs within the ovary every month. In young women with many good quality eggs, even low levels of FSH are enough for egg development. In older women, who have fewer eggs and inferior in quality, the pituitary gland needs to produce more FSH in order to stimulated more eggs.
Today, the most important test used is AMH, ie the anti-mullerian hormone. We consider it to be the most important quantitative and qualitative marker of ovarian function.
However, if one of the above-mentioned test has a normal value, this does not mean that the quality or number of eggs will be good. For this reason, a very useful way to diagnose the condition of the ovary is the woman’s history. Another useful information would be its response to a previous ovarian stimulation.
However, we should remember that high FSH is not the cause of infertility. It is only an indicator of low egg quality. So trying to “cure” high FSH does not make sense and will not help you achieve a pregnancy.
Many therapeutic strategies have been developed for women with low ovarian response. Given that time is valuable to these women, treatment should be aggressive and quick in order to achieve pregnancy before the ovarian reserves finish. One of the novel techniques is the widely discussed PRP. IVF is the best choice because it offers the highest success rate. The stimulation of the ovaries in these women is quite difficult, so the doctor’s experience and ability is crucial!
