Poor Ovarian Response

What is poor ovarian response?

Poor ovarian response means that your ovaries produce a low number of oocytes after you received hormonal injections for ovarian stimulation for IVF/ICSI.

When do I have this problem?

If you have had ovarian stimulation with injections to stimulate your ovaries to produce oocytes for IVF/ICSI and less than four oocytes were retrieved you may be a poor ovarian responder.

How can I know if I am a poor ovarian responder if I have never had IVF/ICSI?

The evaluation of specific markers can predict with a high accuracy whether you have premature ovarian ageing. The three most important markers are:

  1. AMH levels (Anti-Müller hormone)
    AMH is a biochemical biomarker, which can be determined by simple blood analysis. The hormone is produced by the small follicles in your ovaries. These follicles can produce oocytes once you’ve received the injections to stimulate your ovaries for IVF/ICSI. Based on the blood analysis we can predict your chances of producing a good number of oocytes.
  2. 1 Day one of your menstrual cycle is the day you get up with bright red menstrual blood loss.

    The number of antral follicles (AFC — Antral Follicle Count)
    Antral follicles are a preliminary stage of the actual oocytes. The injections you receive for IVF/ICSI stimulate these follicles to produce oocytes. A vaginal ultrasound allows us to count the antral follicles in your ovaries. AFC is typically measured at the start of your menstrual cycle, between day 2 and day 41.

  3. FSH levels (follicle stimulating hormone)
    This biochemical marker can also be determined by a simple blood analysis and is able to predict your chances of producing a good number of oocytes. FSH is a hormone produced by a small gland in your brain called the pituitary which stimulates your reproductive organs to mature follicles.
    It is measured early in your menstrual cycle, on the second or third day. Very high values of this hormone (more than 20) suggest there is a great likelihood you are a poor responder patient.

Why am I a poor ovarian responder patient?

Several reasons are possible, such as:

  • Age: it is a well-established fact that the older you are the less follicles in your ovaries.
  • Surgical history: history of ovarian surgery resulting in a partial or full removal of your ovaries.
  • History of previous treatment for cancer: if in the past you had a ‘gonadotoxic’ treatment, i.e. chemotherapy or radiotherapy that destroyed (part of) the follicles in the ovaries.
  • Genetic causes.
  • Autoimmune reasons.
    Your body’s immune system attacks foreign or abnormal cells that can cause infection, cancer, or other problems. In some cases, it may mistakenly attack hormone-producing organs such as the ovaries, the adrenal glands or the thyroid gland. This can affect the proper operation of your ovaries.

However, many cases of poor ovarian response are due to reasons we cannot explain. Next Level IVF clinic studies these causes and offers advice on your specific condition.

If I am a poor responder what are my chances of having a baby through IVF/ICSI?

Unfortunately, the chances of poor ovarian responders producing a live-born baby through IVF/ICSI are low, presumably lower than 10% even. Your chances are even lower if you try other methods such as artificial insemination (IUI or intrauterine insemination) or try to conceive naturally.
However, the aim of this clinic is to offer new treatment options that can increase your chances of pregnancy and the birth of a healthy baby.

Are hormonal injections and IVF|ICSI treatment always recommended in my situation?

No. If the number of antral follicles in your ovaries is very low (less than 3) and your FSH levels at the start of your cycle are very high (more than 20), there is little chance ovarian stimulation will work. In this case we usually recommend a ‘natural’ IVF cycle, i.e. without medication. But even then the chances of a healthy baby are reasonably slim: not higher than 7%.

I am a poor responder and all treatments have failed. Is there anything else I can try?

For women who have had multiple attempts and failed to produce oocytes, Next Level IVF-clinic may offer a solution. We test pioneering treatments and run large pioneering trials that aim to provide new treatment options for this group of patients. Information about current studies is available here.
However, if you are not suitable for new treatment, you may want to consider egg donation. You use another woman’s eggs to get pregnant.
Experienced staff in our clinic will explain your actual chances of becoming pregnant with your own eggs and will give you information on whether oocyte donation is the best option for you.