Poor Ovarian Response

What is Poor Ovarian Response (POR)?

Poor Ovarian Response (POR) refers to a condition in which a woman’s ovaries respond inadequately to fertility treatments like IVF (In Vitro Fertilization) or ICSI (Intracytoplasmic Sperm Injection). Women with POR produce fewer eggs during ovarian stimulation cycles, leading to a lower chance of successful fertilization and pregnancy. This condition can significantly impact a woman’s ability to conceive, but with the right treatment approach, the chances of pregnancy can be improved.

Poor ovarian response is often diagnosed after multiple IVF attempts where the ovaries fail to produce enough mature eggs, despite proper stimulation. It’s important to note that poor ovarian response doesn’t necessarily mean infertility; it indicates a need for specialized care and treatment options to improve fertility outcomes.

Causes of Poor Ovarian Response

Various factors can contribute to poor ovarian response, including:

1. Age: As women age, the quantity and quality of their eggs decrease. Women over 35 are more likely to experience poor ovarian response.
2. Ovarian Reserve: Women with a low ovarian reserve, meaning they have fewer eggs available, are at a higher risk of poor ovarian response.
3. Hormonal Imbalances: Imbalances in hormones like FSH (Follicle Stimulating Hormone), AMH (Anti-Müllerian Hormone), or estradiol can affect ovarian function and egg quality.
4. Endometriosis: Women with endometriosis may have impaired ovarian function due to inflammation, adhesions, or scarring that affects the ovaries.
5. Polycystic Ovary Syndrome (PCOS): While PCOS is commonly associated with an overproduction of eggs, some women with PCOS may also experience poor ovarian response in fertility treatments.
6. Previous Ovarian Surgery: Surgery on the ovaries, such as the removal of ovarian cysts or fibroids, can reduce ovarian reserve.
7. Genetic Factors: Some women may have a genetic predisposition to poor ovarian response, leading to lower egg quality and quantity.
8. Lifestyle Factors: Smoking, obesity, and excessive alcohol consumption can negatively affect ovarian function.

Symptoms of Poor Ovarian Response

The most common symptom of poor ovarian response is the inability to retrieve a sufficient number of eggs during fertility treatments like IVF. However, other indicators can include:

• Difficulty conceiving despite regular, unprotected intercourse.
• Multiple failed IVF cycles with low egg retrieval.
• Low levels of AMH or FSH.
• Shortened menstrual cycles or irregular periods.

How is Poor Ovarian Response Diagnosed?

Poor ovarian response is typically diagnosed through a combination of the following tests:

1. Hormonal Blood Tests: Blood tests to measure levels of hormones like AMH, FSH, estradiol, and LH are used to assess ovarian reserve.
2. Ultrasound: An ovarian ultrasound helps evaluate the size and appearance of the ovaries and the number of follicles, which can indicate how many eggs are available for retrieval.
3. Antral Follicle Count (AFC): This ultrasound test counts the small, immature follicles in the ovaries to assess ovarian reserve.
4. Ovarian Response to Stimulation: The response to ovarian stimulation drugs during an IVF cycle is also assessed. If there is a poor response (low number of eggs retrieved), it may confirm poor ovarian response.

Treatment Options for Poor Ovarian Response

Though poor ovarian response can be challenging, there are several treatment options available to help improve egg quality, ovarian function, and overall fertility outcomes.

1. Ovarian Stimulation Protocols: Tailored ovarian stimulation protocols with a combination of FSH and LH can be used to maximize the number of eggs retrieved during IVF. The goal is to stimulate the ovaries as much as possible while preventing ovarian overstimulation.

2. Use of Growth Hormones: Some studies suggest that the addition of growth hormones, such as HGH (Human Growth Hormone), can improve ovarian function and egg quality in women with poor ovarian response.

3. Egg Donation: If ovarian reserve is severely compromised, egg donation may be recommended. This involves using eggs from a healthy donor, which are then fertilized and implanted into the recipient’s uterus. Egg donation offers a high success rate for women who have poor ovarian response or low egg quality.

4. Embryo Banking: Women who are facing poor ovarian response can consider embryo banking or egg freezing (if they are younger and wish to preserve fertility for the future). This allows for the collection and freezing of embryos for later use in IVF.

5. Stem Cell Therapy: Although still an emerging option, some fertility clinics offer stem cell therapy to rejuvenate ovaries and improve egg quality. Stem cells can be used to promote new ovarian tissue growth and improve overall fertility.

6. Lifestyle Changes: Healthy lifestyle modifications, including maintaining a balanced diet, regular exercise, stress management, and avoiding smoking or excessive alcohol, can help support ovarian health and fertility.

7. Acupuncture and Traditional Chinese Medicine (TCM): Some women turn to acupuncture and TCM to improve blood flow to the ovaries and regulate hormonal balance, potentially improving ovarian response during IVF cycles.

8. Assisted Reproductive Technologies (ART): If egg retrieval is still successful, ART procedures like ICSI (Intracytoplasmic Sperm Injection) can be used to increase the likelihood of fertilization, especially if egg quality is a concern.

Success Rates and Prognosis for Poor Ovarian Response

The prognosis for women with poor ovarian response depends on various factors, such as age, ovarian reserve, and overall health. Women with low ovarian reserve (indicated by low AMH levels or low AFC) or advanced age may have lower chances of success with traditional IVF cycles, but the use of advanced technologies like egg donation, embryo banking, and tailored stimulation protocols can still result in successful pregnancies.

While the success rate of IVF in women with poor ovarian response is lower than in women with a normal response, there are still significant chances of success with the right treatment approach. Consulting with a fertility specialist can help determine the best course of action based on individual circumstances.

Poor Ovarian Response and IVF

Women diagnosed with poor ovarian response often undergo IVF as the primary treatment for infertility. However, IVF success rates can vary, and additional interventions may be needed to optimize the chances of success. In many cases, women with poor ovarian response benefit from ICSI, which increases the likelihood of fertilization by directly injecting a sperm into each egg.

Additionally, the use of donor eggs may be recommended when the quality or quantity of a woman's eggs is too low to support a successful IVF cycle.