Some women do not respond well to the standard IVF ovarian stimulation protocols to produce a good number of mature follicles. They are considered as Poor Responders. They require large doses of medications for the ovaries to grow follicles and yet develop less than an optimal number of eggs.
Generally, the poor responders should be identified by the fertility doctors before starting an IVF cycle.
At Cocoon Fertility we use ovarian reserve testing to evaluate a woman’s expected response to the stimulating medications. As our ovarian reserve screening, we do :
•Antral Follicle Count (AFC) number of eggs seen on ultrasound on Day-2 of the period
•Anti-Mullerian Hormone (AMH) blood test
•Day 2/3 FSH and LH blood test
These tests help us identify the vast majority of poor responders before they get to an IVF attempt. Identifying the problem in advance allows us an opportunity to customize protocols to improve the response and the outcome with the first IVF attempt.
The egg reserve is usually decreased after the age of 37 and in patients with low Antral Follicle Count (AFC), reduced AMH levels and elevated FSH levels. A reduced AMH level indicates that the egg reserve is depleted and the patient needs optimization of IVF protocol to improve the response.
At the first consultation, we will assess your situation and devise a personalized treatment plan. You will then be requested to call up on the first day of your period in order to book your first scan. This will be scheduled for the second or third day of your cycle. Depending on the scan results and blood reports, you may be prescribed a treatment that would help you give either more eggs or better quality eggs or both, whereby we would be able to positively impact the chance of having a baby.
Strategies for treatment in Poor Responders include :
• Micronized DHEA as pre-treatment helps to improve the microenvironment of the eggs by increasing the egg quantity and improving their quality.
• Studies have been published showing benefit from treatment with Growth Hormone for IVF in poor responders.
• There are also different IVF protocols ranging from high dose of stimulation medications to mild stimulation with tablets and injectables.
• Our clinic recommends repeating a cycle of stimulation to obtain more eggs for IVF and freezing all the resulting embryos. In this way we have a store of a few good quality embryos. We then plan a frozen embryo transfer with optimal endometrial preparation to increase the chances of pregnancy.
The success rate of IVF in poor responders can be variable, however with the specialized protocols, we have an impressive count in the number of pregnancies. Some couples choose egg donation because of the high success rates with donor eggs instead of continuing to attempt low-yield IVF with their own eggs.
The optimized protocols at Cocoon Fertility have helped many patients with low ovarian reserve to conceive and have their own biological children.
Here's everything you need to know about IVF
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