Struggling with poor ovarian reserve! Know All about it and it’s treatment!

Shukan Hospital and IVF Center   >>   Struggling with poor ovarian reserve! Know All about it and it’s treatment!

Ovarian reserve (POR) is a condition in which the number of eggs in a woman’s ovaries is less than would be expected for her age. As it can affect fertility, it can be a challenging issue for women who are trying to conceive. Women of reproductive age with poor ovarian reserve (POR) have a reduced follicular pool in their ovaries. Currently, poor ovarian reserve is one of the main causes of infertility among couples.

The ovarian reserve of women over 35 years of age is generally poor, while the reserve of women under 35 years of age is generally good. Stress, lifestyle, and even environmental factors may contribute to poor ovarian reserve (POR) or premature ovarian aging.

If you are facing challenges related to ovarian reserve and seeking support, consider contacting the experts at Shukan Hospital and IVF Center. They are known as the best IVF center in Ahmedabad and are led by experienced doctors, Dr. Prakash Patel and Dr. Ajay Prajapati. Their expertise and dedication can provide you with the guidance and care you need to navigate this sensitive issue and work towards your dream of starting or expanding your family.

Therefore, it is expected that obstetricians and gynecologists refer their patients to a fertility specialist who has the full picture and all the factors that come together for a pregnancy to occur and be brought to term, bringing a new baby into the lives of aspiring parents!

Causes of POR

  • Age: Aging is the most common cause of poor ovarian reserve. There is a natural decline in the number and quality of eggs as women age.
  • Genetics: Genetic factors may play a role in the reduction of ovarian reserve in some cases. It is possible that some women are genetically predisposed to an earlier
  • Medical Treatments: Chemotherapy and radiation therapy are common causes of toxin-induced ovarian failure. These therapies can damage genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides, and viruses might have hasten ovarian failure.
  • Ovarian Surgery: A reduction in ovarian reserve can result from previous surgery on the ovaries, such as the removal of ovarian cysts or endometriomas.
  • Autoimmune Disorders: This rare condition occurs when your immune system produces antibodies against your ovarian tissue, affecting the follicles that contain eggs and causing the eggs to be damaged. Experiencing a virus may trigger the immune response, but it is unclear what triggers the response.
  • Unknown factors: Idiopathic primary ovarian insufficiency has no known cause. In some cases, your healthcare provider may recommend that you undergo further testing in order to determine the cause, however, this is not always the case.

Risk Factors For Poor Ovarian Response

A poor response to ovarian stimulation can be predicted by other risk factors, in addition to advanced age and reduced ovarian reserve. Younger women may encounter POR for a variety of reasons, including:

  • Single ovary
  • previous ovarian cystectomy
  • chronic smoking
  • unexplained infertility
  • Previous chemotherapy and/or radiotherapy treatment.
  • Auto-immune response
  • Genetic risk factors such as the family history of premature menopause, X chromosome derangements, and fragile X mental retardation 1 (FMR1) pre-mutation.
  • Poor responders represent more than a third of women undergoing assisted reproduction.
  • The incidence of poor ovarian response (POR) following ovarian stimulation varies worldwide between 5.6 and 35.1%
  • 40% of women above the age of 35 are Poor Ovarian Responders
  • 10% of women undergoing gonadotropin stimulations are Poor Ovarian Responders

Challenges For Poor Responders

  • Limited Egg Retrieval: During the ovarian stimulation phase of IVF, one of the primary challenges is the difficulty of retrieving an adequate number of eggs.
  • Reduced Pregnancy Success: Fewer viable embryos are often produced when fewer eggs are retrieved. Therefore, the likelihood of achieving a successful
  • Increased Costs: Poor responders may require higher doses of fertility medications to stimulate their ovaries, increasing the cost of treatment. Furthermore, the need for multiple IVF cycles may further strain financial resources.
  • Emotional Distress: It can be particularly challenging for women and couples who suffer from poor ovarian response to deal with repeated IVF cycles, lower success rates, and the uncertainty of outcomes.
  • Fewer Frozen Embryos: There may be fewer embryos available for cryopreservation in poor responders. In the event that the initial IVF cycle is unsuccessful, this may limit the options for future attempts.
  • Lower Oocyte and Embryo Quality: In addition to a reduced quantity, poor responders may also experience problems with the quality of their eggs and embryos. In the case of low-quality eggs, there is a greater risk of chromosomal abnormalities and a reduced chance of implantation.
  • Time Constraints: There is increasing pressure on women as they age to achieve a successful pregnancy as their fertility declines. Those who do not respond well to fertility treatments may have a limited window of opportunity to receive treatment.
  • Limited Treatment Options: Patients who do not respond well to standard treatment options may exhaust their treatment options quickly, leaving them with fewer alternatives.

It is important to note that poor ovarian response should ultimately be managed according to the specific circumstances of each individual. Working closely with knowledgeable fertility specialists at Shukan Hospital and IVF Center and discussing all available options is essential to navigate these challenges effectively. Individuals and couples experiencing poor ovarian response are encouraged to consult a fertility specialist at Shukan Hospital and IVF Center to address these challenges.

The treatment of poor ovarian response (POR)

The treatment of poor ovarian response (POR) can be complex, and it often necessitates a personalized approach, tailored to an individual’s unique circumstances and requirements. The ultimate objective is to optimize the likelihood of achieving a successful pregnancy. If you’re dealing with poor ovarian response, it’s crucial to explore various treatment options and strategies. Consider seeking guidance and assistance from experts in the field, such as the dedicated professionals at Shukan Hospital and IVF Center, renowned as the best IVF center in Ahmedabad. You’ll find expertise and support from experienced specialists like Dr. Prakash Patel and Dr. Ajay Prajapati to help you navigate this challenging journey towards a successful pregnancy. Poor responders may consider the following treatment options and strategies:

Individualized Ovarian Stimulation Protocols:

An individualized ovarian stimulation protocol is essential for women with poor ovarian response (POR) in order to maximize their chances of successful fertility treatment, particularly with assisted reproductive technologies such as in vitro fertilization (IVF). Protocols such as these are designed to address the specific needs and challenges of women with poor ovarian reserves. An individualized ovarian stimulation protocol for POR should include the following elements:

  • Customized Medication Dosing:

    It is recommended that the doses of gonadotropin medications used for ovarian stimulation be tailored to the patient’s age, ovarian reserve, and response to stimulation in the past. Some women with POR may require higher doses to stimulate follicle growth.

  • “Microflare” Protocol:

    The protocol involves the administration of low-dose gonadotropins early in the menstrual cycle, usually during the luteal phase or on cycle day two. As a result of this approach, better follicle recruitment and development may result in a better response on the part of the ovary.

  • Long versus Short GnRH Agonist Protocol:

    Individual characteristics should be taken into account when choosing between long and short gonadotropin-releasing hormone (GnRH) agonist protocols. One protocol may be more effective for some women than another.

  • Customized Medication Dosing:

    It is recommended that the doses of gonadotropin medications used for ovarian stimulation be tailored to the patient’s age, ovarian reserve, and response to stimulation in the past. Some women with POR may require higher doses to stimulate follicle growth.

  • Gonadotropin Stimulation Monitoring:

    Monitoring the ovarian response through blood tests and ultrasound is essential to make adjustments to the stimulation protocol in real-time.

  • Extended Stimulation:

    The development of follicles may take longer for some poor responders if ovarian stimulation is prolonged or extended.

  • Optimal Trigger Timing:

    When it comes to egg retrieval, timing is crucial. When the majority of the follicles are of an appropriate size, the trigger should be administered.

  • Cryopreservation and Accumulation:

    Only a few eggs can be cryopreserved during a cycle for future use. To accumulate more eggs for a single transfer cycle, multiple cycles can be combined.

  • Sequential Embryo Transfer:

    It may be beneficial to consider a sequential embryo transfer strategy, in which embryos are transferred on different days of development in order to maximize the chances of at least one embryo implanting successfully.

An individualized ovarian stimulation protocol requires continuous monitoring, adaptability, and tailoring to the specific needs of the patient. To optimize your chances of success, you should consult with a fertility specialist who can make real-time adjustments based on your unique response to stimulation.

Natural Cycle or Minimal Stimulation IVF:

Individuals with poor ovarian response (POR) or those who prefer a more minimalistic approach to fertility treatment may benefit from natural cycle IVF and minimal stimulation IVF. The aim of these methods is to retrieve and fertilize a woman’s naturally selected egg(s) without the use of high doses of fertility medications. Here’s an overview of both approaches:

Natural Cycle IVF:

  • Stimulation: An IVF cycle conducted in a natural cycle does not use fertility medications or uses minimal fertility medications. The focus is on the woman’s natural menstrual cycle.

  • Egg Retrieval: During her menstrual cycle, a woman naturally produces one mature egg. Tests for hormones and ultrasounds are usually required to monitor this condition.

  • Fertilization:Embryos are transferred to the uterus after the retrieved egg is fertilized in the laboratory with sperm.

  • Advantages:Compared to traditional IVF with high-dose ovarian stimulation, natural cycle IVF is considered less invasive and less expensive. Women who are strongly opposed to fertility drugs may be able to benefit from it.

  • Challenges:Due to the fact that only one egg is retrieved, success rates aregenerally lower. Women with very low ovarian reserves may not be able to use it.

  • Egg Retrieval: During her menstrual cycle, a woman naturally produces one mature egg. Tests for hormones and ultrasounds are usually required to monitor this condition.

Minimal Stimulation IVF:

  • Stimulation: In minimal stimulation IVF, fertility medications are used at a lower dose than in traditional IVF, aiming to stimulate fewer eggs without overstimulating them.

  • Egg Retrieval:In IVF, multiple eggs are retrieved, usually more than in natural cycle IVF, but fewer than in traditional IVF.

  • Fertilization: One or more embryos are transferred to the uterus after the eggs have been fertilized with sperm in the laboratory.

  • Advantages: IVF with minimal stimulation can be less expensive and less invasive than IVF with traditional stimulation. Some individuals with POR may find it useful as a middle-ground option if they wish to avoid high-dose medications but still want to retrieve more than one egg.

  • Challenges: The success rate of natural cycle IVF may be higher, but it is generally lower than the success rate of conventional IVF. The risk of ovarian hyperstimulation syndrome (OHSS) is still present, although it is reduced compared to traditional IVF.

Consult the Shukan Hospital and IVF Center and IVF Center if you have a poor ovarian response to determine whether natural cycle IVF or minimal stimulation IVF is the best option for you. Consider factors such as your age, ovarian reserve, and previous treatment outcomes when choosing between these methods. You can develop a treatment plan tailored to your needs and circumstances with the help of the best healthcare provider in Ahmedabad, Shukan Hospital and IVF Center.

Adjunct Medications:

Supplemental medications are drugs that may be used in addition to standard ovarian stimulation protocols to treat poor ovarian response (POR). The goal of these medications is to enhance ovarian response and improve the chances of a successful assisted reproductive procedure, such as in in vitro fertilization (IVF). The following medications are commonly used in the management of POR:

  • Growth Hormone (GH): Poor responders often receive growth hormone therapy to improve their ovarian response. Follicular development and egg quality may be enhanced by it. Some studies suggest that GH may have some beneficial effects on ovarian function, but the exact mechanism is unknown.

  • Dehydroepiandrosterone (DHEA): Steroid hormones like DHEA are converted by the body into testosterone and estrogen. DHEA supplementation has been shown to improve ovarian response in women with POR by improving egg quality and potentially increasing egg production.

  • Luteinizing Hormone (LH) or Human Chorionic Gonadotropin (hCG): For some women, adding LH or hCG during ovarian stimulation may support the growth and maturation of follicles. Ovulation is triggered by LH and hCG hormones.

  • Androgens: For example, testosterone gel and dihydrotestosterone may be prescribed for improving ovarian response. IVF success may be enhanced by promoting follicular development.

  • Intralipid Therapy: A lipid emulsion containing soybean oil, egg yolk, glycerin, and water is administered intravenously. Immune-related issues that may interfere with implantation may be treated with it.

  • Coenzyme Q10 (CoQ10): By reducing oxidative stress, CoQ10 can potentially improve egg quality. Pretreatment and treatment during IVF may benefit from its use as a supplement.

The use of adjunct medications should be based on an individual’s specific case and the recommendation of a fertility specialist. There is no guarantee that these medications will benefit all individuals with POR, and their effectiveness varies from person to person. A healthcare provider should also be consulted about potential side effects and risks.

Sequential Embryo Transfer:

A sequential embryo transfer approach involves transferring embryos at different
stages of development rather than waiting for several embryos to develop. The chances of at least one embryo implanting successfully may be increased as a result.

Egg or Embryo Banking:

An increase in the chances of achieving a successful pregnancy can be achieved by collecting eggs or embryos over several cycles and banking them for future use.

Preimplantation Genetic Testing (PGT):

In addition to screening embryos for chromosomal abnormalities, PGT can also improve pregnancy rates by selecting the healthiest embryos for transfer.

Combined IVF and Egg Donation:

If the ovarian response is extremely poor, some women may choose to combine IVF with the use of donor eggs from a younger, more fertile donor.

Lifestyle and Nutritional Support:

In order to keep your reproductive health in good shape, you should maintain a healthy lifestyle, such as consuming a balanced dietexercising regularly, and managing your stress.

Emotional Support:

It can be emotionally challenging to deal with a poor ovarian response. It is essential to seek emotional support, which may include counseling or joining a support group.

Second Opinions:

Obtaining a second opinion from a different fertility specialist may provide fresh insights and recommendations if the initial treatment strategy fails.

Having an open and honest discussion with your healthcare provider at Shukan Hospital and IVF Center is vital for women experiencing poor ovarian response. Our specialists in reproductive medicine are able to tailor treatment plans to meet the specific needs of each patient and adjust strategies according to their specific circumstances. Moreover, success rates and outcomes can vary greatly between individuals, so managing expectations and exploring different options are crucial to achieving a successful pregnancy.