Poor responder is a broad term used to describe a section of infertile women who respond poorly to ovarian stimulation with gonadotropins. These women produce fewer eggs than expected, leading to lower chances of pregnancy within that IVF cycle. Although there is no standard definition of a poor responder, women in this category are typical of advanced reproductive age. They have a long history of lessened ovarian reserve, evidenced by their poor response to conventional stimulation methods. Below is a detailed answer to the question ‘Poor respondents, what are they in IVF?’
Causes Of Poor Response In IVF Treatment
There are numerous reasons why a woman may qualify as a poor responder to infertility treatment. Some of the many possibilities include:
- Obesity or being overweight
- The wrong method of ovarian stimulation
- Poor injection techniques
- Insufficient ovary preparation
- Low medication dosages that cause insufficient ovarian stimulation.
However, some experts agree that the root of poor response to ovarian stimulation is a failure to treat low functional ovarian reserve or diminished ovarian reserve (DOR) properly.
Diagnosing A Poor Responder
In many cases, a poor responder diagnosis is arrived at after going through an IVF cycle, resulting in a poor stimulation outcome. Nevertheless, it is possible to identify possible issues ahead of time via ovarian reserve testing. This test can be done by having a fertility specialist check your FSH levels and conduct the Clomid or Clomiphene challenge test. The Clomiphene challenge test is performed by measuring your day 3 FSH and estradiol levels. You will take 100g of Clomid on days 5 to 9 of your cycle, and your FSH will be measured on day 10. Furthermore, an ultrasound scan can predict antral and resting follicle numbers. Finally, blood tests of your Inhibin B levels on cycle day 3 is the last test that can diagnose poor response to ovarian stimulation.
Treating A Poor Responder
Many fertility specialists agree that women diagnosed as poor responders must discuss whether they fall in the spectrum with their specialists. Some studies indicate that women with higher FSH levels during a Clomid challenge test may experience an unsuccessful IVF cycle. Still, every woman’s diagnosis and treatment can vary. Here are a few of the recommended treatments for poor response to ovarian stimulation.
- Altering Stimulation Cycle Medications
Modifying the medication used during the stimulation cycles can influence IVF success significantly. Therefore, your fertility specialist will take the apparent clinical approach of increasing the standard gonadotropins dose if it fails to stimulate proper multi follicular growth. In addition, different types of gonadotropins may be used to treat poor responses.
- Addition of Androgens
Androgens play a critical role in early follicular and granulosa cell development. These androgens may also enhance FSH receptor expression in granulosa cells, increasing the effects of FSH and potentially enhancing your ovaries’ response to FSH.
- Changing the pituitary down-regulation protocols
- Advanced laboratory techniques like assisted hatching, day two transfers, and continuing egg retrieval irrespective of low follicle numbers
- Estradiol addition in the luteal phase lowers the risk of cycle cancellation and boosts the odds of clinical pregnancies in poor responders.