Poor ovarian response

When ovarian stimulation is commenced the aim is to get 10-12 follicles. As worrying as overstimulation, is the scenario when too few follicles grow in response to stimulation. The cut off that most doctors adhere to is 6 follicles. So when less than 6 follicles are present the response is said to be low.

When I counsel my patients facing this problem, the commonest questions asked are "Why?", "What are the implications?" and "Does this mean I cannot get pregnant?". Let me answer these one at a time. Please do feel free to write to me if you have any further queries.

Why?

The reasons of low response can be :

• Insufficient dose of FSH/hMG
• Ineffective Drug (Good quality injections need to be maintained at the right temperatures in order to work well)
• Unresponsive ovary/Low reserve of eggs in ovary

What are the implications?

The implication of low number of follicles is the retrieval of lower number of eggs and this in turn means a lower number of embryos. On an average, eggs may be retrieved from 70% of follicles. In other words if there are 3 follicles the number of eggs may be only 2. Of these not all eggs may be mature (or usable for making embryos). The outcome would then be a low number of embryos or even no embryo. If there are no embryos there can be no pregnancy! 

Your doctor may advise you to either cancel the cycle in case of a poor response or try Intrauterine Insemination. This may prove to be more cost-effective than an IVF cycle as the success rates are bound to be low. 

Does that mean I cannot get pregnant?

The further course of action after the cycle with poor response depends on the cause. Treatment may be repeated using a higher dose of gonadotrophins or changing the drug. In case of low ovarian reserve being the reason for poor ovarian response, the situation becomes a little tricky. Treatment using drugs like DHEA and Arginine may be tried with variable success. The other option may be Minimal Stimulation IVF using Clomiphene to augment stimulation. The last resort would be Donor egg IVF.

The answer to this question is not easy but is certainly not a "No"!