With advances in reproductive technologies, more and more families are turning to in vitro fertilization (IVF) to build their families. While some may experience smooth IVF journeys, others may face obstacles such as poor ovarian response (POR). POR is a condition that can affect your ability to produce an optimal number of eggs during fertility treatment.
In this article, we will explore what POR means for patients, its prevalence, diagnostic methods, potential treatments, and available options for those diagnosed with this condition.
What is meant by low response to ovarian stimulation?
Poor ovarian response (POR) refers to a suboptimal response (actual or predicted) of the ovaries to stimulation during fertility treatment.
During IVF, fertility medications are used to stimulate the ovaries, which culminates in the retrieval of multiple eggs. However, those with POR may produce fewer eggs than expected, which can significantly impact their chances of successful conception or even lead to a canceled cycle.
POR is often associated with reduced ovarian reserve, which refers to the diminished quantity and eggs remaining in the ovaries.
How common is POR?
The estimated prevalence of POR ranges from 6% to 35%. This wide range is primarily due to researchers and clinicians having varying definitions of POR. In fact, one systematic review of 47 studies focusing on POR patients found a staggering 41 different definitions of POR being utilized.
The likelihood of encountering POR increases with age, as ovarian reserve naturally diminishes over time. However, it is important to know that POR can occur in women of all age groups, including younger patients.
What is considered a “poor response” to IVF? Diagnosing POR
The European Society of Human Reproduction and Embryology (ESHRE) working group established criteria for defining a poor response in IVF.
According to their report, having two or more of the following three features is considered having poor ovarian response:
- Advanced maternal age or any other risk factor for POR
- A history of previous POR
- An abnormal ovarian reserve test
Or, if you experience two episodes of POR after IVF, it is considered a poor response, even without advanced maternal age or low ovarian reserve. Since the term POR specifically refers to the ovarian response, at least one egg retrieval is required for diagnosis.
However, patients of advanced age with an abnormal ovarian reserve may also be classified as poor responders because both factors indicate reduced ovarian reserve and can serve as predictors of the outcome of an ovarian stimulation cycle. If that’s the case, a more accurate term would be "expected poor responders."
How IVF can fail
Each fertility journey is unique, and various factors, including underlying medical conditions, genetic factors, and individual response to medications, can influence the ovarian response to IVF.
Sometimes, IVF isn’t even a viable option due to low ovarian reserve. Ovarian reserve refers to the quantity of eggs remaining in the ovaries. Assessing ovarian reserve through markers such as anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) can provide insights into your potential ovarian response to IVF. A predicted poor response may be indicated by low AMH levels or a reduced number of antral follicles observed during ovarian reserve testing.
Sometimes, even with normal ovarian reserve, you can experience an inadequate ovarian response to stimulation medications, which leads to fewer follicles developing than you would hope. Follicles are fluid-filled sacs within the ovaries that contain developing eggs. During an IVF cycle, hormonal medications support the growth and development of multiple follicles to increase the chances of obtaining viable mature eggs for fertilization. In general, 10–15 follicles is considered to be the optimal response to fertility medications during IVF. In cases of poor ovarian response, the ovaries may not respond adequately to these stimulation medications, resulting in limited follicular development. This poor response may be indicated by a reduced number of developing follicles observed during ultrasound monitoring throughout the stimulation phase of the IVF cycle.
Typically, a good IVF response involves the retrieval of a sufficient number of eggs, allowing for a higher likelihood of successful fertilization and subsequent embryo development. But sometimes, you simply don’t get enough eggs. A poor response can also be characterized by a lower-than-expected number of eggs retrieved, which may fall below the average range for your age group.
Is POR curable?
While POR poses challenges, it does not necessarily mean that you cannot conceive. The severity of POR can vary, and treatment options are available to optimize the chances of successful conception.
Treatment strategies for POR aim to improve ovarian response and enhance the chances of successful egg retrieval. The specific approach will depend on a lot of factors, including the underlying causes of POR and any other reproductive health obstacles you face. Some common treatment options include:
- Adjusting stimulation protocols: Your fertility doctor may modify the medication protocols used during IVF to enhance ovarian response. This may involve altering the dosage or type of fertility medications administered.
- Adding supplements: There is some evidence that DHEA and CoQ10 may improve IVF pregnancy rates for those facing POR.
- Human growth hormone (GH): Some evidence suggests that treatment with GH for POR patients could lead to a higher number of retrieved eggs.
- Third-party reproduction: In certain cases, fertility doctors may recommend alternative approaches such as the use of donor eggs or embryo adoption. These options can increase the chances of success.
What comes next after POR
Navigating a poor response to IVF can be challenging, and you’ll want to work closely with a fertility doctor who can evaluate the specific circumstances and develop an individualized treatment plan. The treatment approach may involve adjusting medication protocols, exploring alternative techniques, or considering options such as donor eggs.
While a poor response to IVF can be disheartening, it does not signify the end of the fertility journey. Advances in reproductive medicine continue to offer new possibilities and hope for those facing challenges in conceiving. With the right support, guidance, and perseverance, individuals and couples can explore alternative paths and find the best course of action to achieve their dream of building a family.
Get the emotional support you need
Dealing with a diagnosis of POR can be emotionally challenging. It is crucial to recognize the emotional impact and seek support from loved ones, support groups, or mental health professionals who specialize in fertility-related concerns. The journey to conception can be complex, and emotional well-being is an essential aspect of the process.
We are here to help you find the perfect egg donor
At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing. We didn’t invent the concept of egg sharing, but we are the first to take it national (and even global!).
Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.
We aim to be the best egg sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:
- Baby guarantee. We truly want to help you bring your baby home, and we will re-match you for free until that happens.
- Donor empowerment. Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
- Diversity: We’re proud about the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
- Human-centered. We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
- Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.
We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!
Meera Shah, MD, FACOG, is a double board-certified OBGYN and reproductive endocrinology and fertility specialist at NOVA IVF in Mountain View, California. She is a Founding Medical Advisor at Cofertility. Dr. Shah has authored numerous research articles on topics ranging from fertility preservation, pregnancy loss, reproductive genetics, and ethnic differences in IVF outcomes. Her medical practice incorporates the highest level of evidence-based medicine and the most cutting edge technologies to optimize outcomes for her patients. Dr. Shah applies this approach to her work with Cofertility, ensuring that Cofertility remains up-to-date on latest medical advancements and research in third-party reproduction and reproductive endocrinology in general. When Dr. Shah isn’t busy working with her patients at NOVA IVF, she enjoys playing pretty much any sport, learning new piano pieces on YouTube, and spending quality time with her husband and three boys. You can find her on Instagram providing fertility-related advice and education at @dr_meerashah.
View all articles