Olha Romanova
chief medical officer, reproductologist, gynecologist, endocrinologist, MD, PhD. ; main specialty: obstetrics and gynecology.

What to do if there is no response to ovarian stimulation in the IVF program?  

Currently, a low response to stimulation occurs in about 35% of cases of all IVF programs and is a widespread problem for a woman and a reproductive specialist.

What is a low response to ovarian stimulation?

One of the important stages of the IVF program is the stimulation of follicle growth in order to obtain oocytes for fertilization and transfer of a euploid (chromosomal healthy) embryo. The number of received oocytes is the response to stimulation. As a rule, 5 mature oocytes at stage M II are considered to be a satisfactory number per stimulation. The required number of oocytes to obtain a euploid embryo for transfer depends proportionally on the reproductive age.

It is important to note that for the same dosage of the drug for stimulation in women of the same reproductive age, there is a different response to stimulation of the follicles. The response during IVF can be so weak that it reduces the effectiveness of the treatment program. Poor (low) response to stimulation is a condition where less than 4 oocytes are obtained from follicle stimulation in IVF programs.

Is it possible to predict a low ovarian response to stimulation?

The main way to determine the response to controlled stimulation of follicle growth is to conduct the stimulation itself and determine the number of oocytes received.

Still, there are factors that help predict a poor response:

  • The reproductive age of a woman is over 38-40 years old
  • AMH below 1.1 ng/ml; FSH level above 11.2 mIU/ml
  • The number of antral follicles during ultrasound is less than 4
  • Low response to stimulation in the previous IVF program (3 or less received oocytes).

What are the causes of low ovarian response to stimulation?

  • One of the main reasons is the reproductive age of a woman over 38 years old (with age, there is a decrease in the ovarian reserve and, accordingly, a decrease in the response of follicles to stimulation)
  • Transferred surgical interventions on the ovaries (removal of cysts, surgical treatment of PCOS);

What are the possible treatments for low ovarian response in an IVF cycle?

The specialists of our reproductive department are successfully engaged in achieving pregnancy and the birth of healthy children in patients with a low response to stimulation.

We managed to develop and improve the most effective treatment protocols:  

  • The use of individual stimulation programs and the number of days of stimulation based on the determination of polymorphisms of sensitivity to FSH, LH, estradiol.
  • The use of preparatory priming before the start of Mandatory support of endocrine health (treatment of endocrine disorders, if any, before the start of stimulation);
  • Double stimulation (stimulation in the luteal phase of the menstrual cycle);
  • The use of a double trigger in oocyte maturation failure in the past;
  • Cryobanking of oocytes with their subsequent fertilization;
  • Consideration of the results of previous stimulations and the index of mature oocytes obtained to determine a personalized treatment regimen;
  • Use of mild stimulation protocols;
  • Application of PRP technology before stimulation preparation in women with low ovarian reserve.

Experience, the use of progressive knowledge, faith in the consequence give us the opportunity to achieve a result with a couple, even in difficult situations – the birth of healthy children in the family!