Poor Responder – is there a solution in sight?

February 17, 2012

An important aspect of modern reproductive medicine is hormonal stimulation of the ovaries.

The first pregnancies using this method IVF were achieved by extracting the egg cell that matured individually in the natural cycle at the optimal time. However, this had several significant disadvantages compared to the IVF modern method. On the one hand, only one egg cell could be used; on the other hand, one was completely dependent on the hormonal processes of the female body, which required a continuous readiness of more than 7 days and 24 hours.

Despite significant advances in reproductive medicine in recent decades, some women do not benefit from or only benefit little from the various methods and additional measures because their ovaries do not respond properly to the interventions used.

Depending on the source of the study, it must be assumed that 9-24% of women belong to these so-called „low responders.“ It is not very helpful when comparing the effectiveness of different treatment approaches that the term „low responder“ is used very differently in professional circles. There are as many as 40 different definitions in use! Just by this fact, it is difficult to compare the study results of different groups.

The criteria include, for example: low number of antral follicles, high FSH, low number of follicles, low number of eggs retrieved, low E2 value on the day of ovulation induction, high gonadotropin dose.

Therapeutic approaches for treating women in this „group“ include, among others:

• Increase in gonadotropin dose
• longer stimulation duration
• Changes in the composition of the hormones used (FSH-LH)
• So-called „flare-up“ protocols
• Use of LH in the pre-cycle
• various additives before or during the therapy cycle (Coenzyme Q10, L-Arginine, Dexamethasone, Aspirin, Androgens, „pill“)

So far, the above measures have barely or only slightly improved the situation of the „poor responders“.

The currently „hopeful candidates“ include:

• Use of growth hormones

• Administration of androgens (testosterone gel, DHEA)

However, their alleged effectiveness still needs to be proven by the results of large-scale studies.

Finally, it should be emphasized that, although repeated hormonal stimulation may not have yielded the desired results, pregnancies can still be achieved through IVF the natural cycle (Natural Cycle IVF) or a modified natural cycle (m-NC). However, both the treatment center and the patient must be willing to accept the naturally lower success rate involved. It should be kept in mind that this involves the acquisition and fertilization of only one egg cell.

Sources:

R. Frydman, Poor Responders: still a problem;

N. Polyzos, P. Devroey, A systematic review of randomized trials for the treatment of ovarian poor responders;

R. Fanchin: Androgens and poor responders, Fertility Sterility Vol. 96, No.5, Nov. 2011