Thursday, January 12, 2023

How IVF can help patients with poor ovarian reserve to have a baby


Patients with poor ovarian reserve are difficult patients to treat for IVF specialists, and the success rate is usually poor. This is because IVF pregnancy rates depend on the quality of the embryos we  transfer, which in turn depends on egg quality.

Because they are poor ovarian  responders ,  the quality and quantity of embryos we are able to generate  for these patients is usually poor. This is why it’s quite challenging to help these women have a baby . You need to understand what your treatment options are , so you can follow this in an organised systematic fashion.

For patients who have had a poor ovarian response in an earlier IVF cycle , the first option is to increase the dose of injections used for super ovulation . It’s impossible to predict whether this will improve ovarian response, but it gives you peace of mind knowing you have explored all the possible options. For these patients, we usually treat them with Vitamin D and DHEA prior to starting the IVF cycle, because this can help to improve their ovarian reserve. Additional supplements such as growth hormone don’t have any beneficial effect , which is why we don't use these .

If the response to the increased dose of super ovulation hormones doesn't help , then our next step is to a mini stimulation protocol . This may sound paradoxical. After all, if a large dose of hormones didn’t work, then how will a smaller dose help ? The hypothesis is that if even using a large dose of hormones doesn't allow us to recruit a large number of mature eggs , then we might as well settle for recruiting a small number of mature eggs by using a lower dose of injections. Surprisingly , the response to this lower dose can be quite good in some patients , so this is a low risk low cost approach that is well worth trying. We will go ahead even if there is one single follicle in these patients, because each of these eggs is worth its weight in gold, and we need to maximize their chances of getting pregnant.

The aim of all these protocols is to get enough eggs so that we can generate enough embryos to give patients a good chance of having a baby. We pool these embryos in 3-4 sequential IVF cycles, and don't transfer any of them. Our goal is to store at least 3- 4 top quality frozen blastocysts before we start transferring them. Ovarian reserve keeps on declining as you get older , while your frozen embryos will remain as good as new , no matter when we use them.

It's true that this particular treatment plan takes quite a lot of time and can be quite expensive. This is why these challenging patients need to have realistic expectations of what IVF technology can offer them so that they have peace of mind they did their best in their quest for a baby.

If everything fails , then Plan B is to use donor eggs . This has a much higher success rate, and it’s easier to accept this option when you know that you have tried everything possible to get pregnant with your own eggs , but everything you tried hasn't worked.

Send me your medical details by filling in the free second opinion form  at and I'll be happy to help you to have a baby !


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