IVF “Poor Responder”

What are Poor Responders to IVF Protocols?

Many women who struggle to get pregnant, even with IVF, are diagnosed as having “poor response,” which means that their ovaries respond poorly to ovarian stimulation, producing much fewer eggs than expected. Poor response to IVF stimulation usually means lower chance of pregnancy in that IVF cycle. This is because the number of high-quality eggs retrieved in an IVF cycle is a major factor contributing to the patient’s pregnancy chances. When ovaries develop only one or two follicles, the patient’s pregnancy chances are much lower than when stimulation produces 10 eggs, for example.

At CHR, we feel that this easy “diagnosis” of “poor response” or “poor responder” simply describes what’s happening, and doesn’t necessarily address the root cause. In order to really help women with pregnancy, we feel that labeling them with “poor response” or “poor responder” isn’t the most practical place to start.

Weighing DHEA Benefits and Risks During IVF Fertility Treatment

Dr. Gleicher discusses the side effects of IVF with DHEA.

Cancelled IVF Cycle due to Poor Response

Another challenge from poor response is the decision to cancel the IVF cycle. When a patient’s ovaries do not respond well to medications used to encourage multiple eggs to develop, some fertility experts simply cancel the IVF cycle, citing lower chances of pregnancy. However, cancelling IVF cycles due to poor response only makes sense if next IVF stimulation can be tailored better to improve the patient’s chances of success. In order to do that, we would need to identify the root cause--or causes--of the poor response.

Poor Response to IVF Stimulation: Causes

There are many reasons a woman could be a "poor responder" to infertility treatment. A few possibilities include:

  • too little ovarian stimulation
  • the wrong kind of ovarian stimulation
  • poor injection techniques
  • obesity

At the root of it, however, a “poor response” to ovarian stimulation is often a consequence of something we call diminished ovarian reserve (DOR) or low functional ovarian reserve.

Ovarian Reserve and Slow Response to IVF Stimulation

Ovarian Reserve (OR) is the term used to describe the ability of a woman’s ovaries to produce high-quality eggs. As women age, their OR naturally declines, which is why it is more difficult for older women to get pregnant, even with fertility treatment. But DOR isn’t exclusive to older women. In fact, approximately 10 percent of women suffer from premature ovarian aging (POA), a condition in which their OR begins to decline much earlier in life than average. These women not only have difficulties conceiving naturally, but often show poor response to ovarian stimulation, especially if a “one-size-fits-all” method is used.

Finding the Best Protocol for Poor Responders

For women suffering from DOR or POA, the problem is not that they show a poor response to stimulation, but that their physician are not addressing their unique ovarian environments with proper treatment are not being addressed in their treatment. At CHR, our first step is determining an appropriate diagnosis based on age-specific FSH/AMH levels and antral follicle counts. Once we have a better idea of a patient’s ovarian environment and ovarian reserve, we develop an individualized treatment plan that specifically addresses the root cause of her “poor response.”

By thoroughly individualizing the IVF protocol for each patient, CHR has been able to help many women overcome their previous poor response to IVF stimulation. To learn more about how CHR designs treatments for IVF poor responders and help women get pregnant with their own eggs even after failed IVF cycles, contact one of our physicians by completing the form below!

One Ovary Not Responding: IVF Solutions

Sometimes, one ovary does not respond to IVF stimulation while the other ovary shows a good response. This unilateral response to ovarian stimulation is somewhat common. There are several potential causes for one ovary not responding, ranging from the difference in blood supply to the ovaries to endometriosis affecting just one of the ovaries. For more details on the causes of unilateral ovarian response and potential treatments, please refer to this post.

Read more about DHEA Treatment

infertility physician

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.

Follow Dr. Gleicher on LinkedIn Center for Human Reproduction: Follow us on Google+. IVF center with best fertility options for each infertility patient. or watch his videos on YouTube Center for Human Reproduction: Follow us on Google+. IVF center with best fertility options for each infertility patient.

Last Updated: June 3, 2019

Additional Resources

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1/3 of women who have been told they need egg donation actually wind up conceiving at the CHR with their own eggs.