IVF Poor Responder

Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on May 05, 2020

IVF Protocols for Poor Responders

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 results in 10 eggs, for example.

At CHR, we feel that this easy “diagnosis” simply describes what’s happening and doesn’t necessarily lead to a solution to do better in the next IVF cycle. We try to pinpoint the root cause(s) of each patient’s lower-than-expected response to stimulation in order to tailor a more successful IVF protocol next time, rather than applying the unhelpful “poor responder” label.

Overcoming poor response to IVF stimulation

Don’t be discouraged if you show signs of poor response to IVF stimulation. At CHR, we work with you to understand why you aren’t producing enough follicles and ultimately find a solution that can work for you. Dr. Barad explains our approach.

Cancelled IVF Cycle due to Poor Response

Many patients come to CHR after being diagnosed as a “poor responder” at other IVF centers. These patients are—understandably—frustrated by the lack of solutions and discouraged by some physicians’ blanket recommendation for egg donation after one or two cycles in which ovarian stimulation didn’t result in enough eggs to establish a pregnancy. Unfortunately, some women even feel that they are being blamed for the failed IVF cycle. When we review the patients’ previous cycles and conduct more in-depth workup, however, our physicians usually find overlooked conditions and problems with cycle management, which, once properly addressed, can lead to a much better cycle outcome.

Another challenge deriving from “poor response” is the cancellation of IVF cycles. 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 the 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:

  • insufficient preparation of ovaries
  • too little ovarian stimulation, i.e., medication dosages not high enough
  • 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 failure to properly treat the condition 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” stimulation protocol 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 physicians are not addressing their unique ovarian environments. Sometimes, patients and their physicians aren’t even aware that they are dealing with DOR, as the condition may not be obvious at the early stage if the hormonal indicators are not viewed in an age-specific way. 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.

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.

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, 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.