Women with low functional reserve (LFOR) require special clinical approaches in their fertility treatments, according to CHR physicians

In the latest OPINIONs piece, CHR points out that many IVF centers do not diagnose low functional ovarian reserve (LFOR) quickly enough, and often fail to provide fertility treatments that specifically address egg quality and quantity issues brought on by LFOR, including pre-cycle supplementation with DHEA with androgen monitoring, microdose agonist protocol and avoidance of embryo selection methodologies, among others.

For immediate release

August 4, 2014 (New York, NY) – Fertility centers often fail to provide optimal fertility treatments to women with low functional ovarian reserve (LFOR), according to a new OPINION commentary issued by the Center for Human Reproduction (CHR).

LFOR is characterized by the ovary’s impaired ability to produce a good number of high-quality eggs. LFOR occurs either in young women whose (for a variety of reasons) ovaries age prematurely, or in older women above age 40. LFOR results in significantly lower pregnancy rates with fertility treatments, including in vitro fertilization (IVF).

The diagnosis of LFOR is, unfortunately, often missed completely or greatly delayed, especially in younger women with premature ovarian aging (POA). The most frequent reason is failure to correctly assess hormone parameters, like follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH). Many fertility centers still use universal (i.e., age-independent) values to determine whether FSH and AMH are in normal range or not, while timely diagnosis of LFOR requires utilization of age-specific hormone values. Diagnosing LFOR in women over 40, in contrast, is usually uncomplicated because practically all women in that age range have LFOR.

“The ‘normal’ range of these hormones change with female age,” explains Norbert Gleicher, MD, Medical Director and Chief Scientist at CHR. “Using one universal cut-off level to differentiate ‘normal’ and ‘abnormal’ inevitably overlooks younger women with abnormally low functional ovarian reserve for their age.”

In the published OPINION, CHR explains how the treatment of patients with LFOR should differ from routine IVF cycles in women with normal ovarian function, once a LFOR diagnosis is reached. At CHR, with a worldwide reputation in successfully treating women with LFOR, the approach includes pre-cycle supplementation with dehydroepiandrosterone (DHEA) coupled with periodic monitoring of androgen levels, avoidance of recently increasingly popular embryo selection methods, like preimplantation genetic diagnosis (PGS) and embryoscopy, and avoidance of any form of suppressive therapy to ovaries during ovarian stimulation.

David H Barad, MD, MS, CHR’s Director of Clinical ART, explains that CHR’s success in treating LFOR relies on understanding the underlying pathology causing LFOR and trying to address these root problems, without resorting to unproven embryo selection technologies, given that women with LFOR typically do not have enough embryos to select from. “Most important, however,” says Dr. Barad, “is the individualization of IVF care for every patient.”

CHR’s excellent IVF cycle outcomes, reported to the national registries of SART/CDC and published on CHR’s website, demonstrate that even women with quite severe LFOR, and at advanced ages, can still expect reasonable pregnancy chances with properly individualized treatment, without resorting to egg donation.

The full text of the piece can be found on CHR’s website, along with all previous installments.

About Center for Human Reproduction
The Center for Human Reproduction (CHR), located in New York City, is one of the world’s leading and best known clinical and research centers in reproductive medicine and infertility. Independently vocal on issues impacting fertility patients, CHR has become known as a center of independent thinking in the profession, through its economic independence freed from political correctness and self-interests.


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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.