Low ovarian reserve

Ovarian reserve is the pool of eggs present in the ovaries at any given time. Low ovarian reserve is when there is a physiological decrease in the number of eggs, resulting in an insufficient number to ensure a reasonable chance of pregnancy. Generally, it is caused by ageing ovaries. Patients can have diminished ovarian reserve but intact ovarian function.

Low Ovarian Reserve and IVF Success

Low ovarian reserve only becomes an issue when a woman has problems getting pregnant. Other women experience this condition in their 30’s and 40’s, but may have had their children earlier in life, so it does not negatively affect them.

IVF success for all age groups is extremely dependent on how many eggs the doctor can obtain at the egg retrieval. A poor responder by definition is a woman from whom three or fewer mature follicles are formed after ovarian stimulation. There is three times less chance of pregnancy if we obtain less than four eggs from poor responders.

Fewer eggs mean fewer embryos to choose for the embryo transfer. Many times poor responders are older so the quality of their eggs is poorer, which decreases the chance of pregnancy and increases the chance of miscarriages. The patient’s response to ovarian stimulation is usually proportionate to their ovarian reserve.

There are several baseline tests used to determine if a woman is a ‘poor responder’:

• Follicle stimulating hormone (FSH)
• Estradiol (E2)
• Inhibin B
• Anti-Mullerian hormone (AMH)
• Antral follicle count (AFC)

These tests reveal how well you would respond to follicular stimulation, based on which your specialists can customize your treatment protocols. The base principle is to harvest as many eggs as possible.