Some couples have difficulty achieving a pregnancy, even by undergoing In Vitro Fertilization. When IVF treatment fails, we have to identify the root of the problem, which could be a low response to ovarian stimulation.

Ovarian stimulation is one of the most important stages in In Vitro Fertilization, because we need to obtain several oocytes to do the treatment. Sometimes the ovaries do not respond properly, and we obtain few oocytes, reducing the chances of achieving a successful pregnancy. We call this low ovarian response.

What causes low ovarian response?

There are several causes of low ovarian response, some of which include

• Ovarian tumors.
• Side effects from previous surgery.
• Endometriosis.
• Aging of the ovaries.
• Previous treatments with drugs that reduce the ovarian reserve.
• Low ovarian reserve. That is, when the patient has few oocytes.

Low ovarian reserve is the main cause of a poor response to stimulation. How does it affect the patient? If we obtain few oocytes to fertilize them, the chances of pregnancy decrease, and embryo implantation may fail.

We know that couples who come to an assisted reproduction clinic yearn to have a baby and it is difficult when they cannot achieve this. As specialists, it is our responsibility to talk to them if we discover that the woman has few mature follicles or few oocytes.

After discussion, we can offer solutions such as:

• Regulating the hormones in the pituitary gland and hypothalamus so that the ovaries function properly.
• Modify the medication and/or dose of ovarian stimulation. For example, different types and amounts of gonadotropins.
• Using growth hormone as an adjuvant treatment, which helps solve the problem.

Pre-treatment with androgens, to get more follicles or better quality of the oocytes in the stimulation.

In the In Vitro Fertilization Laboratory, several strategies can also be followed to increase the chances of a pregnancy: 

Performing advanced techniques such as assisted hatching (opening the hard wall of the embryo called Zona Pellucida).

Use embryo transfer on the 5th day (blastocyst stage).

Accumulate good quality embryos in 2 or 3 IVF cycles and freeze them until at least 2 good quality embryos are reached for transfer.

In our assisted reproduction clinic, we recommend assisted hatching (also known as assisted hatching) in patients with several IVF attempts with low ovarian reserve.

Thanks to the development of new treatments and technologies, success rates have increased globally. But it is important to know that the Embryologist’s experience in the IVF laboratory and the laboratory technology is crucial to ensure the maximum possibilities, both for fertilizing most of the few oocytes obtained and for them to develop in high quality culture media.

In addition, with an optimal environment in the incubators we can increase the chances of transferring good quality embryos and raise the chance of successful treatment.

In other cases, when IVF with your own oocytes fails, an oocytes donation may be a good option.

In our assisted reproduction clinic, our IVF laboratory director has 14 years of experience and has specialized in Japan in the successful management of patients with very few oocytes, such as women with low ovarian reserve. In addition, he has been a professor in the United States for the last 5 years, with extensive experience in the treatment of patients with low ovarian reserve. 

In short, a solution can be found to the low ovarian response. At Citmer we help our patients to get pregnant, always looking for a treatment that fits their needs.