“Poor Responder” is a term used for female who have decreased response to stimulation during test tube baby treatment. According to The Bologna ESHRE criteria “Poor Ovarian Responders” should be considered in patients having at least two of the following criteria:
- A previous episode of poor ovarian response with a standard dose of medication.
- An abnormal ovarian reserve with Antral Follicle Count (AFC) <5–7 follicles or AMH <0.5–1.1 ng/mL.
- Women above 40 years of age or presenting other risk factors for poor response such as previous ovarian surgery, genetic defects, chemotherapy, radiotherapy, and autoimmune disorders.
Low ovarian reserve is normally the cause of poor response. with increased age the ovarian reserve declines but however few women may suffer from premature ovarian failure resulting in decreased response before the expected age. Ovarian response can be analyzed before starting the IVF/ICSI treatment by performing tests like FSH, AMH and Antral follicle count. In some cases clomiphene challenge test can also help to make a diagnosis.
Pre determination of the ovarian reserve by conducting these tests allow the consultant doctor to adjust the dosage for IVF/ ICSI treatment individualized to the patients needs resulting in a more effective treatment. Addition of androgens and medication to increase blood flow to the ovary can also be beneficial in some cases.
By -Dr. Saira Afzal
ACIMC Lahore, Coordinator (MBBS)