Few Problems in IVF are more frustrating than a poor responder to Gonadotropin stimulation.
The commonest causes are advanced age and also Ovarian Surgery.Let me inneumrate it for ease of understanding
- Advanced Fertile age.The fertility goes a steep downhill after the age of 37 years.
- Previous Ovarian surgery
- Severe endometriosis
- Previous pelvic adhesions
- Previous pelvic infections
- Previous chemo/radiotherapy.
Though there are many definitions of poor responders but the most widely accepted one is < 3 Oocytes retrieved despite maximal stimulation.An AMH , 3 Pmol/l or an antral count of < 5.
( One can't stimulate follicles which aren't there).
There are various so called treatment options for Poor responders but only testosterone patches and Letrozole have been used with some success.Unfortunately Letrozole is still not accepted as a fertility medicine in India,once it was withdrawan following the Canadian controversy.DHEAS has also been recently attempted to help the poor responders.
One is tempted to use Gonadotrophins at higher level in such patients as a starting dose