Dr.sathya balasubramanyam

MD DNB MRCOG (UK) FNB(Reprod med)

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Women who are capable of producing less than the optimal amount of eggs with stimulation during various infertility treatment procedures are termed as poor responders. They require a large amount of stimulation for producing sufficient eggs for extraction to conduct procedures such as IVF or ICSI.

Although there is no specific or uniform standard for the definition of a poor responder, women with a peak of estradiol, below 500 or oocytes cut off less than 4 at the time of hCG is considered to come under the category. A poor responder would require intensive stimulation to go through a successful IVF cycle.

poor responders

Though a poor responder can be identified through the stimulation outcome of a failed IVF cycle, there are other diagnostic tests that can help in ascertaining the issue, to clear it before proceeding further with the ART procedures. This can be done by an assessment of ovarian reserve along with ascertaining the basal FSH levels.

A clomiphene challenge test can also help identify the issue. Conducting ultrasound tests to assess the antral follicle count and the condition of ovaries helps in identifying a poor responder as well. The major issue with a poor responder is the feasibility of IVF treatment as a solution to infertility. Identifying the stimulation techniques to overcome the condition is a cause of concern as well.

A woman should have a sufficient ovarian reserve for the success of IVF treatment. So women facing the issue of poor response to stimulation should ideally undergo treatment to improve their oocyte count before proceeding for treatments such as IVF. This will increase their chances of conception and saves them the financial and emotional burden associated with each failed procedure.

The simplest approach for the treatment of a poor responder is to increase the dosage of gonadotropin administered to the patient. Increasing the daily FSH dosage to about 6 ampules a day might also help a little. The use of GnRH antagonists is a relatively new treatment procedure to improve the condition of poor responders. Once the oocytes are collected from these women, assisted hatching might be used for increasing the implantation rates of the embryo.

Although a poor responder finds it more of a challenge to achieve a successful pregnancy than a normal woman, the condition can be treated in many cases, with the right approach and treatment procedure with the most suitable stimulation protocol. An ideal stimulation protocol should be a tailored one to suit the requirements of the concerned patient.

A laboratory with the best facilities for culture and procedures such as assisted hatching can contribute significantly to the success of the treatment. A holistic approach designed to overcome the conditions of the patient could help in increasing her chances of motherhood. In cases where repeated treatment procedures fail, donor eggs can be used, if it is agreed upon by the couple.

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