Low Ovarian Reserve

Low Ovarian Reserve Specialised Unit

Delayed motherhood in our society is currently increasing cases of infertility. The number and quality of oocytes reduces as the years pass and the difficulty to conceive increases. Although on some occasions, this can occur in women with a normal ovarian reserve.

Ovarian reserve level

Women are born with a certain number of oocytes which reduce with each menstrual cycle until they are used up completely when menopause occurs. One of the indicators to evaluate female fertility is the study of ovarian reserve level, that is, knowing the total amount of oocytes that women have in their ovaries. The two most reliable markers to measure ovarian reserve are the Antral Follicle Count done on an ultrasound and determination of the Anti-Müllerian hormone.

During In Vitro Fertilisation (IVF) treatment, the patient must be administered medication to achieve various eggs being fertile in the laboratory. For a favourable prognosis of embryos, a number of oocytes above five is considered to be adequate.

Patients who receive the same dose of medication may have very different responses and at times the number of oocytes obtained is so low that the chance of success is reduced considerably. In these cases, it is fundamental to correctly evaluate and define the best strategies to increase the chance of success.

Evaluation protocol

The low response to ovarian stimulation implies a poor prognosis in terms of in vitro fertilisation treatments and therefore a low rate of pregnancy. When the number of oocytes produced is low, obtaining a good quality egg is key to achieving pregnancy, which requires a specialised and experienced medical team, offering personalised treatment.

Our specialised unit carries out a complete study to identify the cause of low ovarian response:

  • High resolution ultrasound for the study of Antral Follicles
  • Anti-Müllerian hormone (AMH) determination
  • Endocrinology Profile: Thyroids, Prolactin, Sexual Hormones.
  • Karyotype
  • Fragile X Study
  • Thyroid auto-immunity study
  • Adrenal auto-immunity study.

Once the evaluation is carried out, the treatment orientated at achieving the best result is determined:

  • Antral preparation with androgens (DHEA, testosterone) to improve the number of oocytes obtained and the embryo quality.
  • Cycles of oocyte accumulation associated with Pre-implantation Genetic Diagnosis. Completion of serialised stimulations until the adequate number of oocytes is achieved and a genetic selection offers guarantees of achieving healthy embryos, free of chromosome alterations.
  • Cycles of minimal stimulation or natural cycles in selected cases. The quality of the embryos is prioritised over the number, optimising stimulation and growth of the embryos so that the few that are generated have a higher probability of leading to pregnancy.
  • Egg donation programme. In cases in which it is not possible to achieve pregnancy with the woman’s own eggs, due to an insufficient number of oocytes or deficient quality, we have an egg donation programme with eggs from donors, one of the most efficacious treatments in assisted reproduction.

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