Poor Responder

Definition - What does Poor Responder mean?

A poor responder is someone whose ovaries do not respond strongly to fertility drugs. They usually require higher doses of fertility hormones to produce the desired four or more mature egg cells with a fertility treatment.

In some cases, poor responders may continue to make too few eggs to proceed with in vitro fertilization (IVF), even at higher medication doses.

FertilitySmarts explains Poor Responder

There is no universal set of guidelines for classifying someone as a poor responder. Common guidelines used by some IVF providers include people who:

  • Produce few eggs in response to standard fertility treatments (minimums used range from <3 to <6)
  • Have peak estradiol below 500
  • Have elevated FSH levels on day 3 of their cycle
  • Have advanced maternal age
  • Have a history of needing increased dosages of fertility medications

Some women with poor response to fertility treatments may have poor ovarian reserve, meaning they have few healthy follicles left to mature. This is most frequently found in women with advanced maternal age, but can also happen in younger women with some medical conditions.

Some doctors recommend that women with advanced maternal age have ovarian reserve tests done before pursuing IVF, to ensure that they stand a good chance of responding to IVF treatments. Tests for ovarian reserve can include ultrasounds to visually count the number of follicles in the ovary, and blood tests to determine if a woman's ovaries are releasing hormones associated with follicle maturation.

If a woman does not respond strongly to standard fertility treatments but her ovarian reserve is sufficient to warrant continued attempts at IVF, there are several ways in which fertility treatments may be modified to increase chances of success for poor responders. These include:

  • The use of Lupron to prevent premature ovulation may be altered. In normal IVF, Lupron is used to suppress luteinizing hormone and ensure that the developing eggs are not ovulated - after which they survive only one day - before egg collection. In some women, this suppression may interfere with egg development.
  • Flare protocols, which change the timing and dosage of fertility medications to take advantage of a woman's natural hormones.
  • Use of a an antagonist against gonadotropin-releasing hormone, which triggers the woman's body to release luteinizing hormone. By antagonizing GnRH instead of suppressing luteinizing hormone, premature ovulation may be avoided without suppressing other hormones.
  • Some doctors believe that using GnRH antagonists yield better responses for women who are poor responders, but controlled studies have not yet been conducted to see if this is true.

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