The term “poor responder” is typically referred to as someone whose ovaries and body does not respond to fertility medications. Usually they will require much higher doses of stimulation medications to produce 4 or less than optimal number of eggs needed to proceed in an IVF treatment.
How do you diagnose someone who may be a poor responder?
In most cases a poor responder diagnosis is discovered after going through an IVF cycle resulting in a poor stimulation outcome. However, it is possible to identify potential issues ahead of time through ovarian reserve testing.
This can be done through having a provider ideally a fertility specialist, check the FSH levels and conducting the clomiphene challenge test. An ultrasound assessment can help predict both resting and antral follicle numbers. There is one last test that can help determine if a person will be a poor responder and that is cycle day 3 blood testing of the Inhibin B levels.
It is important that women who are diagnosed as poor responders discuss with their fertility specialist on whether they fall in the spectrum. There are studies that indicate that women with elevated FSH levels during a clomiphene challenge test, may have an unsuccessful IVF cycle. However, everybody’s diagnosis can vary as well treatment protocol.
Here are a few different treatments for a poor response to ovarian stimulation that are commonly recommended:
- Altering the pituitary down regulation protocols
- Modifying stimulation cycle medications (e.g., different types and amounts gonadotropins),
- The use of adjuvant therapy (such as, growth hormone or androgen pretreatment), and
- advanced laboratory techniques (e.g., assisted hatching, continuing to egg retrieval despite low follicle numbers, or day 2 transfers).