Low ovarian reserve

Low ovarian reserve

Delayed childbearing in our society today is increasing cases of infertility. The number and quality of oocytes decreases over the years and difficulties in conception increase. Although it can sometimes occur in women with normal ovarian reserve.

Level of ovarian reserve

A woman is born with a certain number of oocytes that are lost with the menstrual cycles until they are exhausted at the menopause. One of the indicators for assessing female fertility is the study of the level of ovarian reserve, i.e. the total number of oocytes a woman has in her ovaries. The two most reliable markers for measuring ovarian reserve are the Antral Follicle Count in the ultrasound scan and the determination of the Antimullerian Hormone.

In an In Vitro Fertilisation (IVF) treatment, the patient must be administered medication in order to obtain several eggs that will be fertilised in the laboratory. For a favourable embryo prognosis, a number of oocytes above five is considered adequate.

Patients receiving the same dose of medication may have very different responses and sometimes the number of oocytes obtained is so low that the chances of success are considerably reduced. In these cases, a correct evaluation is essential to define the best strategies to increase the chances of success.

Assessment protocol

Low response to ovarian stimulation means a poor prognosis in in vitro fertilisation treatments and therefore a lower pregnancy rate. When the number of eggs produced is low, obtaining a good quality egg is key to achieving pregnancy, which requires a specialised and experienced medical team to offer a personalised treatment.

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

  • >High resolution ultrasound for the study of Antral Follicles.
  • Determination of Anti-Müllerian Hormone (AMH).
  • Endocrinological Profile: Thyroid, Prolactin, Sex Hormones.
  • Karyotyp
  • Fragile X study
  • Thyroid autoimmunity study
  • Adrenal autoimmunity study.

Once the assessment has been carried out, the treatment is determined in order to achieve the best result:

  • Antral preparation with androgens (DHEA, testosterone) to significantly improve the number of oocytes obtained and embryo quality.
  • Oocyte accumulation cycles associated with Preimplantational Genetic Diagnosis. Carrying out serial stimulations until an adequate number of oocytes is obtained and a genetic selection that offers guarantees of obtaining healthy embryos, free of chromosomal alterations.
  • Cycles of minimal stimulation or natural cycles in selected cases. The quality of the embryos is prioritised over the number, optimising the stimulation and culture of the embryos so that the few that are generated have a higher probability of generating pregnancy.
  • Egg Donation programme. In cases where it is not possible to achieve pregnancy with your own eggs, due to insufficient number of oocytes or deficient quality, we have an egg donation programme with donor eggs, one of the most effective treatments in assisted reproduction.