Keywords:

Age, genetic factors, IVF, ovarian reserve, poor responder.


Published online: Jul 07 2011

S. Oehninger

Department of Obstetrics and Gynecology, Director, Division of Reproductive Endocrinology and Infertility, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School. Norfolk, USA

Correspondence at: Sergio Oehninger, MD, PhD, The Jones Institute for Reproductive Medicine, 601 Colley Avenue, Norfolk, Virginia 23507, USA. E-mail: OehninsSC@EVMS.edu

Abstract

Poor responders represent more than a third of women undergoing assisted reproduction. Typically they are patients with advanced maternal age and low ovarian reserve. However, there is a younger group that unex- pectedly demonstrates impaired response to controlled ovarian hyperstimulation. The etiologies in many of these cases are still unclear. In our program, the determination of basal cycle day 3 serum FSH, LH and E2 levels, measurement of AMH, and the estimation of the basal antral follicular count by transvaginal ultra- sonography, are the preferred screening tests for ovarian reserve in all IVF patients, and together with the woman’s age, determine the ovarian stimulation regimen to be chosen for the cycle treatment. In spite of a variety of protocols and adjuvant therapies of unproven benefit, these patients have compromised outcomes and continue to represent a challenge to reproductive endocrinologists.