Low ovarian reserve, a challenge with optimistic future

The social changes in recent years have been highly beneficial to achieving rights and equalities, although it has also led to a significant increase in maternal age. But nature does not understand social change and the biological clock keeps ticking as usual. There are several consequences of this delay on female fertility and it depends on each woman, but it is a reality that as women age, the ovarian reserve diminishes and the egg quality lowers.

Each woman is born with a limited number of eggs, which is the number available throughout her life until they completely run out with the onset of menopause menopause. But not all women of the same age have the same reserve. There may be women who have low reserves at a young age and others over 40 who have a normal amount and also a high response to ovarian stimulation in assisted reproduction treatments such as In Vitro Fertilization. In addition, sometimes a patient has a poor response to the stimulation but the egg quality is normal. And occasionally in patients under 40, although their response is poor, the chances for success are good.

Besides age, what other factors influence women’s ovarian reserve, quality and response? Environmental factors are mostly to blame, but above all, genetic factors. That is why applied research and the individualized study of each woman are essential in these cases. In this regard and with these goals, Instituto Bernabeu Alicante was a pioneer in creating the Poor Response Unit to specifically address these reproductive difficulties.

In the study of factors that may cause a woman to have a poor ovarian response, our specialists conclude that an evaluation and individual studies are necessary to establish a personalized protocol and treatment.  Having a specific protocol to improve the response is essential. The ovarian response to stimulation is key in this respect, since the prognosis of assisted reproduction treatments depends on the number of oocytes obtained. The difference between obtaining two or three eggs is crucial. In fact, when three eggs are extracted, the chances of success increase over 50% compared to two eggs.

In addition, these patients must have multidisciplinary support. In this regard, our specific unit for their treatment addresses, analyzes and discusses the low ovarian response problem by joining the knowledge and experience of reproductive medicine, molecular biology, genetics and reproductive biology specialists.

Having a specific department with these features allows the patient to have the latest developments for prognosis. Specific tests, 4D ultrasounds for uterine or ovarian vascular exams, prognostic genetic markers, or Array-CGH are some of the exams that Instituto Bernabeu carries out for designing an individual treatment for each patient. Every woman has specific needs but one common aim: to achieve a better ovarian response and endometrial receptivity in order to increase the chances of pregnancy.

Thanks to the attention given to each particular case and the precision of the exams that are carried out, encouraging results are being achieved in many patients that otherwise would have to turn to egg donation. The Low Ovarian Response Unit of Instituto Bernabeu also covers another fundamental area for women and couples in this situation: specific emotional support.

The patient with a poor response to ovarian stimulation constitutes one of the most important challenges that reproductive medicine specialists confront. In this regard, the bigger the challenge, the better the incentive is to overcome it. Science moves ceaselessly to be able to offer new alternatives in the future to poor ovarian responder patients.

This is the case of one of the research projects of the Poor Ovarian Response Unit of Instituto Bernabeu that has been awarded by the American Society for Reproductive Medicine. Moreover, we have a number of research projects to reactivate the sleeping oocyte in the ovary and have eggs in ovarian failure situations. This possibility may have an immediate medical application in the medium term. The prediction for the future of patients with poor ovarian response is therefore encouraging and completely optimistic, since we are closer to be able to control with greater freedom the hands of the biological clock.