{"id":3865,"date":"2023-01-18T16:46:41","date_gmt":"2023-01-18T16:46:41","guid":{"rendered":"https:\/\/www.institutofertilidadviamed.com\/hospital-santa-angela-de-la-cruz\/clinical-cases\/low-response-to-ovarian-stimulation\/"},"modified":"2023-02-21T10:25:34","modified_gmt":"2023-02-21T10:25:34","slug":"low-response-to-ovarian-stimulation","status":"publish","type":"page","link":"https:\/\/www.institutofertilidadviamed.com\/hospital-santa-angela-de-la-cruz\/en\/clinical-cases\/low-response-to-ovarian-stimulation\/","title":{"rendered":"Low response to ovarian stimulation"},"content":{"rendered":"\t\t
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Low response to ovarian stimulation<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Low response to ovarian stimulation is defined as obtaining a low number of oocytes after an ovarian puncture preceded by controlled ovarian hyperstimulation treatment.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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A limited number of oocytes leads to fewer embryos available during assisted reproduction treatment, resulting in lower clinical pregnancy rates. In addition to the reduced number of oocytes, these cases are usually associated with a lower rate of oocyte maturation, poorer embryo quality, and a higher rate of cancellation of the assisted reproduction cycle. The existence of this phenomenon was discovered thanks to the expansion of assisted reproduction techniques, and it is estimated that between 9 and 25% of patients undergoing these treatments have low ovarian response,<\/strong>although it is difficult to calculate, since the primary cause of low ovarian response is low ovarian reserve, and this depends mainly on the age of the patient.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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The aetiology of this condition is complex and is not yet understood in depth. Among the possible causes described is the depletion of ovarian follicles associated<\/strong>, as mentioned before, with advanced age, endometriosis, genetic and chromosomal alterations, previous ovarian surgeries, pelvic adhesions, metabolic and enzymatic diseases, autoimmune diseases, infections and pathologies caused by toxins.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Numerous definitions have been proposed in the literature to try to accurately characterise this type of patient. The first official consensus among the scientific community was reached in Bologna in 2011, following a meeting of the European Society of Human Reproduction and Embryology<\/em> (ESHRE) (Ferraretti et al.<\/em>, 2011).<\/p>\n

This consensus established that a patient should present two of the following three criteria to be included in the low responder category:<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAdvanced maternal age: \t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t40 years or older, or some other low-response risk factor.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tLow response to a previous ovarian stimulation cycle: \t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tobtaining 3 oocytes or less after a conventional stimulation protocol.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tAbnormal result on ovarian reserve test:\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tAntral follicle count below 5-7 or anti-mullerian hormone level below 0.5-1.1 ng\/mL.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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The Bologna criteria have certain limitations, such as the lack of clarity when defining risk factors for low response or not taking into account oocyte quality, which is associated with diminished ovarian reserve. Even more important is the fact that there is a fair degree of heterogeneity among this population of patients with low ovarian response, and the existence of possible subgroups has been raised.<\/p>\n

In order to solve this problem of heterogeneity, a new classification system called the \u201cPoseidon Criteria\u201d was proposed, developed by the POSEIDON group (Patient-Oriented Strategies Encompassing Individualized Oocyte Number<\/em>) (Alviggi et al.<\/em>, 2016). This system allows for a greater stratification of patients with low response, dividing them into 4 subgroups (1-4), depending on:<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tQuantitative and qualitative parameters such as age and expected rate of aneuploidy\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tOvarian reserve biomarkers (antral follicle count and\/or anti-mullerian hormone)\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tOvarian response in a previous cycle (if performed)\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\tThe objective of the Poseidon criteria is to achieve better (more personalised) clinical management of patients with low response to ovarian stimulation. However, it is not a perfect system and also has its limitations. \t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\tThe treatment of low ovarian response ranges from the donation of oocytes, accumulation of oocytes by vitrification to increase their quantity at the time of fertilisation, personalised stimulation protocols: some with adjunctive medication that will try to improve the response to gonadotrophins, stimulation with high doses of FSH and\/or FSH+LH, milder stimulation, and even natural cycles without ovarian stimulation. \t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Low response to ovarian stimulation Low response to ovarian stimulation is defined as obtaining a low number of oocytes after an ovarian puncture preceded by controlled ovarian hyperstimulation treatment. A limited number of oocytes leads to fewer embryos available during assisted reproduction treatment, resulting in lower clinical pregnancy rates. 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