Poor Ovarian Response / Early Ovarian Insufficiency
One of the most common and troublesome problems in western societies is premature ovarian insufficiency and poor ovarian response to egg production after stimulation for IVF. The result is that we obtain little good quality eggs or no eggs. This consequently leads to very low success rates of IVF because it is now proven that women who respond well to ovarian stimulation and produce several eggs eventually have a better chance of getting pregnant.
According to very recent data from 2012, the most difficult problem in all European countries is “communicative”, that is to convince women that despite the advances in science and the prolonged life expectancy of humans, the biological aging of women’s ovaries was and remains sharp when the woman is over 35 years old. This is because each girl is born with a certain number of eggs in her ovaries, which is gradually decreasing as she grows up, which reduces her ovarian reserve.
The woman’s most important reproductive capacity is not her calendar age, but the biological age of her ovaries, which reflects how her ovaries work and how many ova remain in them.
Moreover, the biological age of the ovaries is not related to the existence of a period, because it has been proven that a woman stops being fertile ten (10) years before her period stops!
To check the egg reserve and their quality in a reliable way and to predict the chances of success of assisted reproduction techniques and the appropriate therapeutic protocols, we perform a hormonal screening (blood test):
FSH and estradiol (between 1-4th day of the period)
High levels of FSH (> 12-14 mIU / ml) indicate that the ovarian reserve is low, while higher (> 20 mIU / ml) indicate almost complete ovarian failure (the ovaries do not function normally). In order to be reliable, FSH should always be measured in combination with estradiol, which should be <50μg / dl. High levels of estradiol should not deceive you, because they also indicate a low egg reserve.
The high price of FSH means that the woman will have a lot of difficulty getting pregnant by itself and she has to rush to the experts because her eggs are of poor quality.
Anti-mullerian hormone (AMH) is a hormone secreted by follicular cells. The levels of AMH in a woman’s blood today are one of the most reliable indicators of her ovarian reserve in eggs and a much better prognostic indicator than FSH for female fertility levels. With age, and especially after 38 years, both AMH levels fall in women. AMH does not change during your cycle, so blood collection can take place on any day of the month.
If your AMH levels are low you need to know that you need to speed up your reproductive processes and speak directly with experts because the success rates of IVF fall as AMH levels drop.
Women over 40 years of age are often prepared for the fact that their ovaries are not responding well to stimulation. But it’s not the same if low ovarian response and premature ovarian failure occurs in women under 38 because these women expect to have good quality eggs because they are young and have a normal cycle. When a woman has a normal cycle, it means that her eggs are of good quality in order to cause hormone generation and induce her period. On the contrary, it does not mean that these eggs are good enough for her to get pregnant.
Is there a treatment for high FSH and low AMH?
The high FSH value is not the cause of infertility, but an indicator for the low ovarian reserve. When the eggs are exhausted, the ovary can not produce new eggs and FSH rises and AMH decreases. So trying to “cure” the high value of FSH is meaningless and wrong and it will NOT help you to get pregnant.
In women with low AMH and high FSH time is valuable. IVF is the best choice because it offers the highest success rate. Treatment should be aggressive in order to achieve pregnancy before the ova reserves are exhausted.
The ultimate solution and treatment for achieving very high pregnancy rates for women with poor ovarian response or early ovarian failure is egg donation.
Most couples test 1-2 cycles with their own egg and if they fail they proceed to the donor egg solution.