Poor Ovarian Response (POR) to Ovulation-Inducing Medications

Definition and Overview
Poor ovarian response (POR) to stimulation typically refers to women with diminished ovarian reserve or inadequate ovarian response to exogenous gonadotropins. In fact, poor ovarian response is considered a reproductive disorder that leads to infertility. It is one of the most significant challenges in assisted reproductive technologies (ART).

Poor ovarian response or anovulatory cycles refer to cycles in which the ovary fails to release an egg, and ovulation does not occur. A woman experiencing anovulation is not necessarily menopausal.

Diagnosis of Anovulation
Diagnosing anovulation is not straightforward. Contrary to popular belief, women with anovulation may still experience seemingly normal menstrual cycles. They usually become aware of the issue when they first attempt to conceive. In IVF/ICSI patients, poor ovarian stimulation may occur, meaning their ovaries fail to respond adequately to medication, resulting in either no oocyte retrieval at the time of oocyte pick-up (OPU) or the retrieval of only 1–9 low-quality oocytes.

Key Problems in Patients with Poor Ovarian Response
One of the major challenges in patients with POR is the poor quality of retrieved oocytes, which often lack the capability to be fertilized naturally or through ART. Managing such patients remains a significant obstacle in assisted reproductive treatments.

Treatment Approaches for Poor Ovarian Response
One recommended protocol for treating these patients is the delayed-start GnRH antagonist protocol. Several standards exist for diagnosing POR, such as assessing ovarian reserve through laboratory tests and evaluating previous IVF cycle outcomes. However, to definitively diagnose poor ovarian response in IVF cycles, four criteria should be evaluated:

1. Age

2. Antral follicle count (AFC)

3. Anti-Müllerian Hormone (AMH) levels

4. Ovarian response to stimulation medications
 

Signs of Poor Ovarian Response to Stimulation Drugs

Decreased ovarian reserve

AMH < 1.3 ng/mL

FSH > 12 IU/L

Regular or irregular menstrual cycles

Antral follicle count ranging from 1 to 5 follicles per ovary

Diagnosis of Poor Ovarian Response
Diagnosis is made through blood hormone tests and pelvic ultrasound.