Poor Ovarian Responders Treatment Unit
With age, there is a lower oocyte quantity and quality resulting in more difficulties when trying to conceive naturally, in addition to failure when using traditional assisted reproduction techniques.
What is the ovarian response?
One of the most important phases during any IVF treatment is ovarian stimulation. In this phase, patients are required to take medication for a period of between 7 and 12 days in order to obtain several oocytes for fertilisation. Therefore, ovarian response is defined as the quantity of oocytes obtained following the above stimulation. This is carried out in order to obtain an adequate amount of oocytes to guarantee favourable embryo prospects. In general terms, an amount of 5 oocytes is considered adequate.
However, we can obtain very different responses from patients who are subject to identical medication doses. In some cases, the total quantity of oocytes is so low that any chances of success are considerably reduced. These cases are referred to as poor ovarian response.
What is the ovarian reserve?
Women are born with the entire amount of oocytes that they will have during their whole life. As time passes by, these oocytes will be lost until they completely run out with the onset of menopause.
Therefore, ovarian reserve is defined as the total quantity of suitable oocytes available in a woman’s ovaries at any given time, which shall determine the amount of oocytes that can be obtained during IVF treatment. When it comes to measuring a woman’s ovarian reserve, the antral follicle count by ultrasound and the anti-Mullerian hormone (AMH) level tests are the most reliable indicators.
Although a low ovarian reserve is the main cause of poor ovarian response, this can also happen in women with otherwise normal ovarian reserves.
As previously indicated, ovarian reserves reduce progressively with age until they completely run out. For that reason, age is one of the main risk factors when it comes to low ovarian reserves. However, reserves can greatly vary even among women of the same age, with some women showing a low reserve earlier than others. Likewise, it is not uncommon for some over 40’s to have a normal reserve and high ovarian stimulation response, therefore resulting in a high amount of oocytes available for IVF treatment. This is due mainly to genetic but also environmental factors.
In these regards, at Instituto Bernabeu’s Poor Responders Unit we are currently working on several research studies in order to develop genetic tests that can predict whether a specific woman is at risk of losing their ovarian reserve sooner,among other research areas.
Social changes in the last few years have resulted in women being forced to delay motherhood. From the age of 35 years old onwards, these women are affected not only by a reduced ovarian response, but also by a considerable progressive decrease in the amount of oocytes. Due to the relationship between age and the ovarian reserve, we have an increasing amount of patients with poor ovarian response to stimulation, resulting in a negative prospect when it comes to IVF treatment. Often referred to as Poor Responders, these are patients are most crucially in need of a correct assessment in order to define the best strategies to follow in order to increase the chances for a successful pregnancy.
LOW OVARIAN RESERVE
LOWER RESULT THAN STIMULATION
EVOLUTION OF THE CROP
EMBRYONIC DEVELOPMENT DAY 5
NORMAL OVARIAN RESERVE
OPTIMAL RESULT TO STIMULATION
EVOLUTION OF THE CROP
EMBRYONIC DEVELOPMENT DAY 5
REMAINING TRANSFER AND FREEZING
Instituto Bernabeu’s Poor Responders Independent Unit
At Instituto Bernabeu we confronted this challenge within the reproductive medicine field in order to improve our patient’s chances to get pregnant with their own eggs by creating a pioneering Unit to treat poor responders. As the first unit of its kind in Spain, we have treated couples from several countries all over the world.
Our multidisciplinary unit led by Dr. Joaquin Llacer comprises a team of practitioners specialising in reproductive medicine, molecular biology, genetics and reproductive biology with the purpose of assisting these couples while offering assistance and research in order to provide a customised treatment plan that is unique for each patient.
All cases dealt with at this Unit are analysed and discussed by a team of specialised professionals.When working with our IB’s poor responders unit, patients are able to access the latest innovations in terms of diagnosis and treatment: specific and cutting edge laboratory tests, 4D gynaecology ultrasound scans for ovarian and uterine research, genetic markers, prognosis and Array-CGH are some of the tests used to design a customised strategy aimed at improving every couple’s chances for success.
Access to top professionals and the most advanced diagnostic tests in order to allow us to define the most adequate strategies in each case.
Over the last few years, our Unit has developed and perfected the most innovative stimulation protocols. From adjuvant therapies to improve ovarian tenderness to luteal phase stimulation, including the accumulation of vitrified oocytes and the use of soft protocols, all the above techniques have been implemented in order to obtain promising results in patients who would otherwise be required to find an oocyte donor.
On the other hand, our experience when dealing with complex cases has helped us to better understand the emotional baggage of our Poor Responder patients in situations where further sensitiveness is required, as well as emotional care.
At Instituto Bernabeu, our Poor Responders Unit is a pioneer in this field of research. As a result of our commitment towards research, our institute was awarded by the American Society for Reproductive Medicine (ASRM) in 2012 for a paper on genetic polymorphisms in Poor Responders. Further to the above, we have been the first clinic worldwide to develop a pharmacogenetics concept applied to ovarian stimulation by introducing out new IBgenIVF test.
Currently, our main research areas are focused in three main aspects:
- Genetic factors that cause ovarian aging with the purpose of developing predictors to assist women when planning their reproductive life.
- Pharmacogenetic advances that will allow us to customise our stimulation protocols depending on each patient’s genetic profile, thus improving their response to hormone application.
- Exploring new ways of stimulation through clinical tests on Poor Responders, such as new luteal phase research studies.
- Administer the patient’s own platelet-rich plasma (PRP) to the ovary to favour the activation of “sleeping follicles” and increase the number eggs.
Our high level of specialisation in poor responder patients allows you to have access to all specialised practitioners required to carry out a personal study plan during your appointment, to ensure that you can complete all the required diagnostic test to analyse and design your customised treatment plan in just one day.
- Poor response risk based on your own genetic profile. IBgen IVF.
- Anti-Müllerian hormone.
- Fragile X.
- High resolution ultrasound
- Personalized analysis of your medical history
- Assessment consultation by a low ovarian reserve specialist.
- Followed by a new specialist consultation in order to assess and design your own treatment plan (may be done by videoconference).