How Specialists Manage Poor Ovarian Response in IVF

Poor ovarian response occurs when the ovaries produce fewer follicles or eggs than expected during IVF stimulation. This can reduce the number of eggs retrieved for fertilisation and may affect the number of embryos available for transfer or freezing.

When fewer mature eggs are retrieved, there may also be fewer embryos available for fertilisation, genetic testing, transfer or freezing later in the IVF process. For patients, this can create concerns about whether the IVF cycle will produce enough viable embryos to support a successful pregnancy attempt. As such, fertility specialists often need to adjust IVF medication protocols, monitoring strategies and treatment planning to help optimise ovarian response and improve IVF management outcomes.

Poor ovarian response is generally caused by a reduced egg follicle pool or reduced responsiveness to hormonal stimulation.

Under normal circumstances, only one egg naturally matures each month. During the IVF process, specialists prescribe fertility stimulation medication to encourage multiple ovarian follicles to grow and mature at the same time. Poor ovarian response occurs when the ovaries react less effectively to these stimulation medications, resulting in fewer follicles developing than expected. This may lead to a lesser number of eggs being collected during egg retrieval.

Some potential root causes are:

As women age, both the number and quality of remaining eggs naturally decrease. This is one of the most common causes of reduced ovarian response during IVF treatment.

Some women naturally have a lower number of remaining eggs even at a younger age. This may reduce how strongly the ovaries respond to fertility stimulation medication.

Surgical procedures involving the ovaries, such as cyst removal or endometriosis surgery, may affect ovarian tissue and reduce egg-producing capacity. In addition, certain cancer treatments, including chemotherapy or radiotherapy, may damage ovarian tissue and reduce ovarian responsiveness.

For this reason, it is sometimes recommended to undergo egg freezing prior to undergoing medical treatment involving the ovaries.

Certain hormonal imbalances or genetic conditions may interfere with how the ovaries respond to stimulation medication.

Although this condition can make IVF treatment more challenging, fertility specialists can use several personalised strategies to assess ovarian response, optimise follicle development and egg retrieval outcomes.

Before starting IVF stimulation, fertility specialists usually carry out several tests and assessments to evaluate how the ovaries are likely to respond to treatment. This helps clinics determine the most suitable stimulation approach and estimate how many eggs may be retrieved during the cycle. This may also aid them in making projections regarding poor ovarian response.

Assessments may include:

Although poor ovarian response can make IVF treatment more challenging, fertility specialists can use different strategies to help optimise follicle development and improve egg retrieval outcomes.

Treatment is often tailored according to the patient's ovarian reserve, medical history and if relevant, their previous response to IVF.

Patients with poor ovarian response often require closer monitoring throughout the IVF cycle. Regular ultrasound scans and hormone blood tests allow fertility specialists to track how the follicles are growing and determine whether medication adjustments are needed during stimulation.

This monitoring process also helps specialists identify the most appropriate timing for the trigger injection and egg retrieval procedure, which may affect whether mature eggs can be successfully collected.

Different patients may respond differently to ovarian stimulation medication. For patients with poor ovarian response, IVF specialists may modify the dosage, type or combination of fertility hormones used during treatment in order to encourage more follicles to continue developing during the stimulation phase.

Depending on the patient's ovarian reserve and previous IVF history, specialists may also adjust how early stimulation begins or how long medication is continued before egg retrieval is scheduled. This longer waiting period may give the body more time to respond to medication.

When fewer eggs are retrieved in a single IVF cycle, fertility specialists may recommend undergoing additional treatment cycles to increase the total number of eggs or embryos available for fertilisation and transfer.

This approach may provide more opportunities for embryo selection, freezing or future transfer attempts, particularly for patients with significantly reduced ovarian reserve.