How to help poor responders in repeat IVF

“When undergoing IVF treatment, egg numbers matter a lot,” says Dr Thanos Papathanasiou, Regional Lead Clinician at Bourn Hall, who is talking about poor responders in IVF at the upcoming Fertility2019 conference.

Most experts agree that the more eggs that are available, the better the chances of having a baby through IVF. On the other side of the spectrum, it is well established that women whose ovaries produce low egg numbers (1-3 eggs per IVF harvest) are less likely to have a baby. These women are called ‘poor responders’ or ‘low responders’. Not surprisingly, a substantial amount of research has focused on this particular group of women and how to optimise their chances of having a baby.

“It is currently possible to identify with a good degree of accuracy (about 80%) which women are at risk of responding poorly during their first round of IVF. However, we are unable to say with such accuracy those that will become poor responders in subsequent cycles. Our research at Bourn Hall aims to fill in this knowledge gap. We have investigated those women that have had at least four eggs retrieved at their initial treatment but have then had only 1-3 eggs in subsequent cycles.

This has been an interesting project for numerous reasons. It is a first of its kind, as it has focused on only repeat cycles. It demonstrates clearly that some women will indeed experience deteriorating performance during repeat IVF. This occurs despite intervention from the clinicians to ensure that repeat cycles are more productive.”

Reasons for poor response in subsequent IVF cycles

“We have looked at whether this is because some women are older when they come back to have their second IVF treatment. It does not appear to be the case, as the majority of women in our clinic have their repeat cycle within one year.

The research also suggests that the performance of the ovaries varies significantly between cycles, which makes it harder to know what to expect during repeat treatment.

There are a number of reasons why it is important to be able to predict which women are more likely to transition to poor response.  Firstly, this allows appropriate counselling when planning a repeat cycle. IVF is undoubtedly a stressful treatment and setting expectations appropriately may help to prepare patients to deal better with an unsuccessful outcome. Secondly, if clinicians are aware of this risk, they may be more proactive in planning the upcoming IVF in such a way so as to avoid or, at least, moderate, poor performance.

For these reasons, we believe that our research at Bourn Hall can make a real difference for the benefit of couples or individuals who seek assisted conception help in order to have a baby.”

Dr Papathanasiou is giving an oral presentation entitled ‘The risk of ‘de novo’ poor ovarian response during repeat IVF: Results of an externally validated prediction model based on more than 4,000 women” at the Fertility2019 conference in January. View the poster: Fertility2019 – poor responders