Description
This webinar will focus on the clinical approach to diagnosing Poor Ovarian Reserve (POR) using key markers such as AMH, antral follicle count (AFC), and basal FSH levels. It will discuss evidence-based strategies for assessing ovarian reserve and differentiating diminished reserve from normal age-related decline. Emphasis will be placed on individualized treatment planning, including stimulation protocols and fertility preservation options. A significant portion of the session will address effective patient counselling, expectation setting, and psychological support. The webinar aims to equip clinicians with practical insights to improve decision-making and patient outcomes in fertility practice.
Summary Listen
- Poor ovarian reserve (POR) signifies a reduced number of oocytes and follicles, decreasing conception chances. Evaluation is crucial for tailored treatment, impacting IVF cycle success rates, which can be as low as 5-15%. The incidence of POR is rising, affecting a significant portion of IVF cycles and leading to frequent cycle cancellations.
- Diagnosis relies on the Bologna criteria: age over 35, retrieval of fewer than 3 oocytes in a previous cycle, antral follicle count (AFC) less than 5, and AMH below 0.5 ng/mL. Age is a primary factor, with ovarian reserve declining from millions of oocytes in fetal life to a few thousand by the age of 40.
- Key diagnostic markers include AMH (anti-Müllerian hormone), AFC, and FSH (follicle-stimulating hormone). AMH, produced by pre-antral follicles, should be assessed; levels below 1 ng/mL indicate POR. AFC, measured on days 2-3 of the menstrual cycle, should be less than 5 follicles across both ovaries. FSH, also measured early in the cycle, is indicative of menopause if above 10 IU/L. Karyotype analysis is reserved for younger patients with low AMH.
- Treatment involves individualized protocols based on age, reserve, and expected response. Mild stimulation is preferred, and a combination of recombinant FSH and HMG (human menopausal gonadotropin) may be beneficial. Unnecessary dosage increases of FSH are not recommended. Estrogen priming may be considered, but routine use of antioxidants is not well-supported by research.
- Adjuvants like DHEA and CoQ10 may offer some benefit, but growth hormone is generally not recommended. Dual triggers (HCG and GnRH agonist) haven't demonstrated significant advantages. Routine freezing of embryos is not typically required, unless PGT-A (preimplantation genetic testing for aneuploidy) is performed.
- Counseling is paramount, emphasizing the challenging but not impossible nature of POR. Realistic outcomes, including potentially low live birth rates and high cycle cancellation rates, must be communicated. Written consent and open discussions about alternative options, such as oocyte donation, adoption, or child-free living, are essential.
- Alternative options, like Oocyte donation, need thorough emotional preparation and should be approached sensitively, especially with younger patients. Support groups and partner counseling can be beneficial. Success with regenerative medicine, such as PRP and stem cells, is still under research and may be considered, keeping in mind that this has not yet been proven.
Sample Certificate
About the Speakers
Dr. Lavanya Kiran
Director and Consultant at KIMS Hospital, Bangalore. Clinical Director at Lakshya Fertility Centre, Bangalore and Founder Chairperson & Medical Director at Orya Care
Financial Disclosure
Comments
Comments
You must be logged in to leave a comment.