Test which has been recently developed is the measurement of the level of the hormone, inhibin B, in the blood. Low levels of inhibin B (which are produced by “good ” follicles) suggest a poor ovarian reserve in Ovarian Reserve Test in India . However , one of the most useful ways of making a diagnosis of poor ovarian reserve is when the patient gives a history of responding poorly to medications used for super-ovulation in the past.
Along with using biochemical tests to assess ovarian function, we can use biophysical markers to test these too. These biophysical tests use ultrasound technology to image the ovaries and the follicles. The most useful test is called an antral follicle count ( AFC) , in which the doctor counts the number of antral follicles ( also referred to as resting follicles) present in the ovary on Day 3 using vaginal ultrasound scanning. Antral follicles are small follicles , usually about 2-8 mm in diameter. The number of antral follicles correlates well with ovarian response.
A normal total antral count is between 15 and 30. If the count is less than 6, the prognosis is poor. The volume of the ovaries also correlates with ovarian response. The volume of each ovary is calculated using the formula ( length × width × height × 0.5 ) and the normal ovarian volume of both ovaries combined is 10 ml. Women with small ovaries ( volume of less than 4 ml) have a poor ovarian response.
While an older woman often expects to have poor ovarian reserve in her ovarian reserve test in India, and is prepared for the fact that she may respond poorly to super-ovulation, when a young woman finds out she is a poor ovarian responder, this comes as a rude blow. Most young women expect that their eggs will be fine, because they are young and have regular cycles, but this is not always true. Regular periods simply mean that the eggs are good enough to produce enough hormones to have normal menstrual cycles; however, this does not mean that the egg quality is good enough to make a baby ! Ovarian reserve is a biological variable, and egg quantity and quality in an individual woman can be average for her age, better than average, or worse than average. Women with poor egg quality are said to have poor ovarian reserve , poor ovarian function, or occult ovarian failure.
Many treatment strategies have been developed in order to treat women with poor ovarian reserve. Because time is at a premium for these women, treatment needs to be aggressive, in order to help them conceive before their eggs run out completely. IVF is usually their best option, as it offers the highest success rates. Super-ovulating these women can be quite tricky, and this is where the experience and the expertise of the doctor makes a critical difference ! While it is true that a skilled doctor will be able to design an optimal super-ovulation for women with poor ovarian reserve, it is also true that the results are still likely to be poor. While Michael Schumacher will drive your car much better than you will ever be able to, if you give him a broken-down lemon to drive , even his skills are likely to let him down !
They usually need much higher doses of Gonadotropins injections ( HMG) for super-ovulation. We have used up to 750 IU of HMG ( 10 amp of 75 IU) daily for difficult women, in order to stimulate them to grow eggs. Unfortunately, this is like scraping the bottom of the barrel, and the quantity and quality of their eggs often still remains poor.
Other clinics have tried using rec FSH (recombinant gonadotropins) or GnRH antagonists, but neither of these help. In the past, doctors tried adding growth hormone injections (because of the “growth factors” this contained) , but this was of no use. Interestingly, some doctors have gone back to using the natural cycle, or trying gentle stimulation with clomiphene for these women, since they don’t see any benefit in spending hundreds of dollars just to get 2-3 more eggs for IVF.