fertility treatments

With advances in reproductive technologies, more and more families are turning to in vitro fertilization (IVF) to build their families. While some may experience smooth IVF journeys, others may face obstacles such as poor ovarian response (POR). POR is a condition that can affect your ability to produce an optimal number of eggs during fertility treatment. 

In this article, we will explore what POR means for patients, its prevalence, diagnostic methods, potential treatments, and available options for those diagnosed with this condition.

What is meant by low response to ovarian stimulation?

Poor ovarian response (POR) refers to a suboptimal response (actual or predicted) of the ovaries to stimulation during fertility treatment. 

During IVF, fertility medications are used to stimulate the ovaries, which culminates in the retrieval of multiple eggs. However, those with POR may produce fewer eggs than expected, which can significantly impact their chances of successful conception or even lead to a canceled cycle. 

POR is often associated with reduced ovarian reserve, which refers to the diminished quantity and eggs remaining in the ovaries.

How common is POR?

The estimated prevalence of POR ranges from 6% to 35%. This wide range is primarily due to researchers and clinicians having varying definitions of POR. In fact, one systematic review of 47 studies focusing on POR patients found a staggering 41 different definitions of POR being utilized. 

The likelihood of encountering POR increases with age, as ovarian reserve naturally diminishes over time. However, it is important to know that POR can occur in women of all age groups, including younger patients.

What is considered a “poor response” to IVF? Diagnosing POR

The European Society of Human Reproduction and Embryology (ESHRE) working group established criteria for defining a poor response in IVF. 

According to their report, having two or more of the following three features is considered having poor ovarian response: 

• Advanced maternal age or any other risk factor for POR 
• A history of previous POR
• An abnormal ovarian reserve test 

Or, if you experience two episodes of POR after IVF, it is considered a poor response, even without advanced maternal age or low ovarian reserve. Since the term POR specifically refers to the ovarian response, at least one egg retrieval is required for diagnosis. 

However, patients of advanced age with an abnormal ovarian reserve may also be classified as poor responders because both factors indicate reduced ovarian reserve and can serve as predictors of the outcome of an ovarian stimulation cycle. If that’s the case, a more accurate term would be "expected poor responders."

How IVF can fail

Each fertility journey is unique, and various factors, including underlying medical conditions, genetic factors, and individual response to medications, can influence the ovarian response to IVF.

Sometimes, IVF isn’t even a viable option due to low ovarian reserve. Ovarian reserve refers to the quantity of eggs remaining in the ovaries. Assessing ovarian reserve through markers such as anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) can provide insights into your potential ovarian response to IVF. A predicted poor response may be indicated by low AMH levels or a reduced number of antral follicles observed during ovarian reserve testing.

Sometimes, even with normal ovarian reserve, you can experience an inadequate ovarian response to stimulation medications, which leads to fewer follicles developing than you would hope. Follicles are fluid-filled sacs within the ovaries that contain developing eggs. During an IVF cycle, hormonal medications support the growth and development of multiple follicles to increase the chances of obtaining viable mature eggs for fertilization. In general, 10–15 follicles is considered to be the optimal response to fertility medications during IVF. In cases of poor ovarian response, the ovaries may not respond adequately to these stimulation medications, resulting in limited follicular development. This poor response may be indicated by a reduced number of developing follicles observed during ultrasound monitoring throughout the stimulation phase of the IVF cycle.

Typically, a good IVF response involves the retrieval of a sufficient number of eggs, allowing for a higher likelihood of successful fertilization and subsequent embryo development. But sometimes, you simply don’t get enough eggs. A poor response can also be characterized by a lower-than-expected number of eggs retrieved, which may fall below the average range for your age group.

Is POR curable?

While POR poses challenges, it does not necessarily mean that you cannot conceive. The severity of POR can vary, and treatment options are available to optimize the chances of successful conception.

Treatment strategies for POR aim to improve ovarian response and enhance the chances of successful egg retrieval. The specific approach will depend on a lot of factors, including the underlying causes of POR and any other reproductive health obstacles you face. Some common treatment options include:

• Adjusting stimulation protocols: Your fertility doctor may modify the medication protocols used during IVF to enhance ovarian response. This may involve altering the dosage or type of fertility medications administered.
• Adding supplements: There is some evidence that DHEA and CoQ10 may improve IVF pregnancy rates for those facing POR. 
• Human growth hormone (GH): Some evidence suggests that treatment with GH for POR patients could lead to a higher number of retrieved eggs. 
• Third-party reproduction: In certain cases, fertility doctors may recommend alternative approaches such as the use of donor eggs or embryo adoption. These options can increase the chances of success.

What comes next after POR

Navigating a poor response to IVF can be challenging, and you’ll want to work closely with a fertility doctor who can evaluate the specific circumstances and develop an individualized treatment plan. The treatment approach may involve adjusting medication protocols, exploring alternative techniques, or considering options such as donor eggs.

While a poor response to IVF can be disheartening, it does not signify the end of the fertility journey. Advances in reproductive medicine continue to offer new possibilities and hope for those facing challenges in conceiving. With the right support, guidance, and perseverance, individuals and couples can explore alternative paths and find the best course of action to achieve their dream of building a family.

Get the emotional support you need

Dealing with a diagnosis of POR can be emotionally challenging. It is crucial to recognize the emotional impact and seek support from loved ones, support groups, or mental health professionals who specialize in fertility-related concerns. The journey to conception can be complex, and emotional well-being is an essential aspect of the process.

We are here to help you find the perfect egg donor

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing. We didn’t invent the concept of egg sharing, but we are the first to take it national (and even global!).

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.

We aim to be the best egg sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Baby guarantee. We truly want to help you bring your baby home, and we will re-match you for free until that happens.
• Donor empowerment. Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud about the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Human-centered. We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!

Epigenetics is a field of study that has gained increasing attention in recent years for its potential implications in various aspects of health and disease. In the context of third-party reproduction, epigenetics plays an important role in the development and growth of embryos, and can also have implications for offspring conceived through assisted reproductive technologies (ART) such as donor egg IVF. In this article, we will explore the concept of epigenetics and how it relates to the use of donor eggs in fertility treatment.

What is epigenetics?

Epigenetics refers to changes in gene expression that occur without a change in the DNA sequence itself. These changes can be heritable and can impact how genes are expressed throughout an individual's lifetime. Epigenetic modifications can occur in response to environmental factors such as diet, stress, and toxins, as well as during embryonic development. These modifications can affect the way that genes are expressed, leading to alterations in cellular function and potentially contributing to the development of certain diseases.

Epigenetics and donor eggs

In donor egg IVF, the genetic material from the egg donor is used to create an embryo that is implanted into the uterus of the intended mother or a gestational surrogate. This means that the resulting offspring will have a different genetic makeup than the intended mother, and therefore may have different epigenetic profiles as well.

Research suggests that epigenetic modifications can occur during embryonic development, and may be influenced by factors such as the age of the egg donor, the method of fertilization, and the environment in which the embryo develops. Studies have found differences in DNA methylation patterns, histone modifications, and gene expression profiles between embryos created using donor eggs and those created using the intended mother's own eggs.

What does this mean for children conceived through donor egg IVF? While it is still unclear what the long-term implications of these differences may be, we know the majority of children conceived through donor egg IVF are healthy and do not experience any adverse health effects related to epigenetic differences.

It begins in the womb

Epigenetics research has revealed that the quality of life inside the womb has a lasting impact on a baby's health. Scientists have found that the most significant influence on gene function occurs in utero, making a birth mother's womb the baby's first and most crucial environment. This underscores the importance of a mother's (or gestational carrier) lifestyle choices in shaping the overall health and well-being of the individual for the rest of their life.

Stress is a significant environmental factor that can influence your child's genetic expression. Managing stress and anxiety during pregnancy can significantly impact the way their baby's genes develop. To cope with stress, there are various relaxation techniques available, including group therapy, meditation, acupuncture, yoga, exercise, journaling, spending time with people you love, and doing things that bring you joy. 

Epigenetics and early childhood

The idea that genes are “set in stone” has been disproven. We now know that early life experiences, such as stress, nutrition, and caregiving, can influence gene expression and ultimately affect a child's development on who they become. 

These epigenetic changes can have long-term effects on physical and mental health, as well as cognitive and behavioral outcomes. The positive experiences you create for your child, such as responsive caregiving and supportive relationships, can also have positive epigenetic effects and promote healthy development.

"The positive experiences you create for your child, such as responsive caregiving and supportive relationships, can also have positive epigenetic effects and promote healthy development."

Will a donor egg baby look like me?

The answer is maybe. There is always a chance – whether genetic, adopted, or born through donor eggs – that a child won’t look like you. There’s also a chance that they will! I know plenty of genetically related children that look nothing like their mother or siblings. But I also know a lot of donor-egg children that look *exactly* like their mothers. In fact, I had no idea one of my closest friends used donor eggs to conceive her children until she confided in me when I began my donor egg journey.

Many families choose to match with a donor with similar physical features, especially for unique features like red hair, blue eyes, or being really tall. But keep in mind – picking a donor that looks like you in no way guarantees the child will look like you or the donor! 

Ethical considerations

The use of donor eggs in fertility treatment raises a number of ethical considerations, particularly when it comes to the potential impact of epigenetic differences on offspring. While it is important for individuals and couples considering donor egg IVF to be aware of the potential implications of epigenetics, it is also important to recognize that the majority of children conceived through this method are healthy and lead normal lives.

Summing it up

Epigenetics is a complex and rapidly evolving field of study with important implications for fertility and reproduction. While the use of donor eggs in IVF can lead to epigenetic differences between offspring and their intended parents, the majority of children conceived through this method are healthy and lead normal lives. 

Even if you use donor eggs or donor embryos, you play a vital role in the development of your baby. While genetics play a role, it's the interaction between genetics and epigenetics that shapes your baby into the individual they become. Don’t forget that you contribute more than you may realize to the growth and development of your child.

If you are considering using donor eggs, register for a free account and get instant access to our egg donor database.

‍

‍Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account today!

Going through fertility treatment can be full of stress, fear, sadness, and even shame. One of you may feel hopeful that donor egg IVF will work, while the other is afraid and not very sure. There are countless doctor visits, endless paperwork, and thousands of dollars being spent. In-between comes finding an egg donor, egg retrieval, embryo creation, hormonal injections, and implantation. But it’s not over yet. Now comes the dreaded two-week wait to find out if all of this has been successful or not.  Although fertility treatment can give you hope and a glimmer of light, it can also steal your peace of mind, and at times, what feels like your sanity. 

A donor egg IVF cycle can be a roller-coaster of emotions and what your partner needs most during this time is support. As the partner of someone going through IVF, what can you do to ensure they feel loved, supported, and understood? 

Actively listen

One of the best things the non-carrying partner can do to help support their partner through this time is to actively listen. Don’t try to fix anything and don’t try to solve anything. Don’t interrupt and be fully present in the conversation. Ask open-ended questions and let them talk. The point is for you to listen for understanding not for responding. 

Ask questions

When times are good and treatment is going well, it is easy to know what to say and do. But when things are not going well, the opposite is very true. It can be very hard to know what to say and how to help. So in times like these, it is okay to simply ask what you can do to make your partner feel loved and supported. Sometimes support may look and feel very different depending on the situation. Asking does not mean that you don’t care, it simply means you care so much that you want to make certain their needs are being met. 

Attend appointments

As the partner, you are also part of the treatment process, regardless if you are involved medically or not, the process of getting pregnant through IVF requires that both of you are present from start to finish. Attending appointments is important for so many reasons. One is so you can tag-team asking the doctor questions, and secondly having two sets of ears can also help verify the understanding of complicated procedures. Having you there helps your partner feel that they are not alone. The doctor’s office can be cold and sterile and having a warm hand to hold can ease some of that discomfort and fear. 

Create a safe space

It can be so difficult to be vulnerable, especially if treatment is not moving according to plan. It may make one feel that they are letting everyone down. Creating a non-judgmental space for your partner to be open, vulnerable, and honest is invaluable. Give them space to tell you how they are really feeling. Be empathic, loving, and non-judgemental. Actively listen and give them time to be fully seen and heard. Intentionally set time aside to be fully present and be open to whatever emotions that may come.

Educate yourself

To really support your partner you need to know what they are going through.  One way to do this is to educate yourself about the treatments, understand the procedures, know the medical terminology, risks, side effects, and outcomes. Read books, articles, and blogs about donor egg IVF. Listen to podcasts, join groups, and ask questions. LIke the ‘90s PSA used to say, “the more you know” the more we can increase empathy and understanding.

Respect your partner’s decisions

Throughout this article I have expounded the importance of you and your partner as a team in this fertility journey. That it takes both of you from start to finish. You both agreed on this plan to grow your family. But after multiple (or maybe even one) attempt, what if they are ready to stop and you aren’t?  You can be honest with what you want and how you feel. But, don’t make guilt a driving force for them to continue with treatment if they are done. At the end of the day it is their body and whatever they choose to do with their body, respect that decision. Sometimes this isn’t so dramatic as wanting to end treatment completely. It can also look like wanting to take a break, wanting to change clinics, adding holistic treatment to the plan. Whatever it may look like, have their back and respect their choices. 

Show tangible support

Showing emotional support is obviously important. But so is taking over responsibilities or chores you don’t normally do. Things like making dinner, making sure the laundry or grocery shopping is done, the dog’s vaccines are up-to-date. Toilet paper roll empty? Replace it. Just the everyday little things that need to be done on a daily basis. Taking some of those things off their plate can relieve a lot of unnecessary stress.

Seek professional help 

Sometimes the emotional toll of IVF can be too much. It is okay to seek professional help for you, or even both of you. Support groups that specialize in donor egg IVF can be a wonderful source of psychological and emotional support. As your partner’s main support it is also important for you to find support and time for self-care as well.

Skip baby-oriented events

If you or your partner is struggling with being around children, it is okay to decline invitations to baby showers, birthdays, or family gatherings that will be full of children. These events can trigger some pretty strong emotions. So when you see that invite, take the initiative and be the one to decline and send a gift in the mail.  

If you have a partner who is going through egg donor IVF, there are many things that you can do to help support your partner through this time. What support looks like may mean different things for different people, but one of the main things is that your partner feels that you are their safe place, and ultimately can be themselves and honest with you. Remember, you are both on the same team and only want the best for each other. Knowing you can count on each other to be there when times are tough strengthens the belief that together you can face whatever life throws at you. 

‍

Religion can be a great source of comfort and solace during the most difficult of times. Religion has been implicated in reduced mortality, expedited recovery from illness, and improved mental health. It can encourage healthy lifestyles, provide social support, and provide meaning to life. But it can also impact help seeking behavior, especially when it comes to fertility treatment. Religiosity has been associated with greater concerns about infertility treatment, which, in turn, decreases the likelihood of help seeking (i.e IVF, egg donation etc).

Religion and assisted reproductive technology (ART)

The use of donor gametes to create embryos can ignite some serious debate in many faith circles. Some faiths say fertility treatments go against their beliefs and should not be used, even if it means someone will never become a parent otherwise. Meanwhile, other religions have no issues with it at all, as long as certain “rules” are followed. 

A Pew Research study conducted in 2013 asked people living in the United States about the moral acceptability of using in-vitro fertilization to have a family. One-third said it is morally acceptable, 12% said it was morally wrong, and 46% said it was not even a moral issue. The survey found modest differences in opinion among social and demographic groups, including religious groups, about the moral acceptability of IVF. 

But for many religious people their religious beliefs strongly inform their understanding of fertility and parenthood. Procreation can be an important tenet of a religion along with prescribed roles for the male and female partner when it comes to parenthood. So what if you want a family and the only way that family can be created is through egg donation? And what if you are someone who holds strongly to their faith - a faith that carried you through troubled times - only to discover that very faith does not give you its blessing to have the family you have prayed for? 

‍

What if you are someone who holds strongly to their faith - a faith that carried you through troubled times - only to discover that very faith does not give you its blessing to have the family you have prayed for?

How do I navigate making a decision?

You want to adhere to the teachings of your religion and at the same time you also have a very strong desire to have a child.  What should you consider when deciding how you want to proceed so you can feel good about your decision? How can you find a way to remain connected to your beliefs even if your choice is different from what is taught by your religion?

Give yourself permission to imagine different options

Play your life tape forward and really imagine how it feels to go against your beliefs in order to achieve pregnancy. Now imagine how it feels to stay strong in your beliefs and never be a parent. Discuss these options with your partner. Write them down in a journal and come back to them in a few weeks. Does one evoke a bigger emotion? Does one feel better than the other? There is no right or wrong and there is no judgment - you are allowed to imagine and really think through your different options. 

Speak to trusted members of your community.

Speak to respected and trusted members of your faith community. Ask questions to fully understand what your religion’s expectations are regarding parenthood and regarding ART and IVF and donor eggs. What are your expectations? Do they match or are they very different? 

If they are different, would you ever make a decision to pursue donor egg IVF that isn’t sanctioned by your religious teachings? If yes, how would your community support you? Would you be ostracized? What does it mean to be against these teachings?  If you would never go against the teachings, then how can your religion provide guidelines about living child free? Would you be able to find peace regarding infertility from your religious teachings? Studies have shown that infertile women with higher levels of spiritual well-being reported fewer depressive symptoms and less overall distress from their infertility experience because of the support from their religious community.  

Summing it up

Faith can be an essential aspect of a person’s life. Sometimes it is possible that not all  tenants align. But that does not necessarily mean that you forsake your faith, nor does that necessarily mean you give up your desire for a family. It may mean digging even further and leaning even stronger into your faith.  It may mean exploring all your different options by researching, talking, asking questions, and praying. All of these things can open doors and create alternative paths to parenthood that you may not have ever considered.

‍