Bad Over Response – Is There a Solution?

Why Do The Ovaries Produce Few Eggs and Is There a Solution?

According to classical knowledge, women are born with eggs that they will use for a lifetime and no new eggs are produced. Although some study results against this classical information have been published recently, let’s look for an answer to the above question in the light of classical information until the results are reflected in the clinic.

It is a normal and physiological process that the eggs in the ovary decrease with increasing age. Even in women who have had children before, getting pregnant becomes more difficult after the age of 39-40 and is almost impossible after the age of 44. Sure, miracles can happen, but there is no significant chance after age 44.

Generally, IVF programs do not want to accept couples for treatment when the woman’s age is over 44. The decrease in ovarian capacity and therefore the loss of reproductive function should not be perceived as equivalent to menopause. In women, a divergence begins in reproductive and hormone secretion functions from the age of 37. While the reproductive function decreases rapidly from this age, the hormone secretion function continues until the age of menopause when the last menstruation will be seen. So, the answer to the question of why I can’t have a child lies in this physiological change.

Ovarian capacity is depleted earlier in women with a family history of early menopause. These women may experience reproductive difficulties approximately 10 years before the genetically programmed age of menopause. For example, a woman who will enter menopause at the age of 40 begins to have difficulties in conceiving a child from the age of 30.

Apart from age and genetic factors, there are other reasons that cause decreased ovarian capacity:

1. Past ovarian surgeries. As the ovary is completely removed or the cyst is removed from it, the capacity will decrease as the number of eggs will decrease. Removing endometriosis cysts, which are known as chocolate cysts, can reduce the ovarian capacity on that side. It is essential that such surgeries be performed by competent surgeons and with maximum respect for normal tissues.

2. Previously radiotherapy and chemotherapy. Especially the fact that youth cancers have become treatable has caused reproductive problems to be seen more frequently in survivors.

3. Heavy smoking. Ovarian reserve decreases in more than 10 cigarettes a day.

Decreased reproductive function of the ovary is observed in women with the following symptoms:


1. The menstrual bleeding approaches each other. In women who used to menstruate once every 28-30 days, bleeding begins to occur every 21-27 days. Sometimes there may be menstrual bleeding at intervals of 15 days. The amount of bleeding usually does not change. My bleeding has decreased, I wonder if I am entering menopause, the argument is generally not true. In some cases, menstrual bleeding may be delayed as a result of the absence or delay of ovulation.

2. The chance of spontaneous or treated pregnancies to end with miscarriage increases. This is usually due to the fact that the remaining eggs are not genetically normal as a result of decreasing ovarian capacity with increasing age or for some other reason. Since the embryo that will be formed as a result of fertilization of an abnormal egg will also be abnormal, it either does not hold in the uterus at all or ends with a miscarriage in the early period. In continuing pregnancies, there is an increase in the number of babies with chromosomal abnormalities (for example, Down syndrome).

3. The number of eggs that develop as a result of stimulating the ovaries in IVF and similar treatments is less. Despite high dose drug administration or modified treatment protocols, the ovaries are resistant to treatment and few eggs develop. The low number of eggs significantly reduces the possibility of pregnancies that can be achieved with these treatments. Weak ovarian response is repetitive and there is no known cure at present.

How to predict poor ovarian response?

Women with a family history of early menopause and women with previous ovarian surgery should be carefully evaluated. Information about ovarian capacity can be obtained with hormone tests (FSH, LH, Estradiol) performed on the 2nd or 3rd day of menstruation. FSH is an indicator of ovarian capacity. If it is high (more than 10), it indicates that the capacity is reduced. Even if it is low in later measurements, the ovary behaves according to the high value. High estradiol (over 65) despite low FSH also indicates low ovarian capacity.

Measurement of hormones such as inhibin B and AMH also gives information about ovarian capacity. However, routine measurements are not recommended because the tests are more expensive and do not contribute to the information obtained by other tests.

The most reliable information about ovarian capacity is obtained by vaginal ultrasound. With vaginal ultrasound, potential egg-developing structures (antral follicles) in the ovary can be seen and counted. If there are less than 6 immature egg structures in both ovaries, it can be said that the ovarian capacity is low.

What can be done?

Transition to IVF treatment should be planned faster. In the presence of decreased ovarian reserve in IVF applications, the success rate decreases depending on the degree of decrease.

Can new egg production be achieved in the ovary?

Studies over the past year have demonstrated the presence of stem cells in female ovaries. Studies on the production of new eggs using stem cells and the use of these eggs to achieve pregnancy have started on animals. With the results of these studies, new hopes will be opened for women with low ovarian capacity, who is a very difficult patient group.


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