Abstract
Women with diminished oocyte reserve do not have very poor oocyte quality similar to women of advanced reproductive age. The very poor pregnancy rates found in many studies of IVF-ET in this population seems to be related to the use of high-dosage FSH stimulation. The presence of significant elevated FSH levels leave many women more prone to FSH receptor downregulation. The best ‘hypothesis’ to fit the poor success rate found with high FSH stimulation is that FSH receptor downregulation leads to an insufficient production of a factor needed to prevent non-disjunction of chromosomes, leading to the creation of embryos with a high percentage of aneuploidy. Mild stimulation, to a reasonable degree obviates the problem with FSH receptors and results in the production of live healthy babies.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
Key issues
• Higher dosage of follicle-stimulating hormone (FSH) drugs leads to a much greater expense for in vitro fertilization (IVF).
• Higher dosage of FSH may lead to the creation of more embryos but a lower percentage of chromosomally normal embryos especially in women with diminished oocyte reserve.
• Conventional or supra high dosage of FSH markedly decreases the pregnancy rate per embryo transfer in women with decreased oocyte reserve.
• The adverse effect of conventional FSH controlled ovarian stimulation (COH) in women with diminished oocyte reserve seems to be on the embryo itself, rather than the uterus.
• Freezing embryos to avoid the adverse effect of COH may be useful in a minority of cases with normal oocyte reserve, but not those with diminished oocyte reserve.
• Age rather than degree of oocyte reserve is a much more important determinant of successful pregnancy.
• Even women with apparent premature menopause can be made to ovulate by restoring downregulated FSH receptors and they actually have a reasonable live delivered pregnancy rate especially if younger.
• Some recent data question a possible adverse effect of dehydroepiandrosterone (DHEA) supplementation in women with diminished oocyte reserve.