Problems with the eggs

Small number - Few eggs

In many cases the ovarian response is subordinate to the woman's age.


This may be due to many factors such as:


  • Surgery in the past that was related to ovarian cysts with subsequent reduction of the number of eggs
  • Treatment with toxic drugs at an early age due to a severe disease (radiation, chemotherapy)
  • Endometriosis with or without surgical removal of bladder endometriosis
  • Injury-ovarian situations (eg iatrogenic as extensive cauterization the drilling)

But mainly, it has to do with idiopathic causes of reduction of ovarian follicles proficiency that is
characterized by:


  • Micro ovarian tumor on ultrasound,
  • Reduction of the number of clusters at level of male (5-10mm, visible on ultrasound follicles) (antral follicle count = AFC)
  • High prices FSH
  • Low prices AMH & Inhibin-b

In these cases, the ovaries do not respond to medications and need a special care for their stimulation. The more aggressive approach it has, for the example: high quantity of drugs, the less effective the production of eggs becomes.


In these cases mild stimulation programs are used. In addition, using the natural cycle for retrieval and fertilization of an egg has resulted in pregnancies, whereas the classic stimulation protocol failed.


At AKESO, 2 techniques of mild ovarian stimulation are generally applicable in women with history of 'poor' response:


  • femara (letrozole), a weak androgen
  • estrogens and GnRH antagonist priming in the luteal phase


The success rates for women who have a satisfactory response to medications is seen best in these programs which must be implemented prior to alternative treatments, such as egg donation.


In general, follicles (each ovarian follicle contains an egg), owe their initial recruitment to the presence of androgens. For this, androgens have been used in the following forms:


  • Testosterone (transdermal gel)
  • DHEA (dehydroepiandrosterone) pills 25mgr 1x3 and
  • LH priming (use LH to increase endogenous androgen production). But, no increase in the success rate has seen so far as to use the Statute determinants.
  • The younger the woman's age (<35) is, the more imperative the need for specific checks is as well as checks related general health:
  • CURVE GLUCOSE
  • Control Thyroid (fT3/fT4/TSH and antithyroid antibodies anti-TPO & anti-TG)
  • Peripheral blood karyotype

Control of autoimmune diseases by detecting antibodies as:


  • ANA
  • APCA
  • ASMA
  • AMA &
  • Anti-ovarian

In many cases the diagnosis and treatment of the underlying disease not only corrects the related problem but also improves ovarian function and stimulation.

However, the message that doctors ought to pass is simple: in no case can a pregnancy (with whatever picture of ovarian function) be ruled out. For this reason, should patients be treated with the help of assisted reproduction, knowing the reduced presence and functionality of ovaries constraints, they should support their decision to do so.


  • Poor response to medication.
  • Inferior quality.
  • Climacteric changes.
  • Failed treatments.
  • High FSH.
  • Low AMH.