“Poor responders” in IVF are now maybe a half of all IVF patients or even more because of the average age. For example, in our clinic, the average age of first-visit patients is 38-39 years old so, not very young from a reproductive point of view. After the age of 35 – 36 normally ovarian reserve starts to decrease and after 37 years old, the speed of disappearance of the antral follicles increases 2.5 times more quickly. In most cases, patients after 38, and 39 have decreased ovarian reserve. Also, we can see, from time to time, young girls with decreased ovarian reserve. We know that in the population, the average age of menopause is 51-52 years old, 10% between 40 and 50, 1 % between 40 and 30, etc. So, we can even have menopause in 20 or 25 which means a decreased ovarian reserve. It may be the genetic origin, it may be some infection in childhood or when this girl was adolescent – it may be different: maybe some treatment like chemotherapy, for example, Hodgkin’s lymphoma at a young age with specific treatment after we can have decreased ovarian reserve. Different problems may give that. Also surgical intervention, for example, endometriosis operated and one-fourth part of the ovary was cut so, of course, we have fewer follicles. Endometriosis per se decreases ovarian reserve as well. so Different problems may impact the lower ovarian reserve but the main problem is surgery and the late reproductive age.
