Is Artificial Insemination Possible in Case of Low Ovarian Reserve?
Artificial insemination (AI) has limited success rates that are related to the woman’s age. As it is a low-yield technique, although not completely contraindicated, it is generally not recommended for women with low ovarian reserve, especially those aged over 35, or with a low antral follicle count (AFC). In these cases, in vitro fertilization (IVF) is recommended as a first-line treatment.
When Is IVF Recommended over AI?
IVF allows for controlled ovarian stimulation to obtain a greater number of oocytes, as well as for the selection of embryos with the best prognosis, thereby improving the chances of pregnancy. For this reason, it is recommended in the following cases:
- Women with low ovarian reserve confirmed by AMH levels <1,1 ng/mL and/or AFC <5–7 follicles.
- Advanced maternal age (>37 years), as oocyte quality declines significantly.
- Previous failure in AI cycles.
- Need for strategies, such as oocyte accumulation, to increase the chances of success.
Alternatives for Women with Low Ovarian Reserve
When ovarian reserve is very low and response to stimulation poor, there are several alternatives available:
- IVF with own oocytes: Using specific ovarian stimulation protocols to optimize response.
- Oocyte Accumulation: Performing multiple stimulation cycles with oocyte cryopreservation until reaching a sufficient number for IVF.
- Egg Donation: When both ovarian response and oocyte quality are poor, egg donation is one of the best alternatives.
Tips to Improve Ovarian Response
Unfortunately, no proven method exists to improve a confirmed low ovarian reserve. However, there are strategies to optimize ovarian response during assisted reproduction treatments:
- Personalized Ovarian Stimulation Protocols: Using tailored protocols, such as mild stimulation.
- Supplementation with Coenzyme Q10 and DHEA (dehydroepiandrosterone): Some evidence suggests that these supplements may improve oocyte quality in certain cases.
- Healthy Lifestyle: Maintaining a proper body mass index, a healthy diet, reducing stress, and avoiding tobacco and alcohol may help improve ovarian response.