Decreased Ovarian Reserve Function and Microstimulation Protocol

  Ovarian reserve function, which refers to the potential of the ovaries to produce eggs in quantity and quality, can indirectly reflect the function of the ovaries. With changes in socioeconomic, cultural, living environment and work pace, the risk factors for the development of premature ovarian failure and reduced ovarian reserve function have increased, leading to a trend of increasing incidence year by year, which seriously affects the reproductive health and quality of life of the majority of women. Premature ovarian failure refers to a gynecological endocrine disorder in which women with normal menstrual periods and regular menstrual cycles experience more than 4 months of persistent amenorrhea, atrophy of reproductive organs, increased follicle-stimulating hormone and luteinizing hormone levels, and decreased estrogen levels before the age of 40. The main clinical manifestations are menstrual disorders, amenorrhea, infertility, reduced sexual function, and perimenopausal syndrome.  Age is an important factor affecting female fertility. As age increases, the natural pregnancy rate and assisted reproduction clinical pregnancy rate decrease, the miscarriage rate increases, the live birth rate decreases, and the probability of chromosomal abnormalities in the offspring increases. Social factors contribute to delaying the age of women at childbearing and increase the rate of infertility and spontaneous abortion due to age. Therefore, we advocate early consultation and treatment measures for such patients.  Low ovarian reserve function is a difficult problem in assisted reproductive technology, and the conventional protocol of ovulation promotion in these patients often results in low egg acquisition rate, low number of embryos available for transfer, and high cycle cancellation rate. Currently, for these patients, our center uses a microstimulation protocol for assisted reproduction. The microstimulation protocol involves the use of a small amount of ovulation stimulating drugs to stimulate follicle growth, and the removed eggs are fertilized in vitro to obtain embryos for transfer back to the uterine cavity, or cryopreserved to accumulate embryos for transfer.  The microstimulation protocol has the following advantages and disadvantages: 1. The small amount of ovulation stimulating drugs used greatly reduces the cost of pregnancy assistance.  2. The treatment can be repeated for several months in a row, shortening the duration of fertility treatment, accumulating embryos and increasing the cumulative pregnancy rate.  3.Reduces the incidence of ovarian hyperstimulation syndrome and other possible side effects caused by the application of ovulation-promoting drugs.  4.Decreased the incidence of multiple pregnancies.  5.However, due to the small number of follicles, the number of eggs available is low, and the eggs may not even be retrieved, resulting in cancelled cycles.  6. The cycle success rate of this option for pregnancy assistance is low due to the possibility of unavailable eggs, failed and abnormal fertilization, unavailable embryos for transfer, or unpredictable special circumstances.  The ovarian microstimulation method is close to the follicular development pattern of the natural cycle, so it can avoid some of the adverse reactions brought about by super ovulation, and the microstimulation protocol is an effective method of ovulation promotion with assisted reproductive technology for women with declining ovarian reserve function and older infertile women.