Purpose of review To present the options and the results in the
management of poor responders in in-vitro fertilization.
Recent findings
There is no controlled ovarian hyperstimulation protocol which is best
suited for all poor responders. Low dose gonadotropin-releasing hormone
agonist regimes appear to be most advantageous. Prediction of
compromised response prior to cycle initiation by a thorough assessment
of ovarian reserve as well as a careful review of past responses could
allow for a more appropriate selection of a controlled ovarian
hyperstimulation protocol for each individual patient. Optimistic data
have been presented by the use of high doses of gonadotropins, flare up
gonadotropin-releasing hormone agonist protocols (standard or
microdose), stop protocols, luteal onset of gonadotropin-releasing
hormone agonist, and short protocols. Natural cycle also seems to be an
appropriate strategy to be considered.
Summary
There is no universal definition for the ‘poor responder’. Numerous
strategies have been proposed to improve ovarian stimulation in poor
responders, but none of them is the ideal for all such patients. More
data from good quality controlled trials are needed