Ovarian stimulation for poor responders

Abstract

Infertility specialists have been struggling to deal with poor responders, reported to range from 9 to 24 %. However, the incidence is abruptly increasing lately due to the increasing population of aged infertile women. The long gonadotropin-releasing hormone (GnRH) protocol is the fi rst line of treatment if more than plural numbers of oocytes are expected, which is followed by the short protocol, and the GnRH antagonist stimulation is used as the last treatment option. Among the GnRH agonist protocols, the microdose agonist fl are with oral contraceptive (OC) pretreatment appears more effective. Natural cycle or mild stimulation is used when the stimulation protocols fail. IVM is an alternative choice when none of the above-mentioned protocols succeed. Growth hormone (GH) appears to have a benefi cial effect, but indications for using GH as well as growth hormone-releasing hormone (GH-RH) are not well defi ned. In addition, it is too early to determine if androgen pretreatment [dehydrepiandrosterone sulfate (DHEA), testosterone] is benefi cial in the treatment of poor responders. It is most important for ART physicians to evaluate the patient response before starting the stimulation and choose the best protocol for the poor responder.