Management of the poor responder: the role of GnRH agonists and antagonists.
OBJECTIVE
Evaluate the relative benefit of various doses and regimens of GnRH agonists (GnRHa) and antagonists (GnRHant) in the management of the poor responder.


METHODS
Review of English language publications with an emphasis on prospective randomized trials where available.


RESULTS
The lack of a uniformly applied definition of the poor responder and dearth of prospective randomized trials make data analysis difficult. Traditional GnRHa flare and long luteal phase protocols do not appear to be beneficial. Reduction of GnRHa doses, "stop" protocols, and microdose GnRHa flare regimes all appear to enhance outcomes, although the relative benefit of one approach over another has not been conclusively demonstrated. GnRHant does improve outcomes in this patient population, although, in general, pregnancy rates appear to be lower in comparison to microdose GnRHa flare regimes.


CONCLUSIONS
There is no one controlled ovarian hyperstimulation (COH) protocol which is best suited for all poor responders. Low dose GnRHa 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 response should allow for selection of an appropriate COH protocol for each individual patient.
Surrey
Eric S
ES
Colorado Center for Reproductive Medicine, Englewood, CO 80113, USA. esurrey@colocrm.com
D004305:Dose-Response Relationship, Drug; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D008183:Luteal Phase / Q000187:drug effects; D010062:Ovulation Induction; D017211:Treatment Failure
D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone