Poor responder protocols for in-vitro fertilization: options and results.
OBJECTIVE
To present the options and the results in the management of poor responders in in-vitro fertilization.


RESULTS
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.


CONCLUSIONS
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.
Loutradis
Dimitris
D
IVF Unit, 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, Athens University Medical School, Athens, Greece. loutradi@otenet.gr
Vomvolaki
Eleftheria
E
Drakakis
Peter
P
D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D010062:Ovulation Induction / Q000379:methods*; D017211:Treatment Failure
D007987:Gonadotropin-Releasing Hormone