Strategies for Poor Responders in IVF Cycles

Chung Hoon Kim

doi:10.4172/2161-038x.s2-001

Abstract

The desired objective of controlled ovarian stimulation (COS) is to allow the growth of a cohort of follicles and to facilitate the recovery of a large number of fertilizable oocytes. However, poor responders with low ovarian reserve often fail to respond adequately despite the maximal dose of gonadotropins administered, with the results that the number as well as quality of oocytes harvested may be very low. These results lead to a significant decrease of pregnancy rate in IVF cycles. Therefore, successful COS for poor responders continues to be a major challenge in IVF program. In this review, I will describe strategies for improvement of ovarian response to COS in poor responders. The strategies described may provide a means of augmenting follicular recruitment by endocrinological manipulation for poor responders undergoing IVF.

Highlights

The desired objective of controlled ovarian stimulation (COS) is to allow the growth of a cohort of follicles and to facilitate the recovery of a large number of fertilizable oocytes
Our recent study showed that GnRH antagonist multiple-dose protocol (MDP) with oral contraceptive pill (OCP) pretreatment is at least as effective as GnRH agonist (GnRH-a) low-dose long protocol (LP) in poor responders and can be advantageous to poor responders because of the shortened time required for follicular maturation and the diminished amount of recombinant human FSH required to provide adequate ovarian stimulation [8]
The combination protocol of the micro-dose GnRH-a flare protocol and a GnRH antagonist protocol was proposed as a valuable new tool for poor responders [9], and another protocol using GnRH-a/ antagonist conversion with estrogen priming (AACEP) was proposed for poor responders [10]

Summary

Introduction

The desired objective of controlled ovarian stimulation (COS) is to allow the growth of a cohort of follicles and to facilitate the recovery of a large number of fertilizable oocytes. Our recent study showed that GnRH antagonist multiple-dose protocol (MDP) with oral contraceptive pill (OCP) pretreatment is at least as effective as GnRH-a low-dose LP in poor responders and can be advantageous to poor responders because of the shortened time required for follicular maturation and the diminished amount of recombinant human FSH (rhFSH) required to provide adequate ovarian stimulation [8]. We performed RCT to investigate the effect of an acetylcholinesterase inhibitor, pyridostigmine cotreatment during COS in poor responders [14].

Results

Conclusion