Evaluation and Treatment of Low Responders

Abstract

Identification and treatment of low responders to ovulation induction is one of the most frustrating challenges in reproductive medicine. Because complex ovulation induction is required so frequently and is so expensive, efficient diagnosis of hyporesponders is critical. At present, the best techniques of evaluating ovarian reserve are basal follicle-stimulating hormone/Estradiol levels early in the proliferative phase and the clomiphene citrate challenge test. When poor responders are identified, strong consideration should be given to adjunctive approaches such as gonadotropin-releasing hormone analog and microdose flare or possibly, embryo hatching in those women undergoing in vitro fertilization.

Molecular cloning of porcine growth differentiation factor 9 (GDF-9) cDNA and its role in early folliculogenesis: direct ovarian injection of GDF-9 gene fragments promotes early folliculogenesis

“…Current ovarian stimulation protocols for infertility treatment influence antral follicle growth mainly by using gonadotropins (Diedrich & Felberbaum 1998). However, in poor responders to gonadotropin stimulation (Scott 1996), it is difficult to enhance the ovulation rate by current infertility therapy. Oocyte donation is the only option for such patients desiring pregnancy (Kalantaridou et al 1998).…”

“…However, a subset of patients has been found to be poor responders to gonadotropin stimulation (Scott 1996). For poor responders to gonadotropins, GDF-9 treatment may represent an alternative approach because of effects on primary and secondary follicle development.…”

Promotion of Ovarian Follicular Development by Injecting Vascular Endothelial Growth Factor (VEGF) and Growth Differentiation Factor 9 (GDF-9) Genes

“…Current ovarian stimulation protocols for infertility treatment influence antral follicle growth mainly by using gonadotropins [48]. However, in poor responders to gonadotropin stimulation [49], it is difficult to enhance the ovulation rate using current infertility therapy. Oocyte donation is the only option for such patients desiring pregnancy [50].…”

Microdose gonadotropin-releasing hormone agonist in the absence of exogenous gonadotropins is not sufficient to induce multiple follicle development

“…The microdose flare protocol has been reported to yield lower cancellation rates, higher serum E 2 levels, and improved ongoing pregnancy rates among poor responders (6)(7)(8) and is now considered one of the most aggressive regimens for ovarian stimulation. High doses of exogenous gonadotropins typically are added on the third day of agonist, but the effective stimulation largely has been attributed to endogenous gonadotropin release (9).…”