How to define, diagnose and treat poor responders? Responses from a worldwide survey of IVF clinics

Abstract

Poor responders represent a significant percentage of couples treated in IVF units (10-24%), but the standard definition of poor responders remains uncertain and consequently optimal treatment options remain subjective and not evidence-based. In an attempt to provide uniformity on the definition, diagnosis and treatment of poor responders, a worldwide survey was conducted asking IVF professionals a set of questions on this complex topic. The survey was posted on www.IVF-worldwide.com, the largest and most comprehensive IVF-focused website for physicians and embryologists. A total of 196 centres replied, forming a panel of IVF units with a median of 400 cycles per year. The present study shows that the definition of poor responders is still subjective, and many practices do not use evidence-based treatment for this category of patients. Our hope is that by leveraging the great potential of the internet, future studies may provide immediate large-scale sampling to standardize both poor responder definition and treatment options.

Randomized controlled trial of gonadotropin‐releasing hormone agonist microdose flare‐up versus flare‐up among poor responders undergoing intracytoplasmic sperm injection

“…Surveys such as that conducted by Patrizio et al . found that the best stimulation protocols for poor ovarian responders were the GnRH antagonist protocol (52%), the short GnRH agonist flare‐up (20%), and microdose (15%) protocols.…”

Basal follicle stimulating hormone and leptin on the day of hCG administration predict successful fertilization in <em>in vitro</em> fertilization

“…8 Another study showed FSH level of 6.5-15 mIU/mL as poor responders. 9 Basal FSH level performed better as a sole prognosticator for treatment failure, but the high cut off level necessary to reach sufficient prognostic power inevitably reduces the number of patients that may benefit from the test. Basal FSH is a limited value in the prediction of pregnancy rate after IVF and should only be applied if clear consequences, therefore another predictive factor is needed to predict fertility success.…”

Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations

“…Patients with poor ovarian response (POR) present a major challenge in IVF, as they are not likely to obtain an optimal number of oocytes after OS, and thus are less likely to conceive and, moreover, will have a higher risk of cycle cancellation. The estimated prevalence of POR ranges from 6% to 35% [3,4]. This wide range is caused by the initial lack of consensus when defining POR.…”