Management of Poor Responders in IVF: Is There Anything New?

Abstract

Despite the fact that in the last two decades an enormous number of papers on the topic of poor ovarian response have been published in the literature, so far it has been impossible to identify any efficient treatment to improve the ovarian response and the clinical outcome of this group of patients. The incidence of poor ovarian responders among infertile women has been estimated at 9–24% but according to recent reviews, it seems to have slightly increased. The limitation in quantifying the incidence of these patients among the infertile population is due to the difficulty of a clear definition in literature. A recent paper by the Bologna ESHRE working group on poor ovarian response has been the first real attempt to find a common definition. Current literature proposes new risk factors which could be the cause of a reduction in ovarian reserve, which also includes genetic factors. This represents the first necessary step towards finding applicable solutions for these patients. To date, there is a substantial lack of literature that identifies an ideal protocol for these patients. The use of the “Bologna criteria” and the introduction of long acting gonadotropin in clinical practice have given rise to new promising stimulation protocols for this group of patients.

Optimal embryo transfer strategy in poor response may include freeze-all

“…In addition, a number of strategies to augment ovarian stimulation with modifiers have also been considered, i.e., DHEA, T, and LH; however, here too no conclusive benefit has been established [30,31]. GnRH antagonist co-treatment protocols continues to be the most often used protocol in poor responder cycles, mostly because ovarian reserve can be assessed by ultrasound on day 2-3 of the cycle, and there is no pituitary suppression in the follicular recruitment phase.…”

A Case Series on Platelet-Rich Plasma Revolutionary Management of Poor Responder Patients

“…A percentage of women under-responds to this type of stimulation and consists of a special patient group reporting poor IVF success rates called "poor responders" [1]. Despite increasing prevalence of poor responders in everyday routine practice [2], breakthrough Poor Ovarian Reserve (POR) research, which is ongoing, fails to provide an efficient approach [3]. This fact contributes to characterizing POR research as a "cold case".…”

The Ideal Stimulation Protocol: Is There One?

“…The incidence of poor ovarian responders among infertile women has been estimated at 9-24 %, but according to recent reviews, it seems to have slightly increased [23]. Current literature proposes new risk factors which could be the cause of a reduction in ovarian reserve, which also includes genetic factors.…”