The term ?poor respond (POR) patients? is used for the group of women who
respond badly to usual doses of gonadotropins in in vitro fertilization (IVF)
treatments; the consequence is low pregnancy rate. A consensus was reached on
the minimal criteria needed to define POR. At least two of the following
three features must be present: 1. advanced maternal age (40 years or more)
2. previous POR (3 or less oocytes with a conventional stimulation protocol)
3. abnormal ovarian reserve (AMH 0.5-1.1 ng/ml or AFC 5-7). The aim is to
find better therapeutic options for these patients. Increased levels of day 3
follicle stimulating hormone (FSH) and estradiol (E2), as well as decreased
levels of anti-M?llerian hormone (AMH) and antral follicle count (AFC), can
be used to assess ovarian reserve, as indirect predictive tests. A larger
number of well designed, large scale, randomized, controlled trials are
needed to assess the efficacy of different management strategies for poor
responders: flare up gonadotropin releasing hormone (GnRH) agonist protocols,
modified long GnRH agonist mini-dose protocols, luteal initiation GnRH
agonist stop protocol, pretreatment with estradiol - GnRH antagonist in
luteal phase, natural cycle aspiration or natural cycle aspiration GnRH
antagonist controlled, adjuvant therapy with growth hormone or
dehydroepiandrosterone (DHEA). The results of up to now used protocols are
unsatisfactory and stimulation of the ovulation in poor responders remains a
challenge, especially when bearing in mind that in the majority of cases the
patients will be menopausal in relatively short period of time.
Poor ovarian response to stimulation for in vitro fertilization
