Poor responders: does the protocol make a difference?

Area of Science:

• Reproductive Endocrinology
• In-Vitro Fertilization (IVF)

Background:

• Inadequate response to gonadotropins in IVF treatment leads to cycle cancellation, reduced embryo availability, and lower pregnancy rates.
• Numerous strategies, including variations in gonadotropin protocols and the use of GnRH agonists/antagonists, have been proposed to enhance ovarian stimulation in poor responders.

Purpose of the Study:

• To evaluate the effectiveness of different ovarian stimulation protocols in poor responders undergoing IVF.
• To identify optimal strategies for improving outcomes in patients with poor ovarian response.

Main Methods:

• Review of prospective randomized trials and existing literature on ovarian stimulation protocols for poor responders.
• Analysis of data from three prospective randomized trials comparing different stimulation protocols.

Main Results:

• Despite various proposed strategies, epidemiologically sound trials are scarce.
• No compelling advantage has been established for one stimulation protocol over another in poor responders based on current prospective randomized trials.
• Inadequate sample sizes may limit the power of existing studies, or protocol differences may not significantly impact outcomes beyond a certain point.

Conclusions:

• Current evidence does not support a superior ovarian stimulation protocol for poor responders in IVF.
• Future advancements for poor responders may lie in alternative approaches such as aneuploidy screening, in-vitro oocyte maturation, and cytoplasm/nuclear transfer, alongside oocyte donation.