A Feasible Option before Cycle Cancellation for Poor Responders; STOP-START Protocol

Area of Science:

• Reproductive Endocrinology
• Infertility Treatments
• Ovarian Response Optimization

Background:

• Controlled ovarian stimulation (COS) remains challenging for a subset of poor ovarian responders.
• Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) groups 3 and 4 represent patients unresponsive to maximal gonadotropin doses.
• A simplified protocol is needed for these difficult-to-treat patients.

Observation:

• The STOP-START protocol was applied to 11 women (mean age 36.5 ± 6.0 years) unresponsive to standard COS.
• Unresponsiveness was defined by lack of follicular growth (>9 mm) or low estradiol (<40 pg/ml) after a week of high-dose recombinant FSH.
• COS was stopped, followed by weekly ultrasound monitoring for secondary follicular growth.

Findings:

• All 11 women exhibited follicular growth within 5–20 days.
• Six women (54.5%) had spontaneous growth; five required subsequent stimulation.
• Oocytes were retrieved from 7 (63.6%) patients, with a mean of 1.6 ± 1.4 oocytes. Five (45.5%) achieved at least one grade A embryo, and two (18.2%) had successful live births.

Implications:

• The STOP-START protocol is a feasible and time-saving option for POSEIDON group 3/4 poor responders.
• This approach may improve outcomes for patients resistant to conventional high-dose gonadotropin therapy.
• Further research can validate the efficacy and broader applicability of this simplified protocol in assisted reproductive technology.