Stimulation for low responder patients: adjuvants during stimulation

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• Certain medications like growth hormone, letrozole, and clomiphene citrate are used off-label in IVF for "low responders."
• Evidence supporting these "add-on" therapies is often limited due to study design challenges, including small sample sizes and difficulties in recruiting patients who have had prior unsuccessful IVF cycles.

Purpose of the Study:

• To review the existing evidence for the use of growth hormone, letrozole, and clomiphene citrate as adjuncts in IVF for women with a low ovarian response.
• To assess the impact of these interventions on ovarian stimulation, oocyte retrieval, and pregnancy outcomes.

Main Methods:

• This is a narrative review of available literature on the use of specific medications as adjuncts in IVF for low responders.
• The review focuses on studies examining growth hormone, letrozole, and clomiphene citrate.

Main Results:

• Growth hormone use in low responders may reduce required ovarian stimulation, increase oocyte yield, and improve clinical pregnancy rates, though evidence for live birth rate improvement is insufficient.
• Clomiphene citrate and letrozole can decrease the need for gonadotropins in low responders but have not demonstrated an improvement in live birth rates.

Conclusions:

• Growth hormone shows potential benefits for low responders in IVF, warranting further investigation into its effect on live birth rates.
• While letrozole and clomiphene citrate may reduce gonadotropin requirements, their clinical utility in improving live birth rates for low responders remains unproven.