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Chapter-05 Protocols for Poor Responders

BOOK TITLE: Handbook of Ovarian Stimulation

Author
1. Hinduja Ritu
2. Shrimali Kalyani
ISBN
9789352700608
DOI
10.5005/jp/books/14200_6
Edition
1/e
Publishing Year
2018
Pages
11
Author Affiliations
1. Rotunda—The Center for Human Reproduction, Mumbai, Maharashtra, India, Nova IVI Fertility, Mumbai, Maharashtra, India, Nova IVF Fertility, Mumbai, Maharashtra, India; Managing Committee, Indian, Society of Assisted Reproduction, Nova IVF Fertility Center, Mumbai, Maharashtra, India, Nova IVF Fertility, Mumbai, Maharashtra, India; Managing Committee, Indian Society of Assisted Reproduction; Managing Committee, Maharashtra Chapter of Indian Society of Assisted Reproduction, NOVA IVF Fertility, Mumbai, Maharashtra, India
2. Indian College of Obstetricians &, Gynaecologists (ICOG), Mumbai, Maharashtra, India; Nova IVI Fertility, Indore, Madhya Pradesh, India, Nova IVI Fertility, Indore, Madhya Pradesh; Indian College of Obstetricians and Gynaecologists (ICOG), Mumbai, Maharashtra, India, Nova IVI Fertility, Indore, Madhya Pradesh
Chapter keywords
Bologna criteria, gonadotropin-releasing hormone, maximal gonadotropin dosage, GnRH analog, oral contraceptive pill, GnRH antagonist, corifollitropin alfa, GnRH agonist, letrozole protocol, growth hormone, androgen, ESHRE, oocyte cryopreservation, poor ovarian response, poor responder

Abstract

Gauging the most efficient stimulation protocol for the management of patients remains the most challenging task in the field of assisted reproduction. Bologna criteria can be considered an important step toward the identification of poor responder patients and consequently to find the most effective strategy in their management. Oocyte cryopreservation for fertility preservation before the ovarian reserve decline is an important option that must be offered. Available evidence indicates no harmful consequence of oocyte vitrification; hence, it is not just a possibility but also a moral duty to fully exploit its potentials especially in the prevention of poor ovarian response. Adjuvant therapy with growth hormone (GH) or GH-releasing factors resulted in no significant improvement. Corifollitropin alfa followed by highly purified human menopausal gonadotropin (HP-hMG) stimulation has shown promising results in two pilot studies when used in young poor responders fulfilling the Bologna criteria. Finally, natural cycle IVF and mild or minimal stimulation IVF protocol have shown comparable result like those obtained in stimulated cycles in true poor responders.

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