What is new in the management of poor ovarian response in IVF?

Vaiarelli A., Cimadomo D., Ubaldi N., Rienzi L., Ubaldi F.M.

Curr Opin Obstet Gynecol. 2018 Jun;30(3):155-162. doi: 10.1097/GCO.0000000000000452

 

Abstract

Purpose of review  The management and treatment of patients with poor ovarian response is still a controversial issue in IVF. Increasing evidences demonstrate that the number of oocytes retrieved after a controlled ovarian stimulation (COS) greatly influences the clinical outcome in terms of cumulative live birth per started cycle. For this reason, any COS should aim to optimize the number of oocytes according to the ovarian reserve of the patient. The aim of this review is to provide an overview of new strategies proposed to manage poor responders according to the novel POSEIDON classification.

Recent findings Gonadotrophins cannot compensate for the absence of follicles in the ovary, therefore, COS in poor responders may benefit from the exploitation of multiple follicular waves within a single ovarian cycle, for instance, through luteal phase stimulation or double stimulation (follicular plus luteal) in the same ovarian cycle (DuoStim) protocols.

Summary Many strategies have been proposed to manage poor responder patients, however, a consensus upon which is the most beneficial has not been yet reached. DuoStim is the most promising approach to increase the number of oocytes collected in a single ovarian cycle; however, more embryological and clinical data is required, as well as an analysis of its cost-effectiveness.

Keywords Bologna criteria, DuoStim, luteal phase, ovarian stimulation, poor ovarian response