Different ovarian stimulation protocols for women with diminished ovarian reserve

Abstract

The ideal stimulation for these patients with diminished ovarian reserve remains a great challenge for the clinician, within the limits of our pharmaceutical quiver.

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

“…In the absence of a defect in granulosa cell FSH receptors effecting their sensitivity to FSH stimulation, inadequate local vascular networks for the distribution of gonadotrophins or the presence of neutralizing anti-FSH antibodies, it is unlikely that increasing the dose of FSH will result in an improved IVF response [36]. The recruitment of primordial follicles into the antral follicle pool takes several months and is a process largely independent of FSH stimulation [37].…”

Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes (Shanghai protocol)

“…The incidence of patients who respond poorly is estimated to be about 5-24% (Loutradis et al, 2003;Ubaldi et al, 2005;Ferraretti et al, 2011;Polyzos and Devroey, 2011). The cause of poor ovarian response may be associated with diminished ovarian reserve (Loutradis et al, 2007;Ferraretti et al, 2011). Various treatment protocols with high doses of gonadotrophins, along with various adjuvant drug therapies, were used to improve ovarian response and pregnancy rates (Loutradis et al, 2003;Ubaldi et al, 2005;Loutradis et al, 2007;Ferraretti et al, 2011;Polyzos and Devroey, 2011).…”

“…The cause of poor ovarian response may be associated with diminished ovarian reserve (Loutradis et al, 2007;Ferraretti et al, 2011). Various treatment protocols with high doses of gonadotrophins, along with various adjuvant drug therapies, were used to improve ovarian response and pregnancy rates (Loutradis et al, 2003;Ubaldi et al, 2005;Loutradis et al, 2007;Ferraretti et al, 2011;Polyzos and Devroey, 2011). Although standard definitions for POR are lacking, the European Society for Human Reproduction and Embryology has proposed that at least two of the following three features must be present in poor ovarian response: advanced maternal age or any other risk factor for poor ovarian response; previous poor ovarian response; or an abnormal ovarian reserve test (Bologna Criteria) (Ferraretti et al, 2011).…”

L’insuffisance ovarienne débutante : quels protocoles ?

“…L'équipe de Loutradis et al [58] ont rapporté des résultats encourageants, mais non publiés, concernant l'augmentation des taux de grossesse après supplémentation de la FSH par l'HCG (200 UI/j) versus supplémentation par de la LH en protocole agoniste court.…”