WHAT İS THE BEST REGİMEN FOR OVULATİON STİMULATİON OF POOR RESPONDER İN IVF ?

The infertile patients with aging ovaries – also sometimes referred to as impending primar ovarian insufficiency , impending premature ovarian failure, or poor ovarian responders are increasing day by day. If someone older than 35 years old, AMH below than 1.2 ng/ ml, follicle count is below than 5 can be named poor responder.  Obviously  , the best treatment for poor responders after a few IVF failures is egg donation. However , most poor respond  patients insist to achieve the desired pregnancy with their own eggs.Possible treatments can be added but none of them magical .

1- Agonist drug protocol is better than antagonist protocol

2- Many studies examined the effect of DHEA supplementation on COS for IVF patients with poor respond patient , with equivocal results.

3- The addition of growth hormon to gonadotropins in COH may up regulate the intraovarian IGF-1 , and augment the stimulatory effect of FSH on folliculogenesis. But its beneficial effect must be evaluated clonidin test before starting .

4- POR patients did not benefit from a high starting dose of gonadotrophin in COH for IVF .

5- In  the presence possible antibodies , the administration of low dose glucocorticosteroids may diminish the autoimmune process and possibly lower the level of activity of these antibodies.

6- Co Q10 supplementation to COH improved patients respond to ovulation induction.

7- Acupuncture and holistic medicine results are not clear .

8- Autologous platelet rich plasma injection by transvaginal sonographic guidance results are insufficient.

9- Drug free in vitro activation of follicles for poor respond patients results are encouraging.