Stimulation for low responder patients: adjuvants during stimulation.

Growth hormone, letrozole, and clomiphene citrate do not have US Food and Drug Administration approval for their use in in vitro fertilization (IVF) cycles. However, despite this fact, they often are used to augment the IVF cycle in women considered "low responders." Unfortunately, because of the problems inherent to recruiting women who have undergone several unsuccessful IVF treatment cycles, and their inevitable low live birth rate, studies involving adjuvants for women considered low responders to ovarian stimulation often are underpowered. This is compounded further by the difficulty in recruiting vulnerable women to a study with a placebo arm. Consequently, the evidence base for their use as adjuncts to IVF treatment may be limited, and consequently their use may be empirical rather than evidence based. This short narrative review describes the evidence for these "add-ons" for a patient with a low response to ovarian stimulation. It suggests that a woman with a low ovarian response will derive benefit from using growth hormone; with a reduction in the ovarian stimulation required for oocyte retrieval, collection of a greater number of oocytes, and improvement in the clinical pregnancy rate. Although there currently is insufficient evidence to state categorically that it leads to an increased chance of a live birth. In the same situation, clomiphene citrate and letrozole lead to a reduced requirement for gonadotropins before oocyte retrieval, but with no improvement in live birth rate for their use.
(Copyright © 2022 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)