Strategies for Poor Responders in IVF Cycles

The desired objective of controlled ovarian stimulation (COS) is to allow the growth of a cohort of follicles and to facilitate the recovery of a large number of fertilizable oocytes. However, poor responders with low ovarian reserve often fail to respond adequately despite the maximal dose of gonadotropins administered, with the results that the number as well as quality of oocytes harvested may be very low. These results lead to a significant decrease of pregnancy rate in IVF cycles. Therefore, successful COS for poor responders continues to be a major challenge in IVF program. In this review, I will describe strategies for improvement of ovarian response to COS in poor responders. The strategies described may provide a means of augmenting follicular recruitment by endocrinological manipulation for poor responders undergoing IVF.