Ovarian Stimulation in Patients with Ovarian Insufficiency

Abstract

In general, patients with low ovarian reserve are difficult to manage and have a relatively poor prognosis. Hormonal changes due to ovarian insufficiency can influence and change the individual menstrual cycle pattern of each patient over time, which may result in difficulties to conceive naturally. Observing the menstrual cycle pattern of patients with low ovarian reserve, it is possible to distinguish different stages of ovarian insufficiency. All clinical stages can be treated by a simple medical treatment, based on oral contraceptive pills, ethinyl estradiol, and Clomiphene citrate, with or without the combination with modified natural cycle in vitro fertilization (IVF). Experience shows that ovulation can successfully be controlled by the use of Clomiphene citrate and does not necessarily require gonadotropin-releasing hormone (GnRH) analogs for pituitary suppression. This knowledge opens a new space for development of alternative protocols respecting the patients’ own physiology with no need for heavy stimulation. Patients with ovarian insufficiency may benefit from this approach, which can be offered before referring them to egg donation.