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Ovarian Stimulation for Poor Responders

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Ovarian Stimulation Protocols

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Abstract

Infertility specialists have been struggling to deal with poor responders, reported to range from 9 to 24 %. However, the incidence is abruptly increasing lately due to the increasing population of aged infertile women. The long gonadotropin-releasing hormone (GnRH) protocol is the first line of treatment if more than plural numbers of oocytes are expected, which is followed by the short protocol, and the GnRH antagonist stimulation is used as the last treatment option. Among the GnRH agonist protocols, the microdose agonist flare with oral contraceptive (OC) pretreatment appears more effective. Natural cycle or mild stimulation is used when the stimulation protocols fail. IVM is an alternative choice when none of the above-mentioned protocols succeed. Growth hormone (GH) appears to have a beneficial effect, but indications for using GH as well as growth hormone-releasing hormone (GH-RH) are not well defined. In addition, it is too early to determine if androgen pretreatment [dehydrepiandrosterone sulfate (DHEA), testosterone] is beneficial in the treatment of poor responders. It is most important for ART physicians to evaluate the patient response before starting the stimulation and choose the best protocol for the poor responder.

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Author information

Authors and Affiliations

  1. Department of Reproductive Endocrinology and Infertility, IVF Osaka Clinic, 1-1-14 Nagata-higashi, Higashiosaka, Osaka, 577-0012, Japan

    Aisaku Fukuda MD, PhD, HCfigLD (ABB)

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  1. Aisaku Fukuda MD, PhD, HCfigLD (ABB)
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Correspondence to Aisaku Fukuda MD, PhD, HCfigLD (ABB) .

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Editors and Affiliations

  1. 1st floor, Rotunda-CHR 36, Mumbai, India

    Gautam N. Allahbadia

  2. IVF Namba Clinic, Osaka, Japan

    Yoshiharu Morimoto

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Fukuda, A. (2016). Ovarian Stimulation for Poor Responders. In: Allahbadia, G., Morimoto, Y. (eds) Ovarian Stimulation Protocols. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1121-1_9

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  • DOI: https://doi.org/10.1007/978-81-322-1121-1_9

  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-1120-4

  • Online ISBN: 978-81-322-1121-1

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