Ovarian Stimulation in Poor Responders: Have We Made Progress?

Background: Poor ovarian responders (POR) pose a challenge to a physicians' ability to choose a stimulation protocol that maximizes the number of oocytes harvested and their chances of conception with multiple protocols aimed at improving pregnancy rates in this poor prognosis population. The Bologna criteria standardized the diagnosis of POR and allows for a more homogenous patient population in clinical trials. Methods: A structured review of the literature, which encompasses research on Bologna-defined POR, identified several proposed protocols to optimize pregnancy rates in poor responders. In addition, we reviewed the utility of utilizing oocyte quality enhancers such as luteal pre-treatment, coenzyme Q10 (CoQ10), dihydroepiandrosterone (DHEA), and growth hormone (GH). Conclusion: Controlled ovarian stimulation strategies with adjuvant aromatase inhibitors and clomiphene citrate have shown similar pregnancy outcomes to higher dose gonadotropin in GnRH antagonist protocols. While the standardization of Bologna defined POR has allowed for more comparable patient populations to study the effectiveness of different protocols for ovarian stimulation, there is currently no convincing data that has determined the ideal protocol for controlled ovarian stimulation in this patient population. Further research is needed to identify optimal treatment strategies.