How to improve the probability of pregnancy in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis

Objective: To systematically review the literature to identify randomized controlled trials, which evaluate interventions aiming to improve the probability of pregnancy in poor responders undergoing in vitro fertilization (IVF). Design: Systematic review and meta-analysis. Setting: University-based hospital. Intervention(s): None. Main Outcome Measure(s): Pregnancy rate. Result(s): Twenty-two eligible randomized controlled trials were identified that evaluated in total 15 interventions to increase pregnancy rates in poor responders. Based on limited evidence, the only interventions that appear to increase the probability of pregnancy were the addition of GH to ovarian stimulation (odds ratio for live birth: 5.22, confidence interval: 95% 1.09-24.99) and the performance of embryo transfer on day 2 compared with day 3 (ongoing pregnancy rate: 27.7% vs. 16.3%, respectively; difference: +11.4, 95% confidence interval: +1.6 to +2 1.0). Conclusion(s): Insufficient evidence exists to recommend most of the treatments proposed to improve pregnancy rates in poor responders. Currently, there is some evidence to suggest that addition of GH, as well as performing embryo transfer on day 2 versus day 3, appear to improve the probability of pregnancy. (Fertil Steril (R) 2009;91: 749-66. (C) 2009 by American Society for Reproductive Medicine.)