Choosing the right stimulation protocol for in vitro fertilization-embryo transfer in poor, normal, and hyper-responders

Abstract

Purpose: To describe the advantages of low-dose stimulation for poor responders, the pros and cons of low dose vs high dose stimulation for normal responders and multiple strategies for hyper-responders especially to reduce the risk of the ovarian hyperstimulation protocol.

Methods: Various strategies are described for these three types of responders.

Results: Poor responders do best with mild stimulation protocols. Conventional stimulation protocols for normal responders have the advantage of providing embryos for future embryo transfers assuming the IVF center has a good cryopreservation program. Mild stimulation protocols save money for normal responders. There are many strategies for hyper-responders to prevent ovarian hyperstimulation syndrome including mild stimulation, high LH/FSH ratio for stimulation combination, GnRH agonist instead of hCG and using clomiphene citrate or aromatase inhibitors.

Conclusions: It is important to choose the right protocol for a given patient. An infertile couple can often help in making the decision.