[Poor responders: How could we improve our results?]

Abstract

Objectives: Finding an efficient treatment for poor responders still poses a tremendous challenge for assisted reproductive technology. In 2011, an international consensus has been reached in Bologna on how to standardize the definition of poor ovarian response (POR) in a simple and reproducible manner. This article provides an objective assessment of the different treatment options currently available.

Methods: A search of the database PUBMED was carried out for studies published in English between October 2000 and April 2016.

Results: There is no ideal protocol to manage poor responders even though the antagonist protocol seems to have an advantage of clinicians. This is thanks to better patient tolerance and reduced total dose of gonadotrophin as well as shorter time of stimulation. It seems that there is no benefit in increasing the gonadotrophin daily doses over 300IU nor using any specific type of gonadotrophin. Today, there is insufficient evidence to recommend any additional treatment for poor responders. Only dehydroepiandrosterone (DHEA) seems to increase embryonic quality and pregnancy rate, however further exploration and complementary prospective studies are necessary.

Conclusion: New treatment strategies such as "oocyte banking" or double stimulation during the same cycle, could provide new prospects in poor responders management.

Keywords: Adjuvant therapy; Androgens; Androgènes; Assistance médicale à la reproduction; Assisted reproductive techniques; Mauvaises répondeuses; Ovarian stimulation; Poor responders; Stimulation ovarienne; Traitements adjuvants.