Journal of Assisted Reproduction and Genetics

, Volume 24, Issue 12, pp 597–611

Different ovarian stimulation protocols for women with diminished ovarian reserve

  • D. Loutradis
  • P. Drakakis
  • E. Vomvolaki
  • A. Antsaklis
Symposium of the aging ovary

DOI: 10.1007/s10815-007-9181-2

Cite this article as:
Loutradis, D., Drakakis, P., Vomvolaki, E. et al. J Assist Reprod Genet (2007) 24: 597. doi:10.1007/s10815-007-9181-2

Abstract

Purpose

To review the available treatments for women with significantly diminished ovarian reserve and assess the efficacy of different ovarian stimulation protocols.

Methods

Literature research performed among studies that have been published in the Pubmed, in the Scopus Search Machine and in Cohrane database of systematic reviews.

Results

A lack of clear, uniform definition of the poor responders and a lack of large-scale randomized studies make data interpretation very difficult for precise conclusions. Optimistic data have been presented by the use of high doses of gonadotropins, flare up Gn RH-a protocol (standard or microdose), stop protocols, luteal onset of Gn RH-a and the short protocol. Natural cycle or a modified natural cycle seems to be an appropriate strategy. Low dose hCG in the first days of ovarian stimulation has promising results. Molecular biology tools (mutations, single nucleotide polymorphisms (SNPs)) have been also considered to assist the management of this group of patients.

Conclusions

The ideal stimulation for these patients with diminished ovarian reserve remains a great challenge for the clinician, within the limits of our pharmaceutical quiver.

Keywords

IVFStimulation protocolsPoor respondersOvarian reserveMutationsSingle nucleotide polymorphisms

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • D. Loutradis
    • 1
  • P. Drakakis
    • 1
  • E. Vomvolaki
    • 1
  • A. Antsaklis
    • 1
  1. 1.IVF Unit, Alexandra Hospital, 1st Department of Obstetrics and GynecologyAthens University Medical SchoolAthensGreece