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Managing poor responder
This document discusses the definition and management of poor responders in IVF treatment. It begins by outlining the ESHRE consensus definition of a poor responder as having two of three features: advanced maternal age, a previous poor response, or an abnormal ovarian reserve test. It then lists factors that can predict a poor response such as AFC, AMH, ovarian volume, and prior poor response. The document discusses precyle adjuvants like DHEA supplementation, cyst drainage, and oral contraceptives. It also reviews stimulation protocols including agonist versus antagonist, natural cycle IVF, and dosing intervals. Laboratory options for poor responders like ICSI, PGS, and embryo transfer timing are discussed. The role of donor
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Managing poor responder
- 1. Managing poor responder DRG A RAMA RAJU Krishnaivf clinic, Krishnaivf.com
- 2. Eshre consensus :Poorresponder
- 3. Poor responder eshredefinition Two of the following three features must be present: Advanced maternal age (≥40 years) or any other risk factor for POR; A previous POR (≤3 oocytes with a conventional stimulation protocol); An abnormal ovarian reserve test (i.e. AFC <5–7 follicles or AMH <0.5–1.1 ng/ml).
- 4. Predicting poor responder AFC AMH Ovarian volume Testosterone PRIORPOOR RESPONSE AGE
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- 7. Simple cyst drainageprior to stimulation
- 8. Precycle oral contraceptionor antagonist suppression combined estrogen priming
- 9. Adjuvants at initiationof cycle Gnrh analog flare GRH AGONIST MICRODOSE FLARE PROTOCL AGONIST VERSUS ANTAGONIST. CLOMIPHENE FLARE LETRIZOLE FLARE
- 10. Gnrh analog flareprotocol
- 11. Antagonist versus Agonistprotocols
- 12. Natural ,clomiphene letrizoleivf Letrizole flare protocol Clomiphene flare protocol
- 13. Poor Responder managementin stimulation phase DOSE HMG VERUS REC FSH LH IN POOR RESPONDER MINIMAL STIMULATIO NATURAL CYCLE IVF DOSING INTERVAL
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- 15. Role of HMGin intial poor response with rec fsh
- 16. Role of lhin poor responder
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- 18. LABARATORY OPTION ICSI FORLOW OOCYTE NUMBER PREIMPLANTATION ENETIC DIAGNOSIS IDEAL DAY OF TRANSFER NUMBER OF EMBRYOS DONOR OOCYTE
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- 20. Preimplantaion genetic screenfor poor responder
- 21. Ideal day oftransfer • The role of day 5 embryo transfer for poor responders is less clear • Randomized controlled trial demonstrating increased clinical pregnancy rates for poor responders undergoing day 2 embryo transfer compared with day 3 embryo transfer
- 22. Number of embryosfor transfer Optimizing the number of cleavage stage embryos to transfer on day 3 in women 38 years of age and older
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- 24. Next 5 yearspoor responder Genomic proteomic metabolomics will play a major role in stimulation protocol.