Human Reproduction, Vol. 14, No. 7, 1744-1748,
July 1999
© 1999 European Society of Human Reproduction and Embryology
A rational approach to the management of low responders in in-vitro fertilization: Opinion
Center for Human Reproduction – Illinois, and the Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA
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Introduction |
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Low ovarian response to stimulation occurs in ~9–24% of patients (Keay et al., 1997
) and still represents one of the most intractable problems of infertility treatment. Clinicians have historically approached low responders in two ways. A first option is to refuse patients entry into in-vitro fertilization (IVF) cycles. Such an approach is, however, obviously discriminatory and serves no practical purpose except for protecting a programme's pregnancy rate (a rather self-serving and medically inappropriate choice). This leaves, as the only ethical choice, attempts to maximize outcomes in IVF cycles for low responders by attempting to improve their historically poor pregnancy and delivery rates.
This paper will briefly review the various stimulation protocols (successful and unsuccessful) that have been attempted to improve IVF results in low responders. Included is our experience with a protocol that has met with some success. We would also like to propose a strategy where one
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