A challenge for the gynecologist is poor responders. They also are difficult cases but not impossible.
Below we give you an idea of the alternative protocols we use to stimulate these patients.
In our team we use the Double Stimulation where we stimulate the ovaries twice both in the first phase of the cycle and in the second. The second is usually shorter. Therefore the patient has a double Pick-up in the same cycle. It allows us to get the maximum number of eggs. Publications about Double Stimulation are multiple and valuable for this type of patient.
The use of the natural cycle in IVF has the advantage of avoiding the use of drugs.
Doctors monitor patients as in conventional controlled ovarian stimulation protocols. The main difference is we only have 1 egg. Specialist give the final hCG injection as soon as the follicle reaches 16 to 18 millimeters. 34-36 hours later the pick-up takes place. However, the couple should know that there is an increased chance that it will not be possible to carry out the embryo transfer. This could happen due to inability to find the egg, inability to fertilize the egg or poor quality of the embryo.
In selected cases, they may use ovarian stimulation with clomiphene citrate (Serpafar). Or with Femara with or without low doses of gonadotropins (mild stimulation). They give the final hCG injection normally and 34-36 hours later they retrieve the egg.