Poor responders are a challenge for the gynecologist and are difficult cases but not impossible.
Below we give you an idea of the alternative protocols used 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 which allows us to get the maximum number of eggs. Publications about Double Stimulation are multiple and have proven to be valuable for this type of patient.
The use of the natural cycle in IVF has the advantage of avoiding the use of drugs.
Patients are monitored as in conventional controlled ovarian stimulation protocols but the main difference is we only have 1 egg. The final hCG injection is given as soon as the follicle reaches 16 to 18 millimeters and 34-36 hours later the pick-up takes place. However, the couple should be informed that there is an increased chance that it will not be possible to carry out the embryo transfer due to inability to find the egg, inability to fertilize the egg or poor quality of the embryo.
In selected cases, ovarian stimulation with clomiphene citrate (Serpafar) or with Femara with or without low doses of gonadotropins (mild stimulation) may be used. The final hCG injection is given normally and 34-36 hours later the egg is retrieved.