The document discusses the definition and management of poor ovarian response. Poor response is generally defined as women with low ovarian reserve or a poor response to ovarian stimulation. As women age, their ovarian reserve declines resulting in fewer remaining eggs. The infertility specialist aims to assess biological age by measuring remaining egg count. Treatment options discussed include clomiphene citrate, letrozole, metformin, gonadotropins, ovarian drilling, and various IVF protocols tailored for poor responders. No single treatment guarantees success, and expectations must be managed through counseling.

1. Management of Poor Ovarian response

8. Poor response & Monofollicular induction

20. Poor response & Multifollicular induction IVF/ICSI

21. Protocols for IVF GnRH Antagonist Protocols GnRH Agonist Protocols 225 IU per day (150 IU Europe) Individualized Dosing of FSH/HMG 250  g per day antagonist Individualized Dosing of FSH/HMG GnRHa 1.0 mg per day up to 21 days 0.5 mg per day of GnRHa 225 IU per day (150 IU Europe) Day 6 of FSH/HMG Day of hCG Day 1 of FSH/HMG Day 6 of FSH/HMG Day of hCG 7 – 8 days after estimated ovulation Down regulation Day 2 or 3 of menses Day 1 FSH/HMG OCP

27. Protocols for IVF GnRH Antagonist Protocols GnRH Agonist Protocols 225 IU per day (150 IU Europe) Individualized Dosing of FSH/HMG 250  g per day antagonist Individualized Dosing of FSH/HMG GnRHa 1.0 mg per day up to 21 days 0.5 mg per day of GnRHa 225 IU per day (150 IU Europe) Day 6 of FSH/HMG Day of hCG Day 1 of FSH/HMG Day 6 of FSH/HMG Day of hCG 7 – 8 days after estimated ovulation Down regulation Day 2 or 3 of menses Day 1 FSH/HMG OCP

40. Poor response TI/IUI Gonadotrophins Modified natural cycle ” Antagonist “ IVM” IVF