Antagonists in poor-responder patients

Objective: To review treatment options for poor-responding patients who are undergoing infertility treatment. Design: Review article and case studies. Results: A comprehensive determination of potential ovarian response for the poor-responding patient is important in the individualization of treatment options for these patients. Treatment options include both the microdose flare leuprolide acetate and GnRH antagonist stimulation protocols. For GnRH antagonist stimulation protocols, individualization of treatment includes use of oral contraceptive pretreatment and alterations in duration of gonadotropin stimulation and start day of antagonist administration. Conclusions: For poor-responding patients, the benefits of using GnRH antagonists for the suppression of premature LH surges plus the determination that stimulation protocols that include GnRH antagonists are at least as good as the microdose flare and provide better cycle outcomes than the long luteal leuprolide acetate down-regulation protocols have the potential to bring changes to the existing protocols for ovarian stimulation. (C) 2003 by American Society for Reproductive Medicine.