الفهرس 
NTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Poor ovarian response, which is defined as the development of an insufficient number of mature follicles after gonadotropin stimulation leading to cycle cancellation or the yield of only a few oocytes.
The Bologna criteria for definition of poor ovarian response was at least two criteria of the following three features must be present:
(i)Advanced maternal age (≥40 years)or any other risk factor.
(ii)A previous poor ovarian response (cycles cancelled or ≤3 oocytes with a conventional protocol)
(iii)An abnormal ovarian reserve test (ORT)(antral follicle count (AFC):5–7 follicles or anti-Mullerian hormone (AMH): 0.5–1.1 ng/ml.[13].
Although many protocols with different doses and types of gonadotropins have been proposed in the literature over the past 20 years for the management of poor responder patients, to date there is no really efficient treatment that could solve the problem of poor ovarian response and the current question is still which is the ideal protocol for patients defined as “poor responders”.
The aim of this study was intended compare two alternative protocols of controlled ovarian hyperstimulation in patient with poor ovarian response undergoing intracytoplasmic sperm injection ICSI namely clomiphene citrate hMG protocol and ultrashort protocol.
This study was a randomized prospective study carried out on sample of sixty women with low AMH. which divided into two group each group include 30 subject one of them allocated to CC-hMG stimulation protocol started by administration of clomiphene citrate tablet 150mg/day from day 2 of cycle to day 6 of cycle and 4 ampules (300 IU)human menopausal gonadotropin (hMG)was started on day 4 of cycle to the day of hCG injection. where the other group allocated to ultra-short stimulation protocol started by administration of triptorelin acetate S/C 0.05 mg /day for 3 days starting from day 2 of the cycle and human menopausal gonadotropin (hMG)6 ampules(450IU/day)will started on day 4 of cycle to the day of hCG injection.
In the present study there is no significant difference between two groups in cancellation rate, duration of induction, ovarian response, oocyte retrieval, number of embryo transfer, pregnancy and implantation rate, while there significant difference (<0.001)in number of ampule of hMG required to stimulation was increased significantly in ultrashort protocol.
There is currently insufficient evidence to recommend a particular treatment and evaluation for poor-responders, more clinical trials with larger patient populations are needed to determine an appropriate approach for ovarian stimulation in poor-responders and modification of currently used stimulation protocols which should be achieved at a minimum increase in cost, duration of treatment, and patient’s risks.