الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In reproductive medicine little progress has been achieved regarding the clinical management of patients with a reduced ovarian reserve or poor ovarian response (POR), a frustrating experience for clinicians as well as patients.
Several definitions were published for poor ovarian responders, most importantly the Bologna criteria made by the ESHRE ( European Society of Human Reproduction and Embryology) in 2011 which depends presence of at least two of the following three characteristics: [i] advanced maternal age (40 years) or any other risk factors for POR; [ii] a previous POR (three oocytes with a conventional stimulation protocol); and [iii] an abnormal ovarian reserve test. Another important classification done by the Poseidon group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) in 2016.
Poseidon group 1: Age < 35 years old with adequate ovarian reserve parameters ( AFC ≥5; AMH ≥ 1.2 ng/ml) and with an unexpected poor or suboptimal ovarian response, group 1a < 4 oocytes retrieved, group 1b 4-9 oocytes retrieved. Poseidon group 2: Older patients ≥35 years old with adequate ovarian reserve parameters ( AFC ≥5; AMH ≥1.2ng/ml) and with an unexpected poor or suboptimal ovarian response, group 2a <4 oocytes retrieved, group 2b 4-9 oocytes retrieved. Poseidon group 3: Young patients ( <35 years) with poor ovarian reserve prestimulation parameters ( AFC <5; AMH <1.2ng/ml). Poseidon group 4: Older patients ( >35 years) with poor ovarian reserve prestimulation parameters ( AFC <5; AMH <1.2ng/ml)
The use of clomiphene citrate, aromatase inhibitors, growth hormone, transdermal testosterone, corticosteroids, estradiol or aspirin are recommended as adjuvant therapies.
Several controlled ovarian hyperstimulation protocols were used to improve outcome of ART in poor responders. For example, Microdose GnRH flare-up protocol, Ultrashort GnRH agonist combined with GnRH antagonist protocol, GnRH antagonist protocol, GnRH agonist protocol, the ANDRO-IVF protocol and lately, Double stimulation protocols.
Double stimulation protocols were reported based on the ‘wave theory’ of antral follicular recruitment which is considered the principle of luteal phase stimulation