Managing poor responders in IVF

Managing poor responders in IVF is a significant challenge for fertility specialists. Several ovarian reserve tests have been developed to predict poor response. These include serum basal follicle-stimulating hormone and estradiol levels, as well as, more recently, anti-Müllerian hormone. Sonographic assessment of ovarian reserve has also been employed including ovarian volume and antral follicle count. However, the most accurate predictor of a poor response cycle is a history of poor response to gonadotropins. This review defines and details the various regimens applied to poor responders over the past several decades of assisted reproduction. In the 'Expert commentary', the authors review the published literature on each protocol and offer our opinion. In the 'Five-year view', the authors suggest the direction that the management of poor responders is heading for autologous, as well as oocyte donation. The authors hope this will be a valuable resource to our colleagues for managing infertile patients with diminished ovarian reserve.