Open access Peer reviewed journalwww.actualgyn.com
Management of patients with poor ovarian response to controlled ovarian hyperstimulation (COH) is a challenging and still a controversial issue. Despite the advances in reproductive medicine in the past decades, there is still no consensus regarding fertility treatment of this population group. In terms of improving the clinical outcomes by increasing the cumulative live birth rates per each started IVF cycle, increasing evidence demonstrate the importance of the number of oocytes retrieved after COH, which can be optimized by correct evaluation of the ovarian reserve, also taking into consideration the woman’s age. The classic paradigm of folliculogenesis (one cycle = one cohort of follicles responsive to stimulation) has been overtaken by the theory of follicular waves, which opened new therapeutical possibilities for the advanced maternal age patients with low ovarian reserve. This article is a review of the up-to-date information regarding low responsive patients, including more precise classification of these patients by the POSEIDON expert group, and a review of the existing data about the Duostim protocol – a promising instrument for improving the results of the fertility treatment in poor responders.