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Poor Responders

 

Should the definition be based on ovarian response only?
  • Yes
  • No

 

Should definition include endometrial response?
  • Yes
  • No

 

How you define poor responders based on number of follicles?
  • Less than 2 follicles
  • Less than 3 follicles
  • Less than 4 follicles
  • Less than 5 follicles
  • Do not use follicle number

 

How you define poor responders based on level of serum estradiol?
  • Less than 3500 pmol/l (910 pg/ml)
  • Less than 3000 pmol/l (780 pg/ml)
  • Less than 2500 pmol/l (650 pg/ml)
  • Less than 2000 pmol/l (520 pg/ml)
  • Less than 1500 pmol/l (390 pg/ml)
  • Less than 1000 pmol/l (260 pg/ml)
  • Less than 500 pmol/l (130 pg/ml)
  • Do not use estradiol for screening

 

Is History important? Previous performance before and during IVF?
  • Yes
  • No

 

What screening methods do you use to identify poor responders?
  • FSH
  • FSH and estradiol
  • FSH, AFC (antral follicular count)
  • FSH, Estradiol, AFC (antral follicular count)
  • FSH, AMH (Anti Mullerian Hormone)
  • FSH, estradiol, AFC and AMH (Anti Mullerian Hormone)

 

Do you measure FSH/LH ratio?
  • Yes
  • No

 

At what level of day 2 FSH would you identify a poor responder?
  • 10 - 12 U/L
  • 12 - 15 U/L
  • 15 - 19 U/L
  • > 19 U/L
  • None of the above

 

In normally cycling patients, would you cancel IVF treatment if day 2 FSH is
  • > 10U/L
  • > 13U/L
  • >18U/L
  • >20U/L
  • If patients is cycling I will not cancel cycle

 

Do you do any dynamic testing?
  • GnRH agonist
  • Clomiphene Citrate challenge test (CCCT)
  • Both of the above
  • None of the above

 

Do you use the ultrasound for diagnosis?
  • 3-D Ultrasound and Doppler study
  • Antral follicle count
  • Both
  • None of the above

 

Would you do genetic testing?
  • Fragile X
  • Karyotype
  • Both
  • None

 

What, in your opinion and experience, is the most important predictor of the above?
  • No of follicles
  • Estradiol Level
  • Previous history
  • FSH
  • AMH
  • Dynamic testing
  • 3-D Ultrasound
  • Karyotype
  • Other

 

Can you estimate the scale of poor responders in your clinic?
  • Less than 5%
  • 6-10%
  • 11-15%
  • 16-20%
  • 20-25%
  • 25-30%
  • >31%

 

Have you seen any change in the incidence during the last 10 years?
  • The incidence decreased
  • The incidence increased
  • No change

 

Would you continue treatment if no oocytes were retrieved at a prior cycle?
  • Yes, for another cycle
  • No

 

Will you continue treatment if oocytes were aspirated but no embryo(s) developed?
  • Yes, for another cycle
  • No

 

Of the following GnRH analogues protocols, which one do you use more often for poor responders?
  • GnRH agonists, long protocol
  • GnRH agonist short protocol
  • Short protocols microdose
  • GnRH agonist using flexible regimen
  • GnRH antagonists
  • No analogues

 

What combination of gonadotropins do you use?
  • FSH alone
  • hMG alone
  • FSH and recLH
  • FSH and hMG
  • FHS and low dose hCG
  • None of the above

 

What should be the starting dose of of gonadotropins (FSH alone or hMG) that you use?
  • Usual dose (150-225 IU)
  • 300-375 IU daily
  • 375-450 IU daily
  • 450-600 IU daily
  • More than 600 IU a day
  • None of the above

 

What is the maximum daily dose of gonadotropins (FSH alone or hMG) that you use?
  • 600
  • 900
  • 1200
  • 1500
  • More

 

If you add hMG how many daily units and when?
  • 75-150 IU from the onset of stimulation
  • 75-150 IU after 5-6 days of stimulation
  • 225-300 IU from the onset of stimulation
  • 225-300 IU after 5-6 days of stimulation
  • A higher dose
  • Do not add hMG

 

If you add rec.LH how many daily units and when?
  • 75-150 IU from the onset of stimulation
  • 75-150 IU after 5-6 days of stimulation
  • 225-300 IU from the onset of stimulation
  • 225-300 IU after 5-6 days of stimulation
  • A higher dose
  • Do not add rec.LH

 

Would you divide the daily dose into two administrations?
  • Yes if is more than 225/day
  • Yes, if is more than 300/day
  • Yes if is equal or more than 450/day
  • No, always one administration

 

How long will you continue with the maximum dose, if there is no response, before you will stop treatment (cycle cancellation)?
  • 4-6 days
  • 7-9 days
  • 9-11 days
  • >11 days

 

Do you use Clomiphene Citrate and gonadotropin?
  • Yes
  • No

 

Will you add hGH to the treatment protocols?
  • Yes
  • No

 

Will you add DHEA (dehydroepiandrostendione 75 mg daily) to the protocol?
  • Yes
  • No

 

If you add DHEA when do you start?
  • Around 3 months before treatment
  • At the beginning of the cycle
  • I do not add

 

Do you add Aspirin?
  • Yes
  • No

 

Do you add Low Weight Molecular Heparin at any time of the stimulation or luteal phase?
  • Yes
  • No

 

Would you prefer natural cycle in these cases?
  • Yes
  • No

 

Would you recommend IVM in such cases?
  • Yes
  • No

 

Do you start gonadotropins in the luteal phase prior to stimulation?
  • Yes
  • No

 

Do you increase dose of exogenous luteal progesterone?
  • Yes
  • No

 

In addition to progesterone, do you support the luteal phase with estrogen, aspirin, or steroids?
  • Estrogen and baby aspirin
  • Estrogen and steroids
  • Estrogen and steroids and baby aspirin
  • Estrogen
  • None

 

Do you bank oocytes for poor responders?
  • Yes
  • No

 

Do you do embryo banking in this group of patients? (Get the embryos freeze and accumulate to replace several embryos in one cycle)
  • Yes
  • No

 

Do you offer assisted Zona hatching?
  • Yes
  • No

 

Assuming none financial constraints, is there a maximum number of failed cycles after which you recommend to stop?
  • 2 failed cycles
  • 3 failed cycles
  • 4 failed cycles
  • 5 failed cycles
  • None