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