DOUBLE STIMULATION PROTOCOL TO IMPROVE PREGNANCY RATE IN POOR RESPONDERS UNDERGOING ICSI

Abstract

The infertile patients with aging ovaries—also sometimes referred to as impending primary
ovarian insufficiency (POI), impending premature ovarian failure (POF), or poor ovarian responders
(POR), constitute a significant bulk of the patients appealing to IVF/ART (1–3). The prevalence of this
group of patients seems to be increasing, due to many patients postponing conceptions to the late
thirties or even beyond the age of forty. In over half of these patients, no etiologic cause can be
pinpointed (1–3). Whereas depletion of most of the ovarian follicles due to older age is well
documented, there are several other etiologies associated with poor ovarian reserve (1–3). Among the
identified etiologies, different causes including chromosomal and genetic etiology (1, 4–8), and
metabolic (4, 9, 10), enzymatic (4, 9, 10), iatrogenic (4, 11), toxic (1–8), autoimmune (1–4), and
infectious causes (1, 2, 4–6, 9).