Title:
Increasing the stimulation dose of rFHS in unexpected poor responders is not associated with better IVF outcome.

Abstract:
The aim of this retrospective study is to determine whether increasing the stimulation dose of rFSH in unexpected poor responders is associated with better IVF outcome or not.
A total of forty eligible women who fulfilled our definition of poor responders (< or = 3 follicles, < 4 oocytes or E2 levels < or = 500 pg/ml on day of hCG administration) and who did not achieve an ongoing pregnancy in the first cycle and who returned for a second higher rFSH dose IVF cycle with a long-agonist protocol were included to the study. The first-low dose cycles and the second-high dose cycles were compared to each other. Each patient functioned as her own control. Main outcome measures of the study were daily and total dose of rFSH, duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos and E2 level on day of hCG injection.
The first-low dose cycles and the second-high dose cycles were comparable regarding patient characteristics. There were no significant differences in duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos and E2 level on day of hCG injection between the first-low and second-high dose cycles. Daily and total dose of rFSH were significantly higher in the second-high dose cycles. Fewer cycles were cancelled during the second higher gonadotrophin dose after first unexpected poor response.
Increasing the starting dose of gonadotrophin after an unexpected poor response in the first IVF cycle is not an effective approach. It may increase the oocyte retrieval rates and embryo transfer rates, but will not add any significant improvement in the number of oocytes retrieved and the number of transferable embryos. The only important benefit of increasing the dose was the low cancellation rate.