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BOOK TITLE: Principles and Practice of Assisted Reproductive Technology
Despite the numerous predictive tests for diminished ovarian reserve including age, the poor ovarian responder (POR) most times is diagnosed only when subjected to ovarian stimulation. As there is no uniform definition of poor response makes the clinical trials incomparable till date. Moreover, majority of published trials on POR suffer from methodological flaws and are, thus, regarded as being high risk for bias. There is no evidence for any particular controlled ovarian stimulation protocol to improve treatment outcome but gonadotropin-releasing hormone antagonist protocols may reduce treatment burden. There is insufficient evidence for most of the adjuvants to improve outcome in women who are poor responders. There may be a role for newer modalities of treatment like oocyte and embryo accumulation, preimplantation genetic screening to rule out aneuploidy, in vitro activation of ovarian cortical tissue. Management of POR still represents a therapeutic challenge for the clinician as it being a heterogeneous group with no uniform protocols and that the prognosis for these patients may vary greatly depending on patient characteristics.