What are the complementary treatment options for poor responders to ovarian stimulation?

This study analyzed treatment options for patients with a poor ovarian response (POR) to ovarian stimulation procedures for infertility. 

They found that supplements with DHEA and coenzyme Q10 (CoQ10) improved pregnancy rates in these women.

Controlled ovarian stimulation (COS) is the first part of assisted reproduction (AR). This involves using drugs to stimulate the ovaries to release follicles. The oocyte (egg) in the follicle can be fertilized by sperm in a dish. This is called in vitro fertilization (IVF). Some women respond poorly to COS. This is called poor ovarian response (POR). POR leads to a low number of oocytes. 

Improving outcomes for POR women is important. Many studies have been carried out to investigate this. Gonadotrophin-releasing hormone (GnRH) is usually given to for COS. Some research suggests that adding additional drugs may improve outcomes. This approach is called adjuvant therapy (AT). It is unclear what drugs may be useful as AT in women with POR.

This study included 46 studies on AT for COS in POR women. 6312 women were included in these studies. 10 AT regimens were investigated. These included testosterone, dehydroepiandrosterone (DHEA), letrozole (Femara), recombinant LH (rLH), recombinant hCG (rHCG), estradiol, clomiphene citrate (Clomid), progesterone, growth hormone (GH), and coenzyme Q10 (CoQ10). The outcomes evaluated included pregnancy rate (PR) and the number of harvested oocytes (NHOs). The number of embryos transferred (NETs) after IVF was also an outcome.

DHEA was associated with a 2.46 times higher PR compared to control treatments. CoQ10 was associated with a 2.22 times higher PR compared to control treatments. hCG had a 2.08 times higher chance of a higher NHO. Oestradiol and GH also had higher NHO rates (2.02 times higher and 1.72 times higher).

The NETs was highest in patients treated with testosterone and GH. A lower dose of GnRH was used in patients receiving AT with clomiphene citrate, letrozole, and GH compared to control treatments. 

The authors concluded that DHEA and CoQ10 improved pregnancy outcomes in women with a POR to stimulation drugs.

There were a lot of differences in the doses and timings of COS protocols. This makes it difficult to make specific comparisons. More controlled studies are needed. 

If you have any concerns regarding infertility management please consult with your physician.