What is the best protocol for poor responders in IVF? Long protocol, estrogen priming , microdose lupron , short protocol with antagonist, low dose , mini ivf or clomid plus gonadotropins?
The answer is none of the above , or more appropriately , any of the above! I have attended a myriad or conferences , conventions and debates on this topic and the conclusion has always been the same!
Often patients come to see me and tell me that they have read online that a certain protocol is much better . this statement is unsubstantiated by facts. In fact when one looks at the actual studies the evidence is that these are allover the place , which basically means that there is no better protocol.
Many of these protocols end up being associated with certain centers. Typical example is the estrogen priming protocol frequently used at Cornell. Many patients read about it and ask for the protocol and I have nothing against trying something different.
Ultimately my perspective is that if all protocols are pretty much equivalent , the reasonable way to go is minimal stimulation. Mostly for 2 reasons : less hormones in your body and less money out of your pocket to buy crazy expensive drugs like Gonal F , Follistim , Bravelle or Menopure.
Link to a great scientific article about this topic here (it's a pdf file)
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