A feasible option before cycle cancellation for poor responders; STOP-START protocol

Despite the advances in controlled ovarian stimulation (COS), management of a subgroup of poor responder patients may still be challenging. We describe a feasible and simplified protocol, namely the STOP-START protocol, for poor responders defined as Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) Groups 3 and 4, who are unresponsive to COS with maximum dose gonadotrophins. Data of 11 women unresponsive to COS were reviewed (n=11). Mean age of the patients was 36.5±6.0 years. Unresponsiveness was defined as no follicular growth >9 mm and/or estradiol level less than 40 pg/ml after a week of rFSH (225-300 IU) administration. In that case, COS was stopped and each woman underwent ultrasound assessment weekly to catch a secondary follicular growth. All women showed at least one follicular growth within five to 20 days. Six women (54.5%) had spontaneous follicular growth and the other five required ovarian stimulation. At least one oocyte was retrieved from seven patients (63.6%). The mean number of oocytes retrieved was 1.6±1.4 and five women (45.5%) had at least one Grade A embryo. Among all, two women got pregnant and both gave live birth (18.2%). In conclusion, STOP-START protocol might be an effective, feasible, and time-saving management option for POSEIDON Group 3/4 poor responders who are unresponsive to standard COS treatment with maximum dose gonadotrophins.