A 34-year-old woman with diminished ovarian reserve (AMH 0.3 ng/mL, AFC 3) undergoes IVF with minimal stimulation protocol (natural modified IVF). She is counselled about live birth rates. Which statement most accurately reflects the evidence regarding IVF in poor ovarian response (DOR)?

• A Higher gonadotrophin doses (> 450 IU/day) consistently improve live birth rates in DOR compared to standard doses
• B Adjuvant DHEA (dehydroepiandrosterone) supplementation for 3 months before IVF has robust RCT evidence for improving live birth rates in DOR
• C Cumulative live birth rates per patient over multiple natural/minimal stimulation IVF cycles are comparable to conventional stimulation in poor responders per POSEIDON group data ✓
• D Oocyte donation immediately is the recommended first-line management for all POSEIDON Group 1–4 patients

Explanation

The POSEIDON (Patient-Oriented Strategies Encompassing Individualised Oocyte Number) group classification subdivided poor ovarian response. Evidence from multiple cycles with natural/minimal stimulation IVF in poor responders shows that cumulative live birth rates over multiple attempts are comparable to conventional high-dose stimulation, which yields few additional oocytes. Higher gonadotrophin doses (> 300 IU) do not reliably improve outcomes in true DOR. DHEA evidence remains inconclusive from RCTs despite promising observational data. Oocyte donation is the most effective option but is not the mandatory first step for all.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.