Managing Difficult Infertile Patients

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This document discusses strategies for managing patients with poor ovarian reserve or polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF). It recommends testing ovarian reserve with antral follicle count (AFC), anti-Mullerian hormone (AMH) and past response history. Treatment options include increasing gonadotropins or using a mini-IVF/natural cycle approach. For poor responders, empiric therapies like acupuncture or supplements like DHEA may help improve reserve before using a letrozole/gonadotropin protocol. Managing expectations and discussing alternative options like donor eggs is important to avoid false hope or wasting money. Preventing ovarian hyperstimulation syndrome in P

Salud y medicina

Dr Aniruddha Malpani, MD www.drmalpani.com

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