By Dr. K D Nayar
For the first time ever, India’s evidence-based clinical guidelines on managing Poor Ovarian Response (POR) have been published internationally in Global Reproductive Health (IFFS Journal). This marks a major milestone for Indian reproductive medicine and provides a structured, science-backed framework for infertility specialists worldwide.
Why This Matters
Poor ovarian response is one of the toughest challenges in IVF, affecting nearly 1 in 5 women undergoing fertility treatments. It often leads to cycle cancellations, fewer eggs retrieved, and lower chances of pregnancy.
Until now, doctors in India often relied on scattered studies or international protocols, which were not always suited to Indian patients. These new guidelines offer a clear, evidence-based road-map tailored to local as well as global practice.
How the Guidelines Were Made
The Indian Fertility Society (IFS) brought together leading fertility experts across the country. Using the PICO framework and the internationally recognized GRADE methodology, they reviewed more than 21,000 research papers and answered 37 key clinical questions.
The result: 44 evidence-based recommendations (33 strong, 11 conditional).
Key Scientific Contributions
l Diagnostic Predictors
AMH and Antral Follicle Count (AFC) are validated as the most reliable biomarkers for predicting ovarian response.
Their clinical utility lies in early identification of women at risk of POR, enabling timely counseling and individualized treatment.
l Stimulation Protocols
High-dose gonadotropins do not improve outcomes — confirming that “more is not better.”
Mild or conventional stimulation, sometimes with oral agents like clomiphene or letrozole, achieves comparable live birth rates at lower cost and stress.
l Drug Choices and Adjuvants
Both hMG and rFSH are effective.
Corifollitropin alfa (CFA) is a safe and convenient alternative.
Adjuvant therapies such as growth hormone, testosterone, DHEA, and CoQ10 are not recommended due to insufficient evidence.
l Laboratory & Procedural Strategies
The guideline discourages follicular flushing, routine PGT-A, and elective freeze-all strategies in poor responders, as benefits are minimal or uncertain.
Treatments Not Recommended
Several popular but experimental approaches — such as PRP, stem cell therapy, and ovarian rejuvenation — should only be used in research settings, not in routine clinical practice.
Research Gaps Identified
The guidelines also point out areas where more research is needed, such as:
l Immunologic testing
l Glucocorticoids as adjuvants
l Alternative/AYUSH therapies
l Routine hormonal monitoring
Large, well-designed trials are essential to establish clarity in these domains.
What This Means for Patients
For couples struggling with infertility, these guidelines ensure:
✅ Safer, more effective treatments
✅ Standardized care across India
✅ Reduced unnecessary interventions
✅ More affordable and patient-friendly protocols
Global Recognition & Scientific Impact
Published in the Winter 2025 issue of Global Reproductive Health, this is the first comprehensive, evidence-based POR guideline from India, and among the few worldwide.
By providing 44 transparent, well-graded recommendations, the guidelines:
lEnhance clinician confidence
lHarmonize practice across fertility centers
lSet new benchmarks for global reproductive medicine
In resource-limited settings, they also serve as a pragmatic roadmap—helping maximize success rates without escalating costs.
✨ Conclusion
The IFS guidelines represent not just a clinical document, but a milestone in scientific inquiry and patient care. They emphasize tailoring interventions to patient needs, eliminating ineffective add-ons, and focusing on strategies with proven efficacy.
For women with poor ovarian reserve worldwide, this is a hopeful step forward — ensuring that IVF care is guided by science, not guesswork.
Full article is available on the link below:
https://journals.lww.com/grh/fulltext/2025/09010/evidence_based_recommendations_for_managing_poor.1.aspx
�� Full guidelines are available on the websites
www.indianfertilitysociety.org & www.akankshaivfcentre.com
