الفهرس 
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Abstract
One of the most frustrating problems in ICSI today is the low pregnancy rate in women with poor ovarian response. They are estimated to comprise approximately 9-24% of IVF/ICSI patients.
Poor responders represent a challenge to the IVF specialists due to their low response to ovarian stimulation..Woman age is a main indicator for poor response as with advancing age there is depletion of primary oocytes. Apart from age, endometriosis and previous pelvic surgery are also indicators for poor ovarian response. Heredity also plays a major role and needs further investigations.
The relevant physiology of follicle development, poor ovarian response prediction, and the different protocols used for ovarian stimulation in ICSI have been reviewed.
Several methods have been suggested for enhancing the result of the treatment of these patients, because high cancellation rates and low pregnancy rates,but they did not show any improvement in pregnancy rates.
This study was carried at Nile Infertility Center during the period between January 2018 and February 2019 and included a total of One hundered and seventy infertile women with poor ovarian response and undergoing ICSI. Eighty five woman in the first group (mild stimulation) and eighty five in the second group (conventional stimulation).
Treatment strategy consisting of one cycle (either mild or conventional) of stimulation for ICSI.
group (1): Have been treated with 150 IU HMG, daily from the second day of the cycle.GnRH antagonist has been commenced on stimulation day 6, daily and up to the day of HCG administration.
group (2): Have been treated with a fixed daily dose of HMG, 450 IU from the second day of the cycle. GnRH antagonist has been commenced on stimulation day 6 daily and up to the day of HCG administration. Monitoring was done In both groups by vaginal ultrasound till the leading follicle reached a diameter of 18 mm or more and at least two follicles reached a diameter of 15 mm or more , HMG was been stopped, and a single dose of 10,000 IU HCG was administered 36 h before the planned time of oocyte retrieval.
After retrieval of oocytes, ICSI performed, and embryos were transferred 2–3 d thereafter.
Intravaginal progesterone was given as a luteal support from the afternoon of the day of oocyte retrieval until a urine pregnancy test were performed 15 d later.
In case of a positive pregnancy test women were monitored using ultrasound during the period of their pregnancy.
Results were as follows:
There were no statistically significant differences between the two groups as regard age, BMI, duration of infertility, basal hormonal profile, cancellation rate. But the total number of the consumped HMG ampuls and the cost were lower in the mild group.
In conclusion, Mild ovarian stimulation reduce patients’ burden of frequent injections, in terms of embryo quality, pregnancy rate, and cost mild ovarian stimulation is a promising alternative to conventional ovarian stimulation for poor ovarian responders.