What is the latest evidence-based protocol for poor ovarian responders according to the Bologna criteria?

Terminology first: ESHRE (2026) replaced "poor response" with "low response", explicitly to avoid implying anything about prognosis or safety for this group. The guideline also asks clinicians to avoid non-standardised terms such as "healthy" responders or "kind" stimulation. What the current guideline supports: Gonadotropin doses above 300 IU/day are not recommended (strong). The GnRH antagonist protocol is recommended over agonist protocols in the general IVF/ICSI population, given comparable efficacy and better safety (strong). Where a GnRH agonist is used, the long protocol is recommended over short or ultrashort (strong). Clomiphene alone, clomiphene with gonadotropins, and gonadotropin stimulation alone are probably equally recommended for low responders (conditional). Double stimulation can be used to accumulate oocytes or embryos where no fresh transfer is planned (strong). Low response alone is not a reason to cancel a cycle (strong). What is recommended against: Growth hormone — probably not recommended (conditional). DHEA — not recommended (strong). Testosterone pre-treatment — probably not recommended (conditional, updated on Naik 2024). Myo-inositol — not recommended (strong). Aspirin and sildenafil — not recommended (strong). Delayed-start stimulation — probably not recommended (conditional). The honest position to convey: the adjuvant literature in this group is largely negative, and the guideline reflects that.