scholarly journals Update on the management of poor ovarian response in IVF: the shift from Bologna criteria to the Poseidon concept

2020 ◽  
Vol 14 ◽  
pp. 263349412094148
Author(s):  
Panagiotis Drakopoulos ◽  
Erlisa Bardhi ◽  
Liese Boudry ◽  
Alberto Vaiarelli ◽  
Antonis Makrigiannakis ◽  
...  
Keyword(s):  
Ovarian Stimulation ◽  
Clinical Management ◽  
Ovarian Response ◽  
Medical Community ◽  
Future Prospects ◽  
Poor Ovarian Response ◽  
Subsequent Evolution ◽  
Bologna Criteria ◽  
Assisted Reproduction Technology ◽  
Poor Ovarian Responders

Despite the considerate progress to which assisted reproduction technology (ART) has been subject since 1978, some issues remain unresolved. Notably, the clinical management of patients with a poor ovarian response is still a challenge in everyday practice, frustrating to both the patient and the fertility expert. Poor ovarian responders (PORs) embody 9–24% of patients undergoing ovarian stimulation, meaning that up to one in four patients conceals a poor reproductive prognosis. The last decade has witnessed the attempts of the medical community to standardize diagnosis of POR with the developing of the Bologna Criteria and the subsequent evolution of the low prognosis patient elaborated in the POSEIDON classification. The aim of this article is to summarize all evidence concerning etiology and management of poor ovarian response, including the most recent advances and future prospects in this regard.

scholarly journals Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations

2020 ◽  
Vol 21 (6) ◽  
pp. 2110
Author(s):  
Antoine Abu-Musa ◽  
Thor Haahr ◽  
Peter Humaidan
Keyword(s):  
Assisted Reproduction ◽  
Ovarian Stimulation ◽  
Clinical Management ◽  
Management Strategies ◽  
Ovarian Response ◽  
Poor Ovarian Response ◽  
Bologna Criteria ◽  
Recent Classification ◽  
Definition Of ◽  
The Impact

Poor ovarian response (POR) to controlled ovarian stimulation (OS) presents a major challenge in assisted reproduction. The Bologna criteria represented the first serious attempt to set clear criteria for the definition of POR. However, the Bologna criteria were questioned because of the persistent heterogeneity among POR patients and the inability to provide management strategies. Based on these facts, a more recent classification, the POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) classification, was developed to provide a homogeneous and refined definition of POR that significantly reduces the heterogeneity of the Bologna criteria definition of POR and helps in the clinical handling and counseling of patients. In this review, we discuss the impact of the POSEIDON classification on the clinical management of patients with POR.

scholarly journals Type and dose of gonadotropins in poor ovarian responders: does it matter?

2021 ◽  
Vol 15 ◽  
pp. 263349412110242
Author(s):  
Liese Boudry ◽  
Annalisa Racca ◽  
Herman Tournaye ◽  
Christophe Blockeel
Keyword(s):  
In Vitro Fertilization ◽  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Oocyte Donation ◽  
Reproductive Technology ◽  
Poor Ovarian Response ◽  
Vitro Fertilization ◽  
Poor Ovarian Responders ◽  
Infertile Patients

Infertile patients with a diminished ovarian reserve, also referred to as poor ovarian responders, constitute a substantial and increasing population of patients undergoing in vitro fertilization. The management of patients with poor ovarian response is still a controversial issue. Almost a century has passed since the introduction of the first gonadotropin. A broad collection of urinary and recombinant gonadotropins, including biosimilars, is commercially available now. Despite great advances in assisted reproductive technology, there remains uncertainty about the optimal treatment regimen for ovarian stimulation in poor ovarian responders. Although oocyte donation is the most successful and ultimate remedy for poor ovarian responders, most patients persist on using their own oocytes in several attempts, to achieve the desired pregnancy. The aim of this review is twofold: first, to provide an overview of the commercially available gonadotropins and summarize the available evidence supporting the use of one or another for ovarian stimulation in poor ovarian responders, and second, to address the controversies on the dosage of gonadotropins for this specific in vitro fertilization population.

scholarly journals Poor ovarian response and the possible role of natural and modified natural cycles

2022 ◽  
Vol 16 ◽  
pp. 263349412110620
Author(s):  
Federica Di Guardo ◽  
Christophe Blockeel ◽  
Michel De Vos ◽  
Marco Palumbo ◽  
Nikolaos Christoforidis ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Current Evidence ◽  
High Dose ◽  
Natural Cycle ◽  
Poor Ovarian Response ◽  
Vitro Fertilization ◽  
Poor Ovarian Responders

About 20% of women undergoing in vitro fertilization struggle with poor ovarian response, indicating a poor prognosis related to low response following ovarian stimulation. Indeed, poor ovarian response, that is associated with both high cancelation rates and low live birth rates, still represents one of the most important therapeutic challenges in in vitro fertilization. In this context, natural cycle/modified natural cycle– in vitro fertilization, as a ‘milder’ approach, could be a reasonable alternative to high-dose/conventional ovarian stimulation in poor ovarian responders, with the aim to retrieve a single oocyte with better characteristics that may result in a single top-quality embryo, transferred to a more receptive endometrium. Moreover, modified natural cycle– in vitro fertilization may be cost-effective because of the reduced gonadotropin consumption. Several studies have been published during the last 20 years reporting conflicting results regarding the use of natural cycle/modified natural cycle– in vitro fertilization in women with poor ovarian response; however, while most of the studies concluded that mild stimulation regimens, including natural cycle/modified natural cycle– in vitro fertilization, have low, but acceptable success rates in this difficult group of patients, others did not replicate these findings. The aim of this narrative review is to appraise the current evidence regarding the use of natural cycle/modified natural cycle– in vitro fertilization in poor ovarian responders.

SAY NO to mild ovarian stimulation for all poor responders: it is time to realize that not all poor responders are the same

2020 ◽  
Vol 35 (9) ◽  
pp. 1964-1971 ◽  
Author(s):  
N P Polyzos ◽  
B Popovic-Todorovic
Keyword(s):  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Poor Responder ◽  
Treatment Modalities ◽  
Poor Responders ◽  
Mild Ovarian Stimulation ◽  
Mild Stimulation ◽  
Current Article ◽  
Poor Ovarian Responders ◽  
Intense Stimulation

ABSTRACT Over the last 25 years, a vast body of literature has been published evaluating different treatment modalities for the management of poor ovarian responders. Despite the evidence that maximizing ovarian response can improve the chances of live born babies in poor responders, there are still voices suggesting that all poor responders are the same, irrespective of their age and their actual ovarian reserve. This has resulted in the suggestion of adopting a mild ovarian stimulation approach for all poor responders, based on the results of several trials which failed to identity differences when comparing mild and more intense stimulation in predicted poor responders. The current article analyzes in detail these studies and discusses the shortcomings in terms of type of population included, outcomes and settings performed, which may actually be responsible for the belief that only mild stimulation should be used. In the era of individualization in medicine, it must be realized that there are subgroups of predicted poor responders who will benefit from an individual rather than ‘one fits all’ mild stimulation approach and thus we should provide the same standard of treatment for all our poor responder patients.

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