scholarly journals Management of Poor Responders in IVF: Is There Anything New?

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Filippo Ubaldi ◽  
Alberto Vaiarelli ◽  
Rosario D’Anna ◽  
Laura Rienzi
Keyword(s):  
Genetic Factors ◽  
Ovarian Response ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Efficient Treatment ◽  
Infertile Women ◽  
Common Definition ◽  
Poor Ovarian Responders ◽  
Long Acting ◽  
Enormous Number

Despite the fact that in the last two decades an enormous number of papers on the topic of poor ovarian response have been published in the literature, so far it has been impossible to identify any efficient treatment to improve the ovarian response and the clinical outcome of this group of patients. The incidence of poor ovarian responders among infertile women has been estimated at 9–24% but according to recent reviews, it seems to have slightly increased. The limitation in quantifying the incidence of these patients among the infertile population is due to the difficulty of a clear definition in literature. A recent paper by the Bologna ESHRE working group on poor ovarian response has been the first real attempt to find a common definition. Current literature proposes new risk factors which could be the cause of a reduction in ovarian reserve, which also includes genetic factors. This represents the first necessary step towards finding applicable solutions for these patients. To date, there is a substantial lack of literature that identifies an ideal protocol for these patients. The use of the “Bologna criteria” and the introduction of long acting gonadotropin in clinical practice have given rise to new promising stimulation protocols for this group of patients.

scholarly journals The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 687
Author(s):  
Polina Giannelou ◽  
Mara Simopoulou ◽  
Sokratis Grigoriadis ◽  
Evangelos Makrakis ◽  
Adamantia Kontogeorgi ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Platelet Rich Plasma ◽  
Ovarian Response ◽  
Poor Responders ◽  
Common Denominator ◽  
Success Rates ◽  
Poor Ovarian Response ◽  
Management Options ◽  
Mitochondrial Replacement Therapy ◽  
Heated Debate

Despite recent striking advances in assisted reproductive technology (ART), poor ovarian response (POR) diagnosis and treatment is still considered challenging. Poor responders constitute a heterogeneous cohort with the common denominator of under-responding to controlled ovarian stimulation. Inevitably, respective success rates are significantly compromised. As POR pathophysiology entails the elusive factor of compromised ovarian function, both diagnosis and management fuel an ongoing heated debate depicted in the literature. From the criteria employed for diagnosis to the plethora of strategies and adjuvant therapies proposed, the conundrum of POR still puzzles the practitioner. What is more, novel treatment approaches from stem cell therapy and platelet-rich plasma intra-ovarian infusion to mitochondrial replacement therapy have emerged, albeit not claiming clinical routine status yet. The complex and time sensitive nature of this subgroup of infertile patients indicates the demand for a consensus on a horizontally accepted definition, diagnosis and subsequent effective treating strategy. This critical review analyzes the standing criteria employed in order to diagnose and aptly categorize POR patients, while it proceeds to critically evaluate current and novel strategies regarding their management. Discrepancies in diagnosis and respective implications are discussed, while the existing diversity in management options highlights the need for individualized management.

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.

scholarly journals Morphokinetic Characteristics and Developmental Potential of In Vitro Cultured Embryos from Natural Cycles in Patients with Poor Ovarian Response

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
N. Hojnik ◽  
V. Vlaisavljević ◽  
B. Kovačič
Keyword(s):  
Implantation Rate ◽  
Ovarian Response ◽  
Time Lapse ◽  
Poor Responder ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Developmental Potential ◽  
The Impact ◽  
Natural Cycles

Background. Patients with poor ovarian response to ovarian hyperstimulation represent an interesting group for studying the impact of embryo cleavage irregularities on clinical outcome since all embryos, regardless of their quality, are usually transferred to the uterus. The aim of our study was to follow the morphokinetics of fertilized oocytes from natural cycles in poor responders. Methods. Zygotes from 53 cycles were cultured in vitro for 3 days. The morphokinetics of their development and transfer outcomes were retrospectively analyzed for the normally and irregularly cleaved embryos. Results. Of all embryos, 30.2% had single and 20.8% multiple cleavage irregularities with the following prevalence: developmental arrest 30.2%, direct cleavage to more than two cells 24.5%, chaotic cleavage 13.2%, and reverse cleavage 11.3%. These embryos had longer pronuclear phases, first cytokinesis, second embryo cell cycles, and less synchronized divisions. The transfer of normally developing embryos resulted in an implantation rate of 30.8% and a delivery rate of 23.1%, but irregularly cleaved embryos did not implant. Conclusions. The use of time-lapse microscopy in poor responder patients identified embryos with cleavage abnormalities that are related with no or extremely low implantation potential. Gained information about embryo quality is important for counselling patients about their expectations.

scholarly journals Whether poor responses have worse perinatal prognosis (retrospective analysis of assisted reproductive technologies cycle)

2018 ◽  
Vol 22 (3) ◽  
pp. 503-508
Author(s):  
G.V. Strelko
Keyword(s):  
Gestational Diabetes ◽  
Ovarian Stimulation ◽  
Preterm Labor ◽  
Perinatal Outcomes ◽  
Ovarian Response ◽  
Control Group ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Normal Response ◽  
Significant Difference

The prevalence of poor ovarian response is 5.6–35.1% in women undergoing controlled ovarian stimulation in ART cycles. The frequency of delivery of poor responders after ART is on average from 9.9% to 23.8%. In clinical practice, the vast majority of poor responders are older women, which may have an effect on perinatal outcomes, respectively. Although numerous studies have reported that the fertility rate after ART in women of this age group is quite low, data on perinatal outcomes in this group of women is limited. Therefore, the aim of our study was to retrospectively analyze and compare perinatal outcomes in women with poor ovarian response to stimulation compared to control group (normal response to stimulation) in assisted reproductive technology programs. 278 women with infertility with a reduced response to stimulation (poor responders), who were the main group, were screened. Indications for the inclusion of women in the main group were the presence of at least two of the following criteria for a poor ovarian response according to the 2011 Bologna criteria and 93 infertile patients with a normal ovarian response to stimulation of the control group. Subsequently, retrospective study of perinatal effects such as preterm labor, low birth weight, gestational diabetes, preeclampsia in 50 women with infertility with reduced response to stimulation and 37 controls with normal response to stimulation in which pregnancy was diagnosed was performed. Variational-statistical processing of the results of the study was performed using the program “Statistica 6.0”. The study demonstrated a significantly lower pregnancy rate in poor responders compared with women from the control group — 50 (17.9%) vs. 37 (39.8%), respectively. Perinatal outcome were similar only to the statistically significant difference in the percentage of spontaneous abortions before 12 weeks of gestation — 9 (18%) vs. 4 (10.8%), respectively, in groups with no significant difference in the preterm labor frequency — 10 (20.8%) and 6 (18.1%) of the low weight of the child at birth — 9 (18.7%) versus 5 (15.1%), respectively, in poor responders patients and in women with normal ovarian response. The frequency of complications such as gestational diabetes and high blood pressure were not significantly different in both clinical groups — 3 (6.25%) versus 2 (6.1%) and 5 (10.4%) versus 3 (9.1%) respectively. Thus, he poor responders in ART programs have a significantly lower pregnancy rate and a higher incidence of pregnancy loss up to 12 weeks compared with women who had a normal response to ovarian stimulation without a significant difference in the rates of various complications of pregnancy and perinatal outcomes. Wide randomized multicentric trials are needed to find out the causal relationships with regard to the effect on pregnancy, miscarriage, perinatal effects of controlled ovarian stimulation regimens, embryotransfers in fresh or cryo cycles etc.

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 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.

TO EVALUATE IVF OUTCOME BETWEEN FLARE-UP VERSUS ANTAGONIST AMONG POOR RESPONDERS’ PROGNOSIS PATIENTS AND RELATED FACTORS AT NATIONAL CENTER FOR ASSISTED REPRODUCTIVE TECHNOLOGY

2021 ◽  
Vol 62 (5) ◽  
Author(s):  
Nguyen Anh Tho ◽  
Ngo Toan Anh ◽  
Nguyen Xuan Hoi ◽  
Nguyen Viet Tien
Keyword(s):  
Poor Response ◽  
Ovarian Response ◽  
Reproductive Technology ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Related Factors ◽  
Biochemical Pregnancy ◽  
Random Control ◽  
Antagonist Protocol ◽  
Significant Factors

Objectives: To assess the outcome of Flare-up versus Antagonist protocol and to determine factors related to poor responders.Methodology: this is a random control trial among 834 patients who were predicted to ovarian poor response from 2014 to 2018.Results: The rate of biochemical pregnancy was 4.5% with Flare-up versus 8,1% with Antagonist (p<0.05). The rate of fertilization, implantation and clinical pregnancy were not significant differentbetween the 2 protocols. Age and number of AFC were significant factors to predict poor ovarian response. However, with Flare-up, there were 2 more factors could be used for the purpose whichwas basal FSH and E2 day 7.Conclusion: The outcome of treatment between Flare-up and Antagonist among predicted poor ovarian response was comparable. Age and AFC were valuable factors in prediction of poor ovarianresponse.

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