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.

scholarly journals Anti-Mullerian hormone (AMH) as predictor of ovarian reserve

2017 ◽  
Vol 6 (9) ◽  
pp. 4006 ◽  
Author(s):  
Chaitanya Ashok Shembekar ◽  
Jayshree Jayant Upadhye ◽  
Manisha Chaitanya Shembekar ◽  
Shravani H. Welekar
Keyword(s):  
Ovarian Response ◽  
Poor Responders ◽  
Success Rates ◽  
Antral Follicles ◽  
Relationship Of ◽  
The Relationship ◽  
High Chance ◽  
Antagonist Protocol ◽  
High Range

Background: Anti-Müllerian hormone (AMH) is produced by the granulosa cells of preantral and small antral follicles and its levels can be assessed in serum. Since the number of ovarian follicles declines with increasing age, AMH levels might be used as a marker for ovarian ageing. Therefore, we studied the relationship between AMH levels and ovarian response during ovarian stimulation for In vitro fertilization.Methods: A total of 100 patients who have undergone their ICSI treatment cycle using a GnRH antagonist protocol were retrospectively included. Co-relation between AMH and antral follicular count (AFC) was assessed.Results: In present study, 36% patients had normal AMH, 18% patients were in low normal range, 5% patients had low values and 2% patients had very low values. 41% of patients had values in high range suggestive of PCOS. Amongst this, 21% had values between 4 to 8 ng/ml where we got good AFC count and good result in terms of pregnancy. 80% were good responders while 20% were poor responders. When we evaluated the relationship of retrieved oocyte counts with the parameters included, we found that only basal AMH levels and the number of antral follicles were statistically correlated.Conclusions: High AMH levels correlated with low cancellation rates, retrieval of more eggs, higher live birth rates and a high chance for freezing of embryos. Low AMH levels (alone) do not predict low success rates in women under 35 years of age.

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 OVARIAN AUTOLOGOUS PLATELET-RICH PLASMA (PRP) TREATMENT IMPROVES OOCYTE AND EMBRYO QUALITY IN WOMEN WITH POOR OVARIAN RESPONSE

2020 ◽  
Vol 114 (3) ◽  
pp. e452-e453
Author(s):  
Dimitar Parvanov ◽  
Rumiana Ganeva ◽  
Nina Vidolova ◽  
Kristina Nikolova ◽  
Magdalena Vasileva ◽  
...  
Keyword(s):  
Embryo Quality ◽  
Platelet Rich Plasma ◽  
Ovarian Response ◽  
Poor Ovarian Response ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet

scholarly journals Novel Approaches in Addressing Ovarian Insufficiency in 2019: Are We There Yet?

2020 ◽  
Vol 29 ◽  
pp. 096368972092615
Author(s):  
Konstantinos Sfakianoudis ◽  
Anna Rapani ◽  
Sokratis Grigoriadis ◽  
Dimitra Retsina ◽  
Evangelos Maziotis ◽  
...  
Keyword(s):  
Platelet Rich Plasma ◽  
Individualized Medicine ◽  
Ovarian Response ◽  
Current Status ◽  
Ovarian Insufficiency ◽  
Novel Treatments ◽  
Mitochondrial Replacement Therapy ◽  
Patient Heterogeneity ◽  
Novel Approaches ◽  
Artificial Gametes

Ovarian insufficiency is described as a multifaceted issue typically encountered in the field of assisted reproduction. The three main identified diagnoses of ovarian insufficiency include premature ovarian failure (POF), poor ovarian response (POR), and advanced maternal age (AMA). Patient heterogeneity in the era of individualized medicine drives research forward leading to the emergence of novel approaches. This plethora of innovative treatments in the service of adequately managing ovarian insufficiency is called to undertake the challenge of addressing infertile patients exploring their reproductive options. This review provides an all-inclusive presentation and critical analysis on novel treatments that have not achieved routine clinical practice status yet, but have recently emerged as promising. In light of the lack of randomized controlled trials conveying safety and efficiency, clinicians are left puzzled in addressing the “how” and “for whom” these approaches may be beneficial. From ovarian injection employing platelet-rich plasma (PRP) or stem cells to artificial gametes and ovaries, ovarian transplantation, and mitochondrial replacement therapy, this descriptive review provides insight toward assisting the practitioner in decision making regarding these cutting-edge treatments. Biological mechanisms, invasiveness levels, efficiency, as well as possible complications, the current status along with bioethical concerns are discussed in the context of identifying future optimal treatment.

Poor ovarian response in patients younger than 35 years: Is it also a qualitative decline in ovarian function?

2009 ◽  
Vol 12 (3) ◽  
pp. 160-165 ◽  
Author(s):  
Rita De Cássia Sávio Figueira ◽  
Daniela Paes Almeida Ferreira Braga ◽  
Marcílio Nichi ◽  
Camila Madaschi ◽  
Luciana Semião-Francisco ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Ovarian Response ◽  
Poor Ovarian Response

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.

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