A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept

Alviggi, Carlo; Andersen, Claus Yding; Buehler, Klaus; Placido, Giuseppe De; Esteves, Sandro C.; Fischer, Robert; Galliano, Daniela; Polyzos, Nikolaos P.; Sunkara, Sesh Kamal; Ubaldi, Filippo Maria; Humaıdan, Peter

doi:10.1016/j.fertnstert.2016.02.005

Cited by 411 publications

(329 citation statements)

References 5 publications

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“…The Poseidon group in 2015 introduced new criteria to identify the 'low prognosis patient' undergoing ART [12][13][14]. Based on female age, ovarian reserve, and previous history of ovarian stimulation -if available-, 'low prognosis' patients were stratified into four specific subgroups, each of which with a distinct prognosis concerning the likelihood of conceiving and delivering a baby with the use of ART ( Supplementary Figure 3).…”

Section: The Interpretation and Impact For Patients Undergoing Assistmentioning

confidence: 99%

“…The primary aim of the Poseidon criteria was to provide patient counselling and clinical guidance regarding interventions that could help these patients conceive in the shortest possible time. The most vulnerable Poseidon patients are those within groups 2 and 4, i.e., ageing patients 35 years or above, with (i) an unexpected suboptimal number of oocytes retrieved in a previous ART cycle despite a normal ovarian reserve (group 2), or (ii) low ovarian reserve in whom the number of oocytes resulting from ovarian stimulation is invariably low (group 4) [12,15,16]. The reason relates to the impact of maternal age and number of oocytes on the availability of euploid embryos, and thus, live birth.…”

Section: The Interpretation and Impact For Patients Undergoing Assistmentioning

confidence: 99%

See 1 more Smart Citation

COVID-19 and assisted reproductive technology services: repercussions for patients and proposal for individualized clinical management

Alviggi

Esteves

Orvieto

et al. 2020

Reprod Biol Endocrinol

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The prolonged lockdown of health services providing high-complexity fertility treatments -as currently recommended by many reproductive medicine entities-is detrimental for society as a whole, and infertility patients in particular. Globally, approximately 0.3% of all infants born every year are conceived using assisted reproductive technology (ART) treatments. By contrast, the total number of COVID-19 deaths reported so far represents approximately 1.0% of the total deaths expected to occur worldwide over the first three months of the current year. It seems, therefore, that the number of infants expected to be conceived and born -but who will not be so due to the lockdown of infertility services-might be as significant as the total number of deaths attributed to the COVID-19 pandemic. We herein propose remedies that include a prognostic-stratification of more vulnerable infertility cases in order to plan a progressive restart of worldwide fertility treatments. At a time when preventing complications and limiting burdens for national health systems represent relevant issues, our viewpoint might help competent authorities and health care providers to identify patients who should be prioritized for the continuation of fertility care in a safe environment.

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Section: The Interpretation and Impact For Patients Undergoing Assistmentioning

confidence: 99%

Section: The Interpretation and Impact For Patients Undergoing Assistmentioning

confidence: 99%

COVID-19 and assisted reproductive technology services: repercussions for patients and proposal for individualized clinical management

Alviggi

Esteves

Orvieto

et al. 2020

Reprod Biol Endocrinol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recently, the POSEIDON group (Patient - Oriented Strategies Encompassing IndividualizeD Oocyte Number) proposed a new classification of ART in patients with DOR or unexpected inappropriate ovarian response and four subgroups have been proposed based on quantitative as well as qualitative parameters which includeAge and expected anomaly rate,Ovarian biomarkers like AFC and AMH, andOvarian response – if an earlier stimulation was performed [74]. …”

Section: The Problem Of Poor Ovarian Responsementioning

confidence: 99%

Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel’s back

Rasool¹

2017

Fertil Res and Pract

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Diminished fertility and poor ovarian response pose a conundrum to the experts in the field of reproductive medicine. There is limited knowledge about the risk factors of diminished ovarian reserve other than the iatrogenic ones. One of the leading causes of infertility in women today is diminished ovarian reserve (DOR). DOR is characterized by a low number of eggs in a woman’s ovaries and/or with poor quality of the remaining eggs, which boils down to impaired development of the existing eggs, even with assisted reproductive techniques. A good number of such women with low ovarian reserve may conceive with their own eggs, if they are given individualized treatment that is tailored for their profile. Such patients should be counseled appropriately for an aggressive approach towards achieving fertility. The sooner the treatment is started, the better the chances of pregnancy.

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“…On the other hand, i.e. from the viewpoint of the fertility specialist, it is interesting to note that proposals aiming at the evaluation of ovarian reserve do not mention to include thyroid function [49], [50].…”

Section: Thyroid Function Thyroid Antibodies and Fertilitymentioning

confidence: 99%

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

Moncayo¹,

Moncayo²

2017

BBA Clinical

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Laboratory medicine approaches the evaluation of thyroid function mostly through the single determination of the blood level of thyroid stimulating hormone (TSH). Some authors have suggested an upper reference value for TSH of 2.5 mIU/L. This suggestion has not been confirmed by recent clinical studies. These studies have delivered a clinically valid reference range going from 0.3 to 3.5 mIU/L. These values are valid for both for the general population as well as in the setting of fertility and pregnancy.Current biochemical evidence about the elements required to maintain thyroid function shows that these not only include dietary iodine but also magnesium, iron, selenium and coenzyme Q10. Iron is important for the synthesis of thyroid peroxidase; magnesium-ATP contributes to the active process of iodine uptake; iodine has to be sufficiently present in the diet; selenium acts through selenoproteins to protect the thyroid cell during hormone synthesis and in deiodination of thyroxine; coenzyme Q10 influences thyroid vascularity. As a consequence, good clinical practice requires additional biochemical information on the blood levels of magnesium, selenium, coenzyme Q10 as well as iron status.Since these elements are also important for the maintenance of reproductive function, we postulate that they constitute the connecting link between both endocrine systems.

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A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept

Cited by 411 publications

References 5 publications

COVID-19 and assisted reproductive technology services: repercussions for patients and proposal for individualized clinical management

COVID-19 and assisted reproductive technology services: repercussions for patients and proposal for individualized clinical management

Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel’s back

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

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