What is new in the management of poor ovarian response in IVF?

Vaiarelli, Alberto; Cimadomo, Danilo; Ubaldi, Nicolò; Rienzi, Laura; Ubaldi, Filippo Maria

doi:10.1097/gco.0000000000000452

Cited by 98 publications

(69 citation statements)

References 85 publications

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“…However, the IVA method has been considered equivocal regarding its efficacy and safety whereas in vitro studies have suggested that activation by pharmacological methods may negatively affect oocytes' quality (118)(119)(120)(121). Indeed, it has been suggested that IVA combined with PI3K/Akt and Hippo signaling pathways before ovarian slices auto-transplantation may bear major negative consequences on follicle health (118,(122)(123)(124)(125).…”

Section: In Vitro Activation Of Folliclesmentioning

confidence: 99%

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

Blumenfeld

2020

Front. Endocrinol.

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The infertile patients with aging ovaries-also sometimes referred to as impending premature ovarian insufficiency (POI), impending premature ovarian failure (POF), or poor ovarian responders (POR), constitute a significant and increasing bulk of the patients appealing to IVF/ART. Different causes have been cited in the literature, among the identified etiologies, including chromosomal and genetic etiology, metabolic, enzymatic, iatrogenic, toxic, autoimmune, and infectious causes. Although the most successful and ultimate treatment of POI/POF/POR patients is egg donation (ED), many, if not most, of these infertile women are reluctant to consent to ED upon the initial diagnostic interview, requesting alternative solutions despite the low odds for success. Despite anecdotal case reports, no unequivocal treatment proved to be successful for these patients in prospective randomized controlled trials. Nevertheless, the addition of growth hormone (GH) to ovarian stimulation in POR with GH deficiency may improve the results of controlled ovarian hyperstimulation (COH) and the IVF success. In patients with autoimmune etiology for POR/POI, the combination of glucocorticosteroids, pituitary-ovarian suppression, and COH may be successful in achieving the desired conception.

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Section: In Vitro Activation Of Folliclesmentioning

confidence: 99%

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

Blumenfeld

2020

Front. Endocrinol.

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“…DuoStim, combining two consecutive stimulations spanning a 5-day interval, has been put forward as a valuable opportunity also for the management of poor-prognosis patients such as women with reduced ovarian reserve and/or advanced maternal age. The aim then is to maximize the number of oocytes retrieved in a single ovarian cycle, or to rescue patients in whom no oocytes were retrieved or competent embryos were not produced after conventional FPS (27)(28)(29)(30). For these thorny populations of patients, there is insufficient evidence to outline an ideal management since, regardless of the COS protocol adopted, consistently low live birth rates have been reported.…”

Section: When Is Duostim Indicated?mentioning

confidence: 99%

“…Moreover, the total amount of gonadotrophins used is lower when COS is performed with r-FSH compared with HMG (66,67). All these aspects must be considered when we treat poor-prognosis patients where even a single oocyte can make a huge difference in terms of cumulative results and cost-benefit (28).…”

Section: Weaknesses Risks and Concerns Related To Duostimmentioning

confidence: 99%

DuoStim – a reproducible strategy to obtain more oocytes and competent embryos in a short time-frame aimed at fertility preservation and IVF purposes. A systematic review

Vaiarelli

Cimadomo

Petriglia

et al. 2020

Upsala Journal of Medical Sciences

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Recent evidence suggests that follicular development occurs in a wave-like model during the ovarian cycle, where up to three cohorts of follicles are recruited to complete folliculogenesis. This understanding overtakes the previous dogma stating that follicles grow only during the follicular phase of the menstrual cycle. Therefore, in in vitro fertilization (IVF), novel protocols regarding ovarian stimulation have been theorized based on the use of gonadotrophins to prompt the growth of antral follicles at any stage of the menstrual cycle. These unconventional protocols for ovarian stimulation aim at a more efficient management of poor-prognosis patients, otherwise exposed to conflicting outcomes after conventional approaches. DuoStim appears among these unconventional stimulation protocols as one of the most promising. It combines two consecutive stimulations in the follicular and luteal phases of the same ovarian cycle, aimed at increasing the number of oocytes retrieved and embryos produced in the short time-frame. This protocol has been suggested for the treatment of all conditions requiring a maximal and urgent exploitation of the ovarian reserve, such as oncological patients and poor responders at an advanced maternal age. At present, data from independent studies have outlined the consistency and reproducibility of this approach, which might also reduce the drop-out between consecutive failed IVF cycles in poor-prognosis patients. However, the protocol must be standardized, and more robust studies and cost-benefit analyses are needed to highlight the true clinical pros and cons deriving from DuoStim implementation in IVF.

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“…The population of patients that fulfilled these eligibility criteria was divided into four different patterns: (1) age ≥40 years and abnormal ORT, (2) age ≥40 years, abnormal ORT and one previous poor response to stimulation, (3) age ≥40 years and one previous poor response, (4) abnormal ORT and one previous poor response to stimulation (11).…”

Section: Bologna Criteria Patternsmentioning

confidence: 99%

“…The occurrence of poor ovarian response amongst patients undergoing ovarian stimulation for in vitro fertilization (IVF) ranges from 9 to 24%, meaning that almost one in four patients harbors a poor reproductive prognosis (1)(2)(3)(4). This category of patients commonly referred to as poor responders (PORs), remains a challenge for the fertility expert, as studies up to now have failed to identify a therapeutic approach that can modify or improve their fertility outcomes (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Heterogeneity Among Poor Ovarian Responders According to Bologna Criteria Results in Diverging Cumulative Live Birth Rates

et al. 2020

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Research Question: Does reproductive outcome differ among the various subgroups of poor ovarian responders according to the Bologna criteria?Design: This was a retrospective, cohort study including poor ovarian responders according to Bologna criteria, undergoing an ICSI cycle from January 2011 until December 2017. Patients were divided into four groups: (1) age ≥ 40 years and abnormal ovarian response test, (2) age ≥ 40 years, abnormal ovarian reserve test and one previous poor response to stimulation, (3) age ≥ 40 years and one previous poor response, (4) abnormal ovarian reserve test and one previous poor response.Result(s): Overall, 846 cycles in 706 Bologna poor ovarian responders were included: 310 cycles in group 1, 169 in group 2, 52 in group 3, and 315 in group 4. There were significant differences in age, antral follicle count, antimüllerian hormone, cycle cancellation rates, and number of retrieved oocytes between the four groups. Live birth and cumulative live birth rate differed significantly between groups and were highest in Group 4 [Live birth rate: 7.4% (1) vs. 4.1% (2) vs. 5.8% (3) vs. 13.4% (4), p = 0.001 and Cumulative live birth rate: 8.3% (1) vs. 4.1 % (2) vs. 9.6% (3) vs. 16.8% (4) p < 0.001]. The multivariate GEE analysis revealed that the number of MIIs and the Bologna criteria pattern were the variables which were significantly associated with cumulative live birth rate. Conclusion(s):Poor ovarian responders represent a heterogeneous population. The young subpopulation has a better clinical prognosis in terms of fresh and cumulative live birth rate.

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What is new in the management of poor ovarian response in IVF?

Cited by 98 publications

References 85 publications

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

DuoStim – a reproducible strategy to obtain more oocytes and competent embryos in a short time-frame aimed at fertility preservation and IVF purposes. A systematic review

Heterogeneity Among Poor Ovarian Responders According to Bologna Criteria Results in Diverging Cumulative Live Birth Rates

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