Management of women with an unexpected low Ovarian response to gonadotropin

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisReviewForskningpeer review

DOI

  • Alessandro Conforti, University Federico II of Naples
  • ,
  • Sandro C. Esteves, Andrology and Human Reproduction Clinic, ANDROFERT, Universidade Estadual de Campinas
  • ,
  • Danilo Cimadomo, GENERA
  • ,
  • Alberto Vaiarelli, GENERA
  • ,
  • Francesca Di Rella, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”
  • ,
  • Filippo Maria Ubaldi, GENERA
  • ,
  • Fulvio Zullo, University Federico II of Naples
  • ,
  • Giuseppe De Placido, University Federico II of Naples
  • ,
  • Carlo Alviggi, University Federico II of Naples

POSEIDON groups 1 and 2 patients respond poorly (<4 oocytes retrieved) or sub-optimally (4–9 oocytes retrieved) to gonadotropin stimulation despite the presence of adequate ovarian parameters, which negatively affect their cumulative chances of delivering a baby using Assisted Reproductive Technology. A polygenic trait involving gonadotropins and/or their receptors seems to be the primary pathophysiology mechanism explaining this phenomenon. The clinical management is mainly focused on maximizing oocyte yield as to increase the likelihood of having at least one euploid embryo for transfer. Indices such as FORT (follicle output rate) and FOI (follicle-to-oocyte index) may be used to determine if the ovarian reserve was properly explored during a previous ovarian stimulation. Testing for the presence of common polymorphisms affecting gonadotropins and/or their receptors can also be considered to identify patients at risk of hypo-response. An individualized estimation of the minimum number of oocytes needed to obtain at least one euploid embryo can assist counseling and treatment planning. Among currently existing pharmacological interventions, use of recombinant FSH in preference over urinary gonadotropin preparations, FSH dosage increase, and use of rLH supplementation may be considered -alone or combined- for optimally managing POSEIDON’s groups 1 and 2 patients. However, given the recent introduction of the POSEIDON criteria, there is still a lack of studies examining the role of interventions specifically to patients classified as groups 1 and 2, thus making it an area for open research.

OriginalsprogEngelsk
Artikelnummer387
TidsskriftFrontiers in Endocrinology
Vol/bind10
Antal sider10
ISSN1664-2392
DOI
StatusUdgivet - 2019

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