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Giannelou P, Simopoulou M, Grigoriadis S, et al. The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment. Diagnostics (Basel). 2020;10(9)doi: 10.3390/diagnostics10090687.
Giannelou, P., Simopoulou, M., Grigoriadis, S., Makrakis, E., Kontogeorgi, A., Pantou, A., Galatis, D., Kalampokas, T., Bakas, P., Bolaris, S., Pantos, K., & Sfakianoudis, K. (2020). The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment. Diagnostics (Basel, Switzerland), 10(9), . https://doi.org/10.3390/diagnostics10090687
Giannelou, Polina, et al. "The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment." Diagnostics (Basel, Switzerland) vol. 10,9 (2020). doi: https://doi.org/10.3390/diagnostics10090687
Giannelou P, Simopoulou M, Grigoriadis S, Makrakis E, Kontogeorgi A, Pantou A, Galatis D, Kalampokas T, Bakas P, Bolaris S, Pantos K, Sfakianoudis K. The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment. Diagnostics (Basel). 2020 Sep 11;10(9). doi: 10.3390/diagnostics10090687. PMID: 32932955; PMCID: PMC7555981.
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Diagnostics (Basel). 2020 Sep 11;10(9). doi: 10.3390/diagnostics10090687.

The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment.

Diagnostics (Basel, Switzerland)

Polina Giannelou, Mara Simopoulou, Sokratis Grigoriadis, Evangelos Makrakis, Adamantia Kontogeorgi, Agni Pantou, Dionysios Galatis, Theodoros Kalampokas, Panagiotis Bakas, Stamatis Bolaris, Konstantinos Pantos, Konstantinos Sfakianoudis

Affiliations

  1. Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
  2. Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli, 15232 Athens, Greece.
  3. Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
  4. Third Department of Obstetrics and Gynecology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 1, Rimini, 12462 Haidari-Athens, Greece.
  5. Assisted Conception Unit, General-Maternity District Hospital "Elena Venizelou", Elenas Venizelou Avenue, 11521 Athens, Greece.

PMID: 32932955 PMCID: PMC7555981 DOI: 10.3390/diagnostics10090687

Abstract

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.

Keywords: Bologna criteria; Poseidon group; adjuvant treatment; diagnosis; gonadotropin stimulation; management; novel approaches; poor ovarian response; second follicular wave

References

  1. Eur J Obstet Gynecol Reprod Biol. 2016 Sep;204:36-43 - PubMed
  2. Hum Reprod. 2013 May;28(5):1369-74 - PubMed
  3. Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:30-4 - PubMed
  4. Reprod Biol Endocrinol. 2019 May 10;17(1):43 - PubMed
  5. Front Endocrinol (Lausanne). 2019 Nov 20;10:814 - PubMed
  6. Fertil Steril. 2018 Jun;109(6):993-999 - PubMed
  7. Eur J Obstet Gynecol Reprod Biol. 2017 Nov;218:39-48 - PubMed
  8. Gynecol Obstet Invest. 2019;84(1):99-106 - PubMed
  9. Ann Ostet Ginecol Med Perinat. 1977 Jan-Feb;98(1):28-42 - PubMed
  10. J Assist Reprod Genet. 2020 Jan;37(1):181-204 - PubMed
  11. Reprod Biomed Online. 2014 Dec;29(6):684-91 - PubMed
  12. Aust N Z J Obstet Gynaecol. 2015 Oct;55(5):473-6 - PubMed
  13. F1000Res. 2013 Nov 12;2:240 - PubMed
  14. Cell Biosci. 2019 Nov 29;9:95 - PubMed
  15. Hum Reprod. 2011 Jul;26(7):1616-24 - PubMed
  16. Hum Reprod. 2019 Nov 1;34(11):2099-2103 - PubMed
  17. J Assist Reprod Genet. 2020 Apr;37(4):855-863 - PubMed
  18. Eur J Pharmacol. 2011 Jan 25;651(1-3):227-33 - PubMed
  19. Fertil Steril. 2003 Jul;80(1):116-22 - PubMed
  20. Hum Reprod. 2015 Feb;30(2):432-40 - PubMed
  21. Hum Reprod. 2002 May;17(5):1207-11 - PubMed
  22. J Biol Chem. 2001 Aug 10;276(32):29871-9 - PubMed
  23. Fertil Steril. 2014 Jul;102(1):108-115.e1 - PubMed
  24. Reprod Biomed Online. 2018 Jan;36(1):12-19 - PubMed
  25. Fertil Steril. 2009 Dec;92(6):2082-4 - PubMed
  26. Medicina (Kaunas). 2018 Oct 25;54(5): - PubMed
  27. Blood. 1996 Apr 1;87(7):3045-52 - PubMed
  28. Fertil Steril. 2011 Nov;96(5):1058-61.e7 - PubMed
  29. Reprod Biol Endocrinol. 2017 Oct 2;15(1):77 - PubMed
  30. Gynecol Endocrinol. 2018 Sep;34(9):756-760 - PubMed
  31. Hum Reprod. 2005 Mar;20(3):616-21 - PubMed
  32. Reprod Biomed Online. 2017 Oct;35(4):343-350 - PubMed
  33. Ultrasound Obstet Gynecol. 2017 Sep;50(3):315-323 - PubMed
  34. Fertil Steril. 1983 Feb;39(2):174-9 - PubMed
  35. Fertil Steril. 2017 Oct;108(4):568-571 - PubMed
  36. Fertil Steril. 2007 Jun;87(6):1350-6 - PubMed
  37. Fertil Steril. 2005 Oct;84(4):1023-6 - PubMed
  38. Biomed Res Int. 2014;2014:352098 - PubMed
  39. Reprod Biol Endocrinol. 2018 Mar 27;16(1):29 - PubMed
  40. Hum Reprod Update. 2003 Jan-Feb;9(1):61-76 - PubMed
  41. Fertil Steril. 2013 Dec;100(6):1594-601.e1-9 - PubMed
  42. Reprod Biol Endocrinol. 2018 Mar 9;16(1):20 - PubMed
  43. Reprod Med Biol. 2018 Sep 19;17(4):421-433 - PubMed
  44. Fertil Steril. 2019 Jan;111(1):86-96 - PubMed
  45. Biol Reprod. 2003 May;68(5):1736-41 - PubMed
  46. Facts Views Vis Obgyn. 2011;3(2):101-8 - PubMed
  47. Proc Natl Acad Sci U S A. 1992 May 15;89(10):4304-8 - PubMed
  48. Gynecol Endocrinol. 2011 Nov;27(11):876-9 - PubMed
  49. J Clin Med. 2020 Jun 10;9(6): - PubMed
  50. J Assist Reprod Genet. 2020 May;37(5):1183-1194 - PubMed
  51. Nat Biotechnol. 2017 Nov 09;35(11):1059-1068 - PubMed
  52. Reprod Biol Endocrinol. 2019 Mar 7;17(1):30 - PubMed
  53. J Assist Reprod Genet. 2013 Nov;30(11):1465-70 - PubMed
  54. JBRA Assist Reprod. 2017 Sep 1;21(3):212-216 - PubMed
  55. Stem Cell Rev Rep. 2018 Feb;14(1):1-12 - PubMed
  56. J Clin Med. 2018 Dec 20;8(1): - PubMed
  57. Syst Biol Reprod Med. 2018 Jun;64(3):216-219 - PubMed
  58. J Ovarian Res. 2015 Jun 12;8:37 - PubMed
  59. Fertil Steril. 2004 Oct;82 Suppl 3:1101-5 - PubMed
  60. Front Endocrinol (Lausanne). 2018 Aug 17;9:461 - PubMed
  61. Front Endocrinol (Lausanne). 2019 Jul 23;10:502 - PubMed
  62. Fertil Steril. 2004 Jun;81(6):1542-7 - PubMed
  63. Fertil Steril. 2008 Jul;90(1):228-30 - PubMed
  64. J Hum Reprod Sci. 2014 Oct-Dec;7(4):236-48 - PubMed
  65. Front Endocrinol (Lausanne). 2020 Apr 16;11:208 - PubMed
  66. Curr Opin Obstet Gynecol. 2018 Jun;30(3):155-162 - PubMed
  67. Hum Reprod. 2009 Dec;24(12):3063-72 - PubMed
  68. J Reprod Infertil. 2018 Jul-Sep;19(3):123-124 - PubMed
  69. Clin Endocrinol (Oxf). 2016 Jan;84(1):99-106 - PubMed
  70. J Assist Reprod Genet. 2018 Nov;35(11):2013-2023 - PubMed
  71. Hum Reprod Update. 2017 Sep 1;23(5):560-579 - PubMed
  72. Mol Hum Reprod. 1998 Mar;4(3):269-80 - PubMed
  73. Fertil Steril. 2018 Aug;110(3):496-505.e1 - PubMed
  74. Front Endocrinol (Lausanne). 2019 May 08;10:281 - PubMed
  75. Mol Biol Rep. 2019 Apr;46(2):1611-1616 - PubMed
  76. F1000Res. 2016 Dec 23;5:2911 - PubMed
  77. Medicina (Kaunas). 2019 Mar 14;55(3): - PubMed
  78. Fertil Steril. 1995 Sep;64(3):577-83 - PubMed
  79. Hum Reprod. 2017 Jul 1;32(7):1537-1538 - PubMed
  80. Fertil Steril. 2002 Apr;77(4):776-80 - PubMed
  81. Hum Reprod. 2002 Oct;17(10):2678-85 - PubMed
  82. Front Endocrinol (Lausanne). 2018 Jun 14;9:317 - PubMed
  83. Biol Reprod. 2003 Sep;69(3):1023-31 - PubMed
  84. Fertil Steril. 2017 Oct;108(4):572-576 - PubMed
  85. PLoS One. 2010 Jan 27;5(1):e8772 - PubMed
  86. Curr Opin Obstet Gynecol. 2008 Aug;20(4):374-8 - PubMed
  87. Fertil Steril. 2019 Jul;112(1):28-30 - PubMed
  88. Gene. 2019 Feb 20;686:250-260 - PubMed
  89. Reprod Biomed Online. 2006 Feb;12(2):221-33 - PubMed
  90. Hum Reprod. 2007 Nov;22(11):2801-4 - PubMed
  91. Cochrane Database Syst Rev. 2015 Nov 26;(11):CD009749 - PubMed
  92. Fertil Steril. 2016 Jun;105(6):1452-3 - PubMed
  93. Bioethics. 2018 Jan;32(1):2 - PubMed
  94. Am Nat. 2018 Jun;191(6):777-782 - PubMed
  95. J Assist Reprod Genet. 2019 Apr;36(4):673-683 - PubMed
  96. Horm Mol Biol Clin Investig. 2019 Nov 29;41(1): - PubMed
  97. Fertil Steril. 2009 Aug;92(2):481-5 - PubMed
  98. Hum Reprod Update. 2020 Feb 28;26(2):247-263 - PubMed
  99. Hum Reprod Update. 2016 Apr;22(3):306-19 - PubMed
  100. Facts Views Vis Obgyn. 2019 Mar;11(1):77-84 - PubMed
  101. Gynecol Endocrinol. 2015 Jul;31(7):565-8 - PubMed
  102. Stem Cell Res Ther. 2018 Oct 4;9(1):263 - PubMed
  103. Fertil Steril. 2011 Jun 30;95(8):2531-3 - PubMed
  104. Fertil Steril. 2019 Apr;111(4):722-733 - PubMed
  105. Int J Gynaecol Obstet. 2020 Jan;148(1):59-64 - PubMed
  106. Cell Transplant. 2019 Sep-Oct;28(9-10):1333-1340 - PubMed
  107. Fertil Steril. 2000 Apr;73(4):667-76 - PubMed
  108. Int J Reprod Biomed. 2018 Apr;16(4):255-260 - PubMed
  109. Eur Rev Med Pharmacol Sci. 2016 Oct;20(20):4354-4361 - PubMed
  110. Hum Reprod. 2004 Jul;19(7):1544-7 - PubMed
  111. Mitochondrion. 2011 Sep;11(5):783-96 - PubMed
  112. Int J Fertil Steril. 2011 Jul;5(2):54-65 - PubMed
  113. Fertil Steril. 2011 Nov;96(5):1066-8 - PubMed
  114. J Assist Reprod Genet. 2011 Sep;28(9):773-83 - PubMed
  115. Front Endocrinol (Lausanne). 2020 Apr 17;11:192 - PubMed
  116. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004379 - PubMed
  117. Fertil Steril. 2015 Jun;103(6):1469-76.e1-3 - PubMed
  118. Nat Rev Mol Cell Biol. 2018 Jan 23;19(2):71-72 - PubMed
  119. Cochrane Database Syst Rev. 2018 Feb 01;2:CD012693 - PubMed
  120. Int J Reprod Biomed. 2017 Feb;15(2):101-108 - PubMed
  121. Front Endocrinol (Lausanne). 2019 Jul 24;10:500 - PubMed
  122. Fertil Steril. 2018 Aug;110(3):410-411 - PubMed
  123. Reprod Biol Endocrinol. 2013 Jun 01;11:51 - PubMed
  124. Fertil Steril. 1998 Oct;70(4):671-5 - PubMed
  125. Fertil Steril. 2016 Jun;105(6):1488-1495.e1 - PubMed
  126. J Res Med Sci. 2018 Jan 29;23:3 - PubMed
  127. Fertil Steril. 2013 Mar 15;99(4):970-8.e1 - PubMed
  128. Hum Reprod Update. 2012 Mar-Apr;18(2):127-45 - PubMed
  129. Fertil Steril. 2019 Apr;111(4):675-676 - PubMed
  130. J Assist Reprod Genet. 2020 May;37(5):1147-1154 - PubMed
  131. Reprod Biol Endocrinol. 2018 Dec 28;16(1):124 - PubMed
  132. Reprod Biol Endocrinol. 2019 Jul 12;17(1):55 - PubMed
  133. Nat Protoc. 2017 Sep;12(9):1817-1829 - PubMed
  134. J Steroid Biochem Mol Biol. 1993 Mar;44(4-6):375-87 - PubMed
  135. Fertil Steril. 2018 May;109(5):908-918.e2 - PubMed
  136. Reproduction. 2019 Oct;158(4):R139-R154 - PubMed
  137. Hum Reprod. 2001 Mar;16(3):513-6 - PubMed
  138. Reprod Biomed Online. 2012 Apr;24(4):424-32 - PubMed
  139. Fertil Steril. 2019 Feb;111(2):219-226 - PubMed
  140. Reprod Health. 2015 May 30;12:52 - PubMed
  141. Cochrane Database Syst Rev. 2017 Nov 02;11:CD008528 - PubMed
  142. Hum Reprod. 2014 Sep;29(9):1842-5 - PubMed

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