Ovarian Reserve Markers to Identify Poor Responders in the Context of Poseidon Classification

Abstract

It is well-known that poor ovarian reserve is a cause of infertility, poor response to gonadotrophin stimulation and poor success rate after in vitro fertilization (IVF) cycles. Some years ago a consensus was elaborated on precise criteria which can lead to a correct identification of poor responders (the Bologna criteria). More recently, the POSEIDON group has proposed a new stratified classification of patients with low prognosis, also with the aim of providing clinical indications for the management of these patients. A literature search was carried out for studies that investigated the ability of ovarian reserve markers, in particular AMH and AFC, to predict poor ovarian response in IVF cycles; secondly, studies regarding the Bologna criteria and their prognostic value were analyzed and available literature on POSEIDON classification was reported. The most recent markers of ovarian reserve (serum AMH and ultrasound AFC) have shown to provide a direct and accurate measurement of ovarian follicle pool. These markers have generally shown comparable predictive power for ovarian response and a number of retrieved oocytes in IVF cycles. “Abnormal ovarian reserve test” is a very important parameter both in the Bologna criteria and in the POSEIDON classification. Several studies have already been published about the reproductive outcome of patients defined as poor responders according to the ESHRE Bologna criteria: all of them agree on the poor IVF outcome and low pregnancy rate of these patients. Instead, being the POSEIDON classification of very recent publication, the efficacy of the POSEIDON approach in improving management and outcomes of POR patients has yet to be tested and validated with future prospective clinical trials. Prediction of poor response may help clinicians choose the stimulation protocol with the aim of gaining patient compliance and cost reduction, and many efforts have been made by researchers in this sense, including the formulation of the Bologna criteria and of the POSEIDON classification, in which the ovarian reserve markers (AMH and AFC) play a fundamental role.

Antioxidative enzyme-related gene expression levels in cumulus cells during in vitro fertilization: A comparison between normal and poor ovarian responders

“…Although various evidences indicated the correlation between oxidative stress and IVF outcomes [26], the gradual decrease of antioxidant activity in advanced-age related cohorts, both POR and NOR participants, as presented in our study should be considered. Indisputably, oocyte quantity and quality have tremendously declined in advanced-age patients [27]. However, fertilization competence has been also in uenced by various factors such as sperm quality, microenvironment during the IVF procedure, while clinical pregnancy depends on diverse factors such as embryo quality including ploidy status, uterine receptivity as well as maternal co-morbidities.…”

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

“…More recently, a new classification of poor ovarian reserve patients in IVF/ART has been put forward by the POSEIDON (Patient Oriented Strategies Encompassing Individualized Oocyte Number) group (20)(21)(22). In this classification, four subgroups have been suggested according to qualitative and quantitative parameters, like the Bologna criteria, namely:…”

Long-Acting GnRH Agonist Improves IVF Outcomes of Young Patients with Diminished Ovarian Reserve by Increasing Endometrial Receptivity.

“…Currently, there is no uniform de nition for DOR. In this study, the de nition of DOR is as following : (i) woman with any of the risk factors for POR and/or (ii) an abnormal ovarian reserve test (i.e., AFC < 7 follicles or anti mullerian hormone (AMH) <1.2 ng/ml) [12,22]. Exclusion criteria included patients with severe uterine malformation, severe uterine adhesions, chromosomal abnormality, hydrosalpinx (if not surgically removed or ligated), antiphospholipid syndrome, thyroid or adrenal dysfunction, and severe impairment of renal or hepatic function.…”

“…However, most of the therapeutic strategies had limited success. Up to now, there is not su cient evidence to recommend a treatment optimizing IVF outcomes for DOR [12].…”