Update on the management of poor ovarian response in IVF: the shift from Bologna criteria to the Poseidon concept

Drakopoulos, Panagiotis; Bardhi, Erlisa; Boudry, Liese; Vaiarelli, Alberto; Makrigiannakis, Antonis; Esteves, Sandro C.; Tournaye, Herman; Blockeel, Christophe

doi:10.1177/2633494120941480

Cited by 49 publications

(36 citation statements)

References 93 publications

(116 reference statements)

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“…There are indications that lifestyle modifications with weight loss prior to assisted reproductive technologies (ART) show benefits compared to immediate treatment in obese women with PCOS [5]. Yet, ART is a promising option 2 of 17 with suitable interventions for the clinical management of infertility, including in vitrofertilization (IVF) and intracytoplasmic sperm injection (ICSI) [6]. With a steadily rising demand over the past decades, it is essential to understand which factors may optimize the outcome of ART treatment, as live birth rate (LBR) is still observed in around 36% to 50% of attempts only [7,8].…”

Section: Introductionmentioning

confidence: 99%

Pronounced Trace Element Variation in Follicular Fluids of Subfertile Women Undergoing Assisted Reproduction

Schmalbrock

Weiss²,

Rijntjes

et al. 2021

Nutrients

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Female subfertility is a growing concern, especially in view of an increasing prevalence of polycystic ovary syndrome (PCOS). Assisted reproductive technologies (ART) offer a perspective for pregnancy, but the outcome rate is still suboptimal. The trace elements (TE), copper (Cu), selenium (Se), and zinc (Zn) are essential for fertility and development. We hypothesized that TE concentrations are related to oocyte quality and growth and affect pregnancy outcomes in women undergoing ART. Concentrations of TE were measured by total reflection X-ray fluorescence. Extracellular glutathione peroxidase 3 (GPX3) and selenoprotein P (SELENOP) were determined as additional Se biomarkers. Corresponding serum and follicular fluid (FF) samples were available from women with (n = 20) and without (n = 20) PCOS diagnosis undergoing hormone treatment within the ART procedure, respectively, and FF samples were classified into five groups based on morphological assessment. Serum showed higher TE concentrations than FF, and TE levels correlated positively between both matrices. Individual FF from the same women showed surprisingly high variability in TE concentration, and follicles without oocytes displayed the lowest TE concentrations. Both Se biomarkers GPX3 and SELENOP were present in FF and correlated positively to Se concentrations. Some notable relationships were observed between morphokinetic parameters, TE concentrations, and GPX3 activity. A slightly depressed serum Zn concentration was observed in PCOS. Our results indicate a direct relationship between TE in serum and FF, positive correlations between the three Se biomarkers in FF, and high variability between the FF from the same woman with the lowest TE concentrations in the follicles with the poorest quality. The differences observed in relation to PCOS diagnoses appear relatively minor. Collectively, the data support the notion that TE assessment of follicles may contribute to optimal oocyte selection and subsequently influence ART success.

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Section: Introductionmentioning

confidence: 99%

Pronounced Trace Element Variation in Follicular Fluids of Subfertile Women Undergoing Assisted Reproduction

Schmalbrock

Weiss²,

Rijntjes

et al. 2021

Nutrients

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“…The current popular view for classification is the Poseidon Criteria 17 which seek to stratify significantly more homogeneous subpopulations taking age, ovarian reserve and previous ovarian response after stimulation with gonadotrophins into account. This has led to the distinguishing of at least four groups with suggestions for different treatments for each subgroup 18 (see Figure 1 ).…”

Section: Definition Of Poor Respondersmentioning

confidence: 99%

Human growth hormone use in poor ovarian response – caution and opportunities

Norman

Hart

2021

Clin Med�Insights�Reprod�Health

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Human growth hormone has found favour as a co-gonadotrophin in assisted reproduction particularly in the circumstances of a poor response to stimulation. Its use has been based on animal studies suggesting insulin-like growth factor-1 enhances granulosa and cumulus cell function and possibly oocyte quality. While there is limited ovarian cellular information in women, the use of human growth hormone is alleged to improve egg numbers, embryo quality, clinical pregnancies and live birth in women with a poor ovarian response. A number of cohort studies have claimed these benefits compared with prior nil treatment, but there are a limited number of quality randomised controlled studies. The few good randomised trials indicate an enhanced ovarian response in terms of oestradiol secretion and oocyte maturity with controversial improvement in ongoing pregnancy and live birth. Given the cost of the medication, the lack of convincing data on enhanced clinical outcomes and the theoretical possibility of side effects, we propose it is still too early to determine human growth hormone’s true cost-benefit for widespread use. However, a number of emerging randomised trials may tilt the equation to a positive outlook in the future. Meanwhile, the hormone should only be used after full informed consent from the patient as to its effectiveness and efficacy.

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“…In such cases, maximizing the oocyte yield can lead to higher cumulative birth rates. However, optimal treatment options should be considered [ 11 ]. In contrast, some clinical trials showed that needling women with diminished ovarian reserves at multiple acupoints could yield positive outcomes [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial

Kim

Lee

Choi

et al. 2021

JCM

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Acupuncture is believed to improve ovarian reserve and reproductive outcomes in women undergoing in vitro fertilization (IVF). This study was conducted to evaluate the effect of network-optimized acupuncture followed by IVF on the oocyte yield in women showing a poor ovarian response. This study was an exploratory randomized controlled trial conducted from June 2017 to January 2020 at the Pusan National University Hospital. Women diagnosed with poor ovarian response were enrolled and randomly divided into two groups: IVF alone and Ac + IVF groups (16 acupuncture sessions before IVF treatment). Eight acupoints with high degree centrality and betweenness centrality were selected using network analysis. Among the participants, compared with the IVF treatment alone, the acupuncture + IVF treatment significantly increased the number of retrieved mature oocytes in women aged more than 37 years and in those undergoing more than one controlled ovarian hyperstimulation cycle. The negative correlation between the number of retrieved mature oocytes and consecutive controlled ovarian hyperstimulation cycles was not observed in the Ac + IVF group irrespective of the maternal age. These findings suggest that physicians can consider acupuncture for the treatment of women with poor ovarian response and aged > 37 years or undergoing multiple IVF cycles.

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Update on the management of poor ovarian response in IVF: the shift from Bologna criteria to the Poseidon concept

Cited by 49 publications

References 93 publications

Pronounced Trace Element Variation in Follicular Fluids of Subfertile Women Undergoing Assisted Reproduction

Pronounced Trace Element Variation in Follicular Fluids of Subfertile Women Undergoing Assisted Reproduction

Human growth hormone use in poor ovarian response – caution and opportunities

Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial

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