How to define, diagnose and treat poor responders? Responses from a worldwide survey of IVF clinics (Jun 2015)

reproductive biomedicine online
How to define, diagnose and treat poor responders? Responses from a worldwide survey of IVF clinics
Reprod Biomed Online. 2015 Jun;30(6):581-92
1Pasquale Patrizio, 2Alberto Vaiarelli, 3Paolo E. Levi Setti, 4Kyle J. Tobler, 5Gon Shoham, 6Milton Leong, 7Zeev Shoham
Author(s) affiliation:
1Yale University Fertility Center, New Haven, Connecticut, USA. Electronic address: This email address is being protected from spambots. You need JavaScript enabled to view it..
 2Centre for Reproductive Medicine, Vrije University Brussels, Belgium.
3Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Research Hospital Fertility Center, Rozzano, Milan 20084, Italy.
4Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
5Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
6The Women's Clinic, Hong Kong.
7Department of Obstetrics and Gynaecology, Kaplan Medical Center, Rehovot, Israel; Hadassah Medical School, Jerusalem, Israel.


Short description:
Physiologically, after the period of optimal fertility (at age 18–31 years), oocyte quality decreases in parallel with the progressive reduction in number of follicles, and this deterioration accelerates after 37–38 years of age (Faddy, 2000, Faddy et al, 1992 and Gougeon, 1996). It has been estimated that, in the general population, about 10% of women younger than 40 years have a premature reduction in the number of ovarian follicles ( Nikolaou, Templeton, 2003 and van Noord et al, 1997).

Several possible causes for diminished ovarian reserve have been identified, and include inherited chromosomal (De Vos et al, 2010 and Gleicher et al, 2009) and genetic disorders (e.g. Fragile-X and galactosaemia) (te Velde and Pearson, 2002) and iatrogenic causes (Treloar, 1981 and Ferraretti et al, 2011); however, most cases of premature ovarian insufficiency are still unexplained (Nikolaou and Templeton, 2003).
Link to the journal


Abstract taken from PubMed

Poor responders represent a significant percentage of couples treated in IVF units (10-24%), but the standard definition of poor responders remains uncertain and consequently optimal treatment options remain subjective and not evidence-based. In an attempt to provide uniformity on the definition, diagnosis and treatment of poor responders, a worldwide survey was conducted asking IVF professionals a set of questions on this complex topic. The survey was posted on www.IVF-worldwide.com, the largest and most comprehensive IVF-focused website for physicians and embryologists. A total of 196 centres replied, forming a panel of IVF units with a median of 400 cycles per year. The present study shows that the definition of poor responders is still subjective, and many practices do not use evidence-based treatment for this category of patients. Our hope is that by leveraging the great potential of the internet, future studies may provide immediate large-scale sampling to standardize both poor responder definition and treatment options. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
Link to the paper on PubMed

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