Loutradis D, Drakakis P, Vomvolaki E, Antsaklis A
1st Department of Obstetrics and Gynecology, Athens University Medical School, Sirinon 62, P. Faliro, 175 61, Athens, Greece.
J Assist Reprod Genet. 2007 Dec;24(12):597-611. doi: 10.1007/s10815-007-9181-2. Epub 2007 Nov 22.
To review the available treatments for women with significantly diminished ovarian reserve and assess the efficacy of different ovarian stimulation protocols.
Literature research performed among studies that have been published in the Pubmed, in the Scopus Search Machine and in Cohrane database of systematic reviews.
A lack of clear, uniform definition of the poor responders and a lack of large-scale randomized studies make data interpretation very difficult for precise conclusions. Optimistic data have been presented by the use of high doses of gonadotropins, flare up Gn RH-a protocol (standard or microdose), stop protocols, luteal onset of Gn RH-a and the short protocol. Natural cycle or a modified natural cycle seems to be an appropriate strategy. Low dose hCG in the first days of ovarian stimulation has promising results. Molecular biology tools (mutations, single nucleotide polymorphisms (SNPs)) have been also considered to assist the management of this group of patients.
The ideal stimulation for these patients with diminished ovarian reserve remains a great challenge for the clinician, within the limits of our pharmaceutical quiver.
回顾针对卵巢储备显著减少的女性的现有治疗方法，并评估不同卵巢刺激方案的疗效。
在PubMed、Scopus检索机和Cochrane系统评价数据库中发表的研究中进行文献研究。
对反应不良者缺乏明确、统一的定义，且缺乏大规模随机研究，这使得难以对数据进行解释以得出精确结论。使用高剂量促性腺激素、激发GnRH-a方案（标准或微剂量）、停止方案、GnRH-a黄体期开始和短方案已呈现出乐观的数据。自然周期或改良自然周期似乎是一种合适的策略。在卵巢刺激的最初几天使用低剂量hCG有令人期待的结果。分子生物学工具（突变、单核苷酸多态性（SNP））也被认为有助于管理这组患者。
在我们现有的药物范围内，为这些卵巢储备减少的患者找到理想的刺激方案对临床医生来说仍然是一个巨大的挑战。
