S.I.S.Me.R Reproductive Medicine Unit, Via Mazzini 12, 40138 Bologna, Italy.
Hum Reprod. 2011 Jul;26(7):1616-24. doi: 10.1093/humrep/der092. Epub 2011 Apr 19.
The definition presented here represents the first realistic attempt by the scientific community to standardize the definition of poor ovarian response (POR) in a simple and reproducible manner. POR to ovarian stimulation usually indicates a reduction in follicular response, resulting in a reduced number of retrieved oocytes. It has been recognized that, in order to define the poor response in IVF, at least two of the following three features must be present: (i) advanced maternal age or any other risk factor for POR; (ii) a previous POR; and (iii) an abnormal ovarian reserve test (ORT). Two episodes of POR after maximal stimulation are sufficient to define a patient as poor responder in the absence of advanced maternal age or abnormal ORT. By definition, the term POR refers to the ovarian response, and therefore, one stimulated cycle is considered essential for the diagnosis of POR. However, patients of advanced age with an abnormal ORT may be classified as poor responders since both advanced age and an abnormal ORT may indicate reduced ovarian reserve and act as a surrogate of ovarian stimulation cycle outcome. In this case, the patients should be more properly defined as 'expected poor responder'. If this definition of POR is uniformly adapted as the 'minimal' criteria needed to select patients for future clinical trials, more homogeneous populations will be tested for any new protocols. Finally, by reducing bias caused by spurious POR definitions, it will be possible to compare results and to draw reliable conclusions.
这里提出的定义代表了科学界首次以简单且可重复的方式尝试标准化卵巢反应不良（POR）的定义。卵巢刺激引起的 POR 通常表明卵泡反应减少，导致取回的卵母细胞数量减少。已经认识到，为了在 IVF 中定义不良反应，至少必须存在以下三个特征中的两个：（i）高龄或任何其他 POR 危险因素；（ii）先前的 POR；和（iii）卵巢储备测试（ORT）异常。在没有高龄或异常 ORT 的情况下，两次最大刺激后的 POR 发作足以将患者定义为不良反应者。根据定义，POR 一词是指卵巢反应，因此，诊断 POR 需要一个刺激周期。然而，高龄且 ORT 异常的患者可能被归类为不良反应者，因为高龄和异常 ORT 都可能表明卵巢储备减少，并作为卵巢刺激周期结果的替代指标。在这种情况下，患者应更恰当地定义为“预期不良反应者”。如果 POR 的这一定义被统一作为选择未来临床试验患者所需的“最低”标准，那么将对任何新方案进行更同质的人群测试。最后，通过减少由虚假 POR 定义引起的偏差，将有可能比较结果并得出可靠的结论。
