Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, GA Utrecht, The Netherlands.
Hum Reprod Update. 2012 Jan-Feb;18(1):1-11. doi: 10.1093/humupd/dmr037. Epub 2011 Oct 10.
BACKGROUND In IVF treatment a considerable proportion of women are faced with a low number of oocytes retrieved. These poor responders have reduced pregnancy rates compared with normal responders. However, this may not be applicable to all poor responders. This review aims at identifying patient characteristics and ovarian reserve tests (ORT) that will determine prognosis for pregnancy in poor responders. METHODS A systematic search was conducted in PubMed, Embase, Cochrane and SCOPUS databases in April 2010. Studies regarding patient characteristics or ORT in poor responders and their pregnancy prospects were included. All included papers were summarized in descriptive tables. RESULTS Nineteen studies were included. Pooled data of six studies comparing poor and normal responders demonstrated clearly lower pregnancy rates in poor responders (14.8 versus 34.5%). Ten studies indicated that older poor responders have a lower range of pregnancy rates compared with younger (1.5-12.7 versus 13.0-35%, respectively). Four studies showed that pregnancy prospects become reduced when fewer oocytes are retrieved (0-7% with 1 oocyte versus 11.5-18.6% with 4 oocytes). Five studies concerning pregnancy rates in subsequent cycles suggested a more favourable outcome in unexpected poor responders, and if ≥2 oocytes were retrieved. CONCLUSIONS Poor responders are not a homogeneous group of women with regards to pregnancy prospects. Female age and number of oocytes retrieved in particular will modulate the chances for pregnancy in current and subsequent cycles. Applying these criteria will allow the identification of couples with a reasonable prognosis and balanced decision-making on the management of poor responders.
在体外受精（IVF）治疗中，相当一部分女性面临着取出的卵子数量较少的问题。这些反应不良的患者与正常反应的患者相比，怀孕率降低。然而，这可能并不适用于所有反应不良的患者。本综述旨在确定患者特征和卵巢储备测试（ORT），以确定反应不良患者的妊娠预后。
2010 年 4 月，我们在 PubMed、Embase、Cochrane 和 SCOPUS 数据库中进行了系统检索。纳入了关于反应不良患者的患者特征或 ORT 及其妊娠前景的研究。所有纳入的文献均在描述性表格中进行了总结。
纳入了 19 项研究。六项研究的汇总数据表明，反应不良组的妊娠率明显低于正常反应组（14.8%比 34.5%）。十项研究表明，年龄较大的反应不良患者的妊娠率范围低于年龄较小的患者（分别为 1.5%-12.7%比 13.0%-35%）。四项研究表明，随着取卵数的减少，妊娠前景也会下降（1 个卵时为 0%-7%，4 个卵时为 11.5%-18.6%）。五项关于后续周期妊娠率的研究表明，在意外反应不良的患者中，如果取出≥2 个卵，后续周期的结局更为有利。
反应不良的患者在妊娠前景方面并不是一个同质的群体。女性年龄和取出的卵子数量尤其会影响当前和后续周期的妊娠机会。应用这些标准将有助于识别具有合理预后的夫妇，并在反应不良患者的管理方面做出平衡的决策。
