Szymusik Iwona, Marianowski Piotr, Zygula Aleksandra, Wielgos Miroslaw
1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
Neuro Endocrinol Lett. 2015;36(3):209-13.
Despite the vast experience in controlled ovarian hyperstimulation, there are still women who respond poorly to gonadotropins, which results in few oocytes at retrieval, reduced number of embryos for transfer and consequently unsatisfactory pregnancy rates. Although such patients are quite common in IVF practice, the exact prevalence of so-called "poor responders" is difficult to estimate due to the variety of applied definitions. The urgent need for an internationally accepted definition of poor ovarian response (POR) was addressed by an ESHRE Workshop held in Bologna in 2010, where the consensus was reached and criteria were finally established. The application of this uniform definition may allow a correct estimate of POR prevalence and, what is more important, designing proper trials to assess and finally compare the interventions used in POR patients. The article describes the possible physiology of POR and patient characteristics, mentions risk factors and laboratory tests of decreased ovarian reserve. Finally it reviews the possible management of POR with different stimulation protocols in the light of EBM. Basing on published meta-analyses, various additional alternatives (such as estradiol priming, the addition of rLH, growth hormone, androgens and androgen-modulating agents, aspirin) are also summarized. Despite the two decades of trying, there is still no consensus on what is best for POR. No single treatment can be recommended over another, as the evidence for all of them is insufficient. It is obvious that interventions used in POR require properly designed large randomized studies, because until now there is no evidence-based treatment for that particular group of patients.
尽管在控制性卵巢刺激方面有丰富经验，但仍有一些女性对促性腺激素反应不佳，这导致取卵时获得的卵母细胞数量少，可供移植的胚胎数量减少，进而导致妊娠率不尽人意。虽然这类患者在体外受精实践中很常见，但由于所采用的定义多种多样，所谓“反应不良者”的确切患病率难以估计。2010年在博洛尼亚举行的欧洲人类生殖与胚胎学会（ESHRE）研讨会上探讨了对卵巢反应不良（POR）进行国际认可定义的迫切需求，会上达成了共识并最终确定了标准。应用这一统一的定义可能有助于正确估计POR的患病率，更重要的是，有助于设计适当的试验来评估并最终比较用于POR患者的干预措施。本文描述了POR可能的生理机制和患者特征，提及了卵巢储备功能下降的风险因素和实验室检查。最后，根据循证医学对采用不同刺激方案治疗POR的可能性进行了综述。基于已发表的荟萃分析，还总结了各种其他替代方法（如雌二醇预处理；添加重组促黄体生成素、生长激素、雄激素及雄激素调节剂、阿司匹林）。尽管经过了二十年的尝试，但对于POR的最佳治疗方法仍未达成共识。由于所有治疗方法的证据都不充分，因此无法推荐某一种治疗方法优于另一种。显然，用于POR的干预措施需要经过适当设计的大型随机研究，因为到目前为止，针对这一特定患者群体尚无循证治疗方法。
