Esteves Sandro C, Roque Matheus, Bedoschi Giuliano M, Conforti Alessandro, Humaidan Peter, Alviggi Carlo
ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.
Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil.
Front Endocrinol (Lausanne). 2018 Aug 17;9:461. doi: 10.3389/fendo.2018.00461. eCollection 2018.
Women with impaired ovarian reserve or poor ovarian response (POR) to exogenous gonadotropin stimulation present a challenge for reproductive specialists. The primary reasons relate to the still limited knowledge about the POR pathophysiology and the lack of practical solutions for the management of these conditions. Indeed, clinical trials using the current standards to define POR failed to show evidence in favor of a particular treatment modality. Furthermore, critical factors for reproductive success, such as the age-dependent embryo aneuploidy rates and the intrinsic ovarian resistance to gonadotropin stimulation, are not taken into consideration by the current POR criteria. As a result, the accepted definitions for POR have been criticized for their inadequacy concerning the proper patient characterization and for not providing clinicians a guide for therapeutic management. A novel system to classify infertility patients with "expected" or "unexpected" inappropriate ovarian response to exogenous gonadotropins-the POSEIDON criteria-was developed to provide a more nuanced picture of POR and to guide physicians in the management of such patients. The new standards are provoking as they challenge the current terminology of POR in favor of the newly defined concept of "low prognosis." This article provides readers a critical appraisal of the existing criteria that standardize the definition of POR and explains the primary reasons for the development of the POSEIDON criteria.
卵巢储备功能受损或对外源性促性腺激素刺激卵巢反应不良（POR）的女性给生殖专家带来了挑战。主要原因在于对POR病理生理学的了解仍然有限，以及缺乏针对这些情况的实际管理解决方案。事实上，使用当前标准定义POR的临床试验未能显示出支持特定治疗方式的证据。此外，当前的POR标准没有考虑到生殖成功的关键因素，如年龄相关的胚胎非整倍体率和卵巢对促性腺激素刺激的内在抵抗。因此，公认的POR定义因其在正确描述患者特征方面的不足以及未为临床医生提供治疗管理指南而受到批评。一种用于将对促性腺激素有“预期”或“意外”不适当卵巢反应的不孕症患者进行分类的新系统——POSEIDON标准——被开发出来，以更细致地描述POR，并指导医生管理此类患者。新的标准引发了争议，因为它们挑战了当前POR的术语，转而支持新定义的“低预后”概念。本文为读者提供了对现有标准化POR定义标准的批判性评估，并解释了POSEIDON标准制定的主要原因。
