Reproductive Endocrinology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Front Endocrinol (Lausanne). 2020 Apr 17;11:192. doi: 10.3389/fendo.2020.00192. eCollection 2020.
The infertile patients with aging ovaries-also sometimes referred to as impending premature ovarian insufficiency (POI), impending premature ovarian failure (POF), or poor ovarian responders (POR), constitute a significant and increasing bulk of the patients appealing to IVF/ART. Different causes have been cited in the literature, among the identified etiologies, including chromosomal and genetic etiology, metabolic, enzymatic, iatrogenic, toxic, autoimmune, and infectious causes. Although the most successful and ultimate treatment of POI/POF/POR patients is egg donation (ED), many, if not most, of these infertile women are reluctant to consent to ED upon the initial diagnostic interview, requesting alternative solutions despite the low odds for success. Despite anecdotal case reports, no unequivocal treatment proved to be successful for these patients in prospective randomized controlled trials. Nevertheless, the addition of growth hormone (GH) to ovarian stimulation in POR with GH deficiency may improve the results of controlled ovarian hyperstimulation (COH) and the IVF success. In patients with autoimmune etiology for POR/POI, the combination of glucocorticosteroids, pituitary-ovarian suppression, and COH may be successful in achieving the desired conception.
不孕伴卵巢衰老的患者 - 有时也被称为即将发生的卵巢早衰（POI）、即将发生的卵巢功能衰竭（POF）或卵巢低反应（POR），构成了大量且不断增加的寻求 IVF/ART 的患者群体。文献中提到了不同的原因，在已确定的病因中，包括染色体和遗传病因、代谢、酶、医源性、毒性、自身免疫和感染性原因。尽管 POI/POF/POR 患者最成功和最终的治疗方法是捐卵（ED），但许多（如果不是大多数）这些不孕女性在初次诊断性访谈时不愿意同意 ED，尽管成功的几率很低，但仍要求选择其他解决方案。尽管有一些轶事病例报告，但在前瞻性随机对照试验中，没有一种明确的治疗方法被证明对这些患者有效。然而，在 GH 缺乏的 POR 患者中，将生长激素（GH）添加到卵巢刺激中可能会改善控制性卵巢过度刺激（COH）和 IVF 的结果。对于 POR/POI 的自身免疫病因患者，糖皮质激素、垂体-卵巢抑制和 COH 的联合治疗可能成功实现预期妊娠。
