Di Guardo Federica, Blockeel Christophe, De Vos Michel, Palumbo Marco, Christoforidis Nikolaos, Tournaye Herman, Drakopoulos Panagiotis
Gynecology and Obstetrics Section, Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Ther Adv Reprod Health. 2022 Jan 14;16:26334941211062026. doi: 10.1177/26334941211062026. eCollection 2022 Jan-Dec.
About 20% of women undergoing fertilization struggle with poor ovarian response, indicating a poor prognosis related to low response following ovarian stimulation. Indeed, poor ovarian response, that is associated with both high cancelation rates and low live birth rates, still represents one of the most important therapeutic challenges in fertilization. In this context, natural cycle/modified natural cycle- fertilization, as a 'milder' approach, could be a reasonable alternative to high-dose/conventional ovarian stimulation in poor ovarian responders, with the aim to retrieve a single oocyte with better characteristics that may result in a single top-quality embryo, transferred to a more receptive endometrium. Moreover, modified natural cycle- fertilization may be cost-effective because of the reduced gonadotropin consumption. Several studies have been published during the last 20 years reporting conflicting results regarding the use of natural cycle/modified natural cycle- fertilization in women with poor ovarian response; however, while most of the studies concluded that mild stimulation regimens, including natural cycle/modified natural cycle- fertilization, have low, but acceptable success rates in this difficult group of patients, others did not replicate these findings. The aim of this narrative review is to appraise the current evidence regarding the use of natural cycle/modified natural cycle- fertilization in poor ovarian responders.
约20%接受体外受精的女性存在卵巢反应不良的问题，这表明卵巢刺激后反应低下与预后不良相关。事实上，卵巢反应不良与高取消率和低活产率均有关联，仍是体外受精领域最重要的治疗挑战之一。在此背景下，自然周期/改良自然周期体外受精作为一种“温和”的方法，对于卵巢反应不良者而言，可能是高剂量/传统卵巢刺激的合理替代方案，目的是获取单个具有更好特征的卵母细胞，这可能会形成单个优质胚胎，并移植到更易接受胚胎着床的子宫内膜。此外，改良自然周期体外受精可能具有成本效益，因为促性腺激素的使用量减少。在过去20年中发表了几项研究，报告了在卵巢反应不良的女性中使用自然周期/改良自然周期体外受精的相互矛盾的结果；然而，虽然大多数研究得出结论，包括自然周期/改良自然周期体外受精在内的温和刺激方案在这一困难患者群体中的成功率较低但可接受，但其他研究并未重复这些发现。本叙述性综述的目的是评估目前关于在卵巢反应不良者中使用自然周期/改良自然周期体外受精的证据。
