Defining Low Prognosis Patients Undergoing Assisted Reproductive Technology: POSEIDON Criteria-The Why.
Defining Low Prognosis Patients Undergoing Assisted Reproductive Technology: POSEIDON Criteria-The Why.
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DOI：
10.3389/fendo.2018.00461
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发表时间：
2018
影响因子：
5.2
通讯作者：
Alviggi C
中科院分区：
文献类型：
--
作者：
Esteves SC;Roque M;Bedoschi GM;Conforti A;Humaidan P;Alviggi C
卵巢储备受损或卵巢反应差（POR）外源性促性腺激素刺激的妇女提出了生殖专家的挑战。主要原因是对POR病理生理的认识仍然有限，缺乏对这些疾病管理的实际解决方案。事实上，使用现行标准定义POR的临床试验未能显示出支持特定治疗方式的证据。此外，生殖成功的关键因素，如年龄依赖性胚胎非整倍体率和卵巢对促性腺激素刺激的内在抗性，目前的POR标准没有考虑到。因此，对POR的公认定义因其在适当的患者特征方面的不足以及没有为临床医生提供治疗管理指南而受到批评。一种将卵巢对外源性促性腺激素“预期”或“意外”不适当反应的不孕症患者进行分类的新系统——POSEIDON标准——被开发出来，以提供更细致的POR图像，并指导医生管理这类患者。新标准对目前的POR术语提出了挑战，支持新定义的“低预后”概念。本文为读者提供了对现有标准的关键评估，这些标准标准化了POR的定义，并解释了开发POSEIDON标准的主要原因。
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.
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影响因子：
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