ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria
ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria
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DOI：
10.1093/humrep/der092
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发表时间：
2011-07-01
影响因子：
6.1
通讯作者：
Gianaroli, L.
中科院分区：
文献类型：
--
作者：
Ferraretti, A. P.;La Marca, A.;Gianaroli, L.
这里提出的定义代表了科学界首次以简单且可重复的方式标准化卵巢反应不良 (POR) 定义的现实尝试。对卵巢刺激的 POR 通常表明卵泡反应减少，导致回收的卵母细胞数量减少。人们已经认识到，为了定义 IVF 反应不佳，必须具备以下三个特征中的至少两个： (i) 高龄产妇或 POR 的任何其他危险因素； (ii) 之前的 POR； (iii) 卵巢储备测试 (ORT) 异常。在没有高龄产妇或异常 ORT 的情况下，最大刺激后两次 POR 足以将患者定义为反应不良者。根据定义，POR 一词指的是卵巢反应，因此，一个刺激周期被认为对于 POR 的诊断至关重要。然而，ORT 异常的高龄患者可能被归类为反应不佳者，因为高龄和 ORT 异常可能表明卵巢储备减少，并可作为卵巢刺激周期结果的替代指标。在这种情况下，患者应该更正确地定义为“预期反应不佳者”。如果 POR 的定义被统一调整为选择患者进行未来临床试验所需的“最低”标准，则任何新方案都将测试更多同质人群。最后，通过减少虚假 POR 定义引起的偏差，可以比较结果并得出可靠的结论。
The definition presented here represents the first realistic attempt by the scientific community to standardize the definition of poor ovarian response (POR) in a simple and reproducible manner. POR to ovarian stimulation usually indicates a reduction in follicular response, resulting in a reduced number of retrieved oocytes. It has been recognized that, in order to define the poor response in IVF, at least two of the following three features must be present: (i) advanced maternal age or any other risk factor for POR; (ii) a previous POR; and (iii) an abnormal ovarian reserve test (ORT). Two episodes of POR after maximal stimulation are sufficient to define a patient as poor responder in the absence of advanced maternal age or abnormal ORT. By definition, the term POR refers to the ovarian response, and therefore, one stimulated cycle is considered essential for the diagnosis of POR. However, patients of advanced age with an abnormal ORT may be classified as poor responders since both advanced age and an abnormal ORT may indicate reduced ovarian reserve and act as a surrogate of ovarian stimulation cycle outcome. In this case, the patients should be more properly defined as 'expected poor responder'. If this definition of POR is uniformly adapted as the 'minimal' criteria needed to select patients for future clinical trials, more homogeneous populations will be tested for any new protocols. Finally, by reducing bias caused by spurious POR definitions, it will be possible to compare results and to draw reliable conclusions.