Poor ovarian response to stimulation for in vitro fertilization
| Autor: | Snežana Vidaković, Nebojsa Radunovic, Svetlana Spremovic-Radjenovic, Jovan Bila, Aleksandra Gudovic, Milan Dokic |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Anti-Mullerian Hormone endocrine system medicine.medical_specialty therapeutic protocols Pregnancy Rate media_common.quotation_subject medicine.medical_treatment lcsh:Medicine Fertilization in Vitro Gonadotropin-releasing hormone Luteal phase Follicle-stimulating hormone follicular reserve Ovulation Induction Pregnancy poor ovarian response Internal medicine Humans Medicine Ovarian reserve Ovulation media_common In vitro fertilisation business.industry Ovary lcsh:R General Medicine Prognosis Antral follicle in vitro fertilization (IVF) Pregnancy rate Treatment Outcome Endocrinology Female Follicle Stimulating Hormone business Infertility Female hormones hormone substitutes and hormone antagonists |
| Zdroj: | Srpski Arhiv za Celokupno Lekarstvo, Vol 143, Iss 5-6, Pp 354-361 (2015) |
| ISSN: | 2406-0895 0370-8179 |
| Popis: | The term ?poor respond (POR) patients? is used for the group of women who respond badly to usual doses of gonadotropins in in vitro fertilization (IVF) treatments; the consequence is low pregnancy rate. A consensus was reached on the minimal criteria needed to define POR. At least two of the following three features must be present: 1. advanced maternal age (40 years or more) 2. previous POR (3 or less oocytes with a conventional stimulation protocol) 3. abnormal ovarian reserve (AMH 0.5-1.1 ng/ml or AFC 5-7). The aim is to find better therapeutic options for these patients. Increased levels of day 3 follicle stimulating hormone (FSH) and estradiol (E2), as well as decreased levels of anti-M?llerian hormone (AMH) and antral follicle count (AFC), can be used to assess ovarian reserve, as indirect predictive tests. A larger number of well designed, large scale, randomized, controlled trials are needed to assess the efficacy of different management strategies for poor responders: flare up gonadotropin releasing hormone (GnRH) agonist protocols, modified long GnRH agonist mini-dose protocols, luteal initiation GnRH agonist stop protocol, pretreatment with estradiol - GnRH antagonist in luteal phase, natural cycle aspiration or natural cycle aspiration GnRH antagonist controlled, adjuvant therapy with growth hormone or dehydroepiandrosterone (DHEA). The results of up to now used protocols are unsatisfactory and stimulation of the ovulation in poor responders remains a challenge, especially when bearing in mind that in the majority of cases the patients will be menopausal in relatively short period of time. |
| Databáze: | OpenAIRE |
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