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Obstetrics and Gynegology2022№8
Current approaches to diagnosing and...

Current approaches to diagnosing and managing female poor responders to ovarian stimulation with gonadotropins in assisted reproductive technology programs

DOI
https://dx.doi.org/10.18565/aig.2022.8.12-21

Perminova S.G., Belova I.S., Mityurina E.V., Savostina G.V.

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia
Female poor responders to ovarian stimulation (OS) make up a large cohort among all infertile women seeking assisted reproductive technology (ART) programs (9–24%). The Bologna criteria do not fully reflect the diverse group of female poor responders to OS. The novel POSEIDON classification stratifies a large heterogeneous cohort of female poor responders into 4 groups according to the age of patients, the levels of antral follicle and anti-Müllerian hormone, and the prognosis of pregnancy. The paper gives possible mechanisms for the pathogenesis of a poor response to OS. Particular attention is paid to patients with normal ovarian reserve and an unpredictable poor response to OS (1, 2 POSEIDON), which is associated with the lower ovarian sensitivity to gonadotropin stimulation due to the presence of polymorphisms in the genes of gonadotropins and their receptors. The authors discuss whether it is expedient to use new clinical and laboratory poor response predictors (FORT, FOI, and OSI). The use of an ART calculator is shown to be appropriate for predicting the number of oocytes required to obtain at least one euploid blastocyst. The paper presents different approaches to optimizing treatment in female poor responders, depending on whether they belong to a particular POSEIDON group. It considers adjuvant therapy methods aimed at obtaining a larger number of oocytes and increasing the effectiveness of ART programs.
Conclusion: Using the POSEIDON criteria in clinical practice, clarifying the prognostic value of the new diagnostic criteria (FORT, FOI, and OSI) for a poor ovarian response to gonadotropin stimulation, and assessing the feasibility of testing for polymorphisms in the genes of gonadotropins and their receptors in unpredictable poor responders to OS can be a help in better assessing a large heterogeneous group of poor responders to OS and elaborating personalized approaches to OS in the IVF program, which requires further investigations.

Keywords

poor ovarian response
POSEIDON criteria
embryonic aneuploidies
infertility
diminished ovarian reserve
Full text (in Russian)

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Received 02.06.2022

Accepted 14.06.2022

About the Authors

Svetlana G. Perminova, MD, PhD, Leading Researcher at Reproductology Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics,
Gynecology and Perinatology, Ministry of Health of Russia, perisvet@list.ru, 117997, Russia, Moscow, Ac. Oparin str., 4.
Irina S. Belova, graduate student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, irina-belova00@mail.ru, 117997, Russia, Moscow, Ac. Oparin str., 4.
Elena V. Mityurina, PhD, Senior Researcher at Reproductology Department, V.I. Kulakov National Medical Research Center for Obstetrics,
Gynecology and Perinatology, Ministry of Health of Russia, e_mityurina@oparina4.ru, 117997, Russia, Moscow, Ac. Oparin str., 4.
Guzel V. Savostina, graduate student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, +7(925)633-35-16, savostina2324@gmail.com, 117997, Russia, Moscow, Ac. Oparin str., 4.

Authors' contributions: Perminova S.G., Mityurina E.V., Savostina G.V. – editing and final approval of the manuscript;
Belova I.S. – search and analysis of literature, processing the source material, writing the text of the manuscript.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The article has been prepared without financial support.
For citation: Perminova S.G., Belova I.S., Mityurina E.V., Savostina G.V.
Current approaches to diagnosing and managing female poor responders to ovarian stimulation with gonadotropins in assisted reproductive technology programs.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 8: 12-21 (in Russian)
http://dx.doi.org/10.18565/aig.2022.8.12-21

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