NEWS: ESHRE Defines Poor Response to Ovarian Stimulation

The lack of clear consensus on the definition of poor ovarian response (POR) in ART has made it difficult to compare results of various studies conducted to improve ovarian response; in turn hindering the identification of poor responders and selection of an optimal ovarian stimulation strategy. In a first realistic endeavor, the European Society of Human Reproduction and Embryology (ESHRE) working group proposed a standardized, simple, and reproducible definition for POR. The ESHRE consensus is published in the recent issue of the journal, Human Reproduction.

On behalf of the ESHRE working group, Anna Pia Ferraretti from the S.I.S.me.R Reproductive Medicine Unit, Bologna, Italy, and coworkers, arrived at a consensus on the definition of POR, and recommend that at least two of the following must be met to consider patients as poor responders:• Advanced maternal age or presence of other risk factors of POR• History of POR• Abnormal ovarian reserve test (ORT)

Apart from the above three criteria, the ESHRE group suggested the following:• Patients can be considered as poor responders following two POR episodes after maximal stimulation, if advanced maternal age or abnormal ORT is not a factor.• Although one stimulated cycle is necessary for diagnosing POR, patients with advanced age or abnormal ORT may be categorized as poor responders, as both the factors suggest the possibility of decreased ovarian reserve, and therefore serve as markers of stimulation cycle outcomes. Such patients should be classified as ‘expected poor responders’.

The Group indicated that such a comprehensive criteria will help researchers select a homogenized population for future studies, and lower bias due to spurious POR definitions; thus facilitating the comparison of results for obtaining accurate conclusions.

Several studies have attempted to arrive at an objective definition of POR. In one such study, Kailasam et al (Human Reproduction, 2004) proposed the inclusion of the degree of ovarian stimulation in the definition of POR during IVF cycles in women 3,000 IU FSH cumulative dose to obtain sufficient follicles. Cancellation at ≥300 IU FSH/day is linked to a substantially worse prognosis and was also considered as a criterion to define POR. The scientists indicated that their findings may help in the development of a standardized definition for poor response.

With the absence of uniform criteria for defining POR, the recent consensus could assist both clinicians and researchers improve ovarian response and treatment outcomes, as well as develop and evaluate protocols for its prevention and management.

1. Ferraretti AP, La Marca a, Fauser BC, et al; ESHRE working group on Poor Ovarian Response Definition. ESHRE consensus on the definition of ’poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011 Jul;26(7):1616-1624.

2. Kailasam C, Keay SD, Wilson P, Ford WC, Jenkins JM. Defining poor ovarian response during IVF cycles, in women aged Hum Reprod. 2004 Jul;19(7):1544-7.

<a href="http://www.ivfnewsdirect.com/?p=1561tag:news.google.com,2005:cluster=http://www.ivfnewsdirect.com/?p=1561Mon, 19 Sep 2011 18:17:57 GMT 00:00″>NEWS: ESHRE Defines Poor Response to Ovarian Stimulation

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