Treatment modalities for poor ovarian responders.

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). The term poor ovarian response (POR) was first introduced by the Bologna Criteria (BC), as a condition which includes at least two of the following features: advanced maternal age (⩾40 years), a previous POR with ⩽3 oocytes retrieved after conventional stimulation and/or an abnormal ovarian reserve test [i.e. antral follicle count (AFC) < 7 or anti-Müllerian hormone (AMH) < 1.1 ng/ml]. In the case of non-advanced maternal age and normal ovarian reserve test, POR is defined when a patient reports two episodes of POR following maximal ovarian stimulation.1 Although the BC represented a milestone in the field of in vitro fertilization (IVF),2 criticism about its substantial heterogeneity of the population may have prevented its widespread use in clinical practice. In this regard, a recent re-evaluation of these criteria has been proposed by the Poseidon Group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number)3 in order to overcome limitations of the BC. Some of the weaknesses of the BC are the ambiguity in defining risk factors, its substantial heterogeneity, the lack of accounting for oocyte quality, and other factors that can be associated with a low ovarian reserve.4–6 In this view, the Poseidon Group classification has been developed to better stratify the ‘low-prognosis patient’ by considering (1) qualitative and numerical parameters (e.g. expected aneuploidy rate and patient’s age); (2) ovarian reserve indicators (AFC and/or AMH); and (3) ovarian response to previous stimulation cycle, including four subgroups of patients: [Group 1: women younger than 35 years with AFC ⩾ 5 and AMH ⩾ 1.2; Group 2: women of age ⩾ 35 with AFC ⩾ 5 and AMH ⩾ 1.2; Group 3: women younger than 35 years old with AFC < 1 and AMH < 1.2 ng/ml; Group 4: ⩾35 with AFC < 1 and AMH < 1.2 ng/ml].