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Front. Endocrinol. | doi: 10.3389/fendo.2019.00281

Ovarian reserve markers to identify poor responders in the context of Poseidon classification

 Valentina Grisendi1, Elisa Mastellari2 and  Antonio La Marca1*
  • 1Mother-Infant Department, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria di Modena, Italy
  • 2University of Modena and Reggio Emilia, Italy

It is well known that poor ovarian reserve is a cause of infertility, poor response to gonadotrophin stimulation and poor success rate after in vitro fertilization (IVF) cycles. Some years ago a consensus was elaborated on precise criteria which can lead to a correct identification of poor responders (the Bologna criteria). More recently, the POSEIDON group has proposed a new stratified classification of patients with low prognosis, also with the aim of providing clinical indications for the management of these patients.
A literature search was carried out for studies that investigated the ability of ovarian reserve markers, in particular AMH and AFC, to predict poor ovarian response in IVF cycles; secondly, studies regarding the Bologna criteria and their prognostic value were analyzed and available literature on POSEIDON classification was reported.
The most recent markers of ovarian reserve (serum AMH and ultrasound AFC) have shown to provide a direct and accurate measurement of ovarian follicle pool. These markers have generally shown comparable predictive power for ovarian response and a number of retrieved oocytes in IVF cycles.
“Abnormal ovarian reserve test” is a very important parameter both in the Bologna criteria and in the POSEIDON classification. Several studies have already been published about the reproductive outcome of patients defined as poor responders according to the ESHRE Bologna criteria: all of them agree on the poor IVF outcome and low pregnancy rate of these patients. Instead, being the POSEIDON classification of very recent publication, the efficacy of the POSEIDON approach in improving management and outcomes of POR patients has yet to be tested and validated with future prospective clinical trials.
Prediction of poor response may help clinicians choose the stimulation protocol with the aim of gaining patient compliance and cost reduction, and many efforts have been made by researchers in this sense, including the formulation of the Bologna criteria and of the POSEIDON classification, in which the ovarian reserve markers (AMH and AFC) play a fundamental role.

Keywords: IVF, Poor response, ovarian reserve markers, AMH, AFC, Bologna criteria, live birth rate, POSEIDON classification

Received: 21 May 2018; Accepted: 16 Apr 2019.

Edited by:

Peter Humaidan, Aarhus University, Denmark

Reviewed by:

Jung Ryeol Lee, Seoul National University College of Medicine, South Korea
Andreas N. Schüring, University Hospital Münster, Germany
Carlo Alviggi, University of Naples Federico II, Italy  

Copyright: © 2019 Grisendi, Mastellari and La Marca. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Antonio La Marca, Azienda Ospedaliero-Universitaria di Modena, Mother-Infant Department, Section of Obstetrics and Gynecology, Modena, 41123, Modena, Italy, antlamarca@libero.it