Abstract
The infertile patients with aging ovaries—also sometimes referred to as impending premature ovarian insufficiency (POI), impending premature ovarian failure (POF), or poor ovarian responders (POR), constitute a significant and increasing bulk of the patients appealing to IVF/ART. Different causes have been cited in the literature, among the identified etiologies, including chromosomal and genetic etiology, metabolic, enzymatic, iatrogenic, toxic, autoimmune, and infectious causes. Although the most successful and ultimate treatment of POI/POF/POR patients is egg donation (ED), many, if not most, of these infertile women are reluctant to consent to ED upon the initial diagnostic interview, requesting alternative solutions despite the low odds for success. Despite anecdotal case reports, no unequivocal treatment proved to be successful for these patients in prospective randomized controlled trials. Nevertheless, the addition of growth hormone (GH) to ovarian stimulation in POR with GH deficiency may improve the results of controlled ovarian hyperstimulation (COH) and the IVF success. In patients with autoimmune etiology for POR/POI, the combination of glucocorticosteroids, pituitary-ovarian suppression, and COH may be successful in achieving the desired conception.
Highlights
The infertile patients with aging ovaries— sometimes referred to as impending primary ovarian insufficiency (POI), impending premature ovarian failure (POF), or poor ovarian responders (POR), constitute a significant bulk of the patients appealing to IVF/ART [1,2,3]
Several comprehensive reviews have summarized the genetic etiology, and the list of chromosomal aberrations associated with POI/POF/POR has been increasing in the last decade due to great improvements in genetic technology [1, 12,13,14,15,16,17,18]
Three decades ago, we reported on a panhypopituitary patient who failed to conceive on several hMG/hCG controlled ovarian hyperstimulation (COH) cycles, and after addition of a very small amount of daily growth hormone (GH), along hMG/hCG, she successfully conceived and gave birth [74]
Summary
Edited by: Kazuhiro Kawamura, International University of Health and Welfare (IUHW), Japan. Reviewed by: Bunpei Ishizuka, Rose Ladies Clinic, Japan Eleonora Porcu, University of Bologna, Italy. Specialty section: This article was submitted to Endocrinology of Aging, a section of the journal
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