Women undergoing assisted reproductive technologies (ART), patients with PCOS, and poor ovarian response
Care Setting
Reproductive endocrinology clinics and assisted reproduction centers
Key Highlights
Endocrine interventions in ART improve intermediate outcomes but do not always increase pregnancy or live birth rates.
Follicular function regulation is closely linked to cellular metabolism and oxidative stress, especially in PCOS and poor-prognosis cases.
Follicle fate decisions depend on context-specific receptor networks and pathway crosstalk, offering alternative compensatory mechanisms.
Guideline-Based Recommendations
Diagnosis
Use POSEIDON criteria for refined stratification of poor ovarian response based on age, biomarkers, and stimulation history.
Management
Select oocyte maturation triggers (GnRHa, hCG, dual) balancing efficacy and safety; GnRHa preferred for lower OHSS risk in high responders.
Consider FSH priming to improve in vitro maturation metrics, acknowledging variable effects on broader reproductive outcomes.
Individualize gonadotropin dosing in ART cycles based on patient prognosis rather than assuming higher doses improve outcomes.
In PCOS, explore combination therapies (e.g., Metformin and Curcumin) to target endocrine and metabolic dysfunction.
Monitoring & Follow-up
Monitor oxidative stress markers and metabolic parameters in PCOS patients to assess follicular microenvironment health.
Risks
Be vigilant for ovarian hyperstimulation syndrome (OHSS) risk when selecting maturation trigger strategies.
Recognize that aggressive stimulation may not improve outcomes and may increase costs and psychological burden.
Patient & Prescribing Data
Predicted high responders, poor ovarian responders (POSEIDON groups), and PCOS patients undergoing ART
GnRHa triggers reduce OHSS risk without compromising efficacy; Follitropin delta shows promise in hypo-responders; increasing gonadotropin doses may not universally improve live birth rates.
Clinical Best Practices
Prioritize patient-centered outcomes such as live birth rates over intermediate laboratory metrics when evaluating ART success.
Apply individualized treatment protocols guided by robust evidence and patient stratification frameworks like POSEIDON.
Integrate metabolic and endocrine assessments in managing PCOS to address both reproductive and systemic health.
Consider oxidative stress modulation as a therapeutic target in follicular dysfunction.
