Follicle-stimulating hormone (FSH) is the driving factor behind folliculogenesis and plays an essential role in the success of in vitro fertilisation (IVF). However, in a subset of patients, characterised as poor responders, FSH fails to stimulate a sufficient ovarian response to achieve the maximum potential cumulative fertility of ART methods. The management of these patients is challenging, and the optimal FSH dosage remains unclear. This systematic review focuses on the available literature since 2011 to allow for the stratification of poor responders to be as closely aligned as possible to the European Society of Human Reproduction and Embryology (ESHRE) definition, announced in that year, and the POSEIDON criteria, published later in 2016. We also provide a review and critical appraisal of primary research papers reporting on randomised controlled trials, as they can provide quality evidence compared to other methods. Although several studies have explored the concept of modifying treatment protocols based on poor ovarian response status, the results suggest that simply a higher FSH dose above conventional thresholds is ineffective in providing substantial fertility benefits. The synthesis of the outcomes from the reviewed literature underlines the importance of tailored protocols that address both the quantity and quality of oocytes, achieving improved reproductive outcomes while minimising the physical and economic burdens of treatment. Future research is recommended to validate these strategies in well-designed RCTs with large sample sizes and robust definitions of poor response, according to international standards.
Παύλος Ν. Παπαδόπουλος (Wed,) studied this question.