A systematic review of randomized trials for the treatment of poor ovarian responders: is there any light at the end of the tunnel?

Objective: To assess the definitions for poor ovarian responders used among randomized trials for the treatment of women with impaired response to stimulation. Design: Systematic review. Setting: None. Patient(s): Poor ovarian responders. Intervention(s): Treatment modalities for the management of poor ovarian responders. Main Outcome Measure(s): Number and nature of the criteria used to define poor ovarian response to stimulation and threshold values used. Result(s): Among 47 randomized trials, 41 different definitions for the patients with poor ovarian response have been used. No more than 3 trials used the same definition, whereas even trials from the same research groups used different definitions across different trials. None of the criteria used was adopted in more than 50% of the trials. Age and antral follicle count were adopted only in 9% of the definitions, whereas the criteria of number of follicles on the final stimulation day and number of oocytes retrieved were used in more than 40% of the trials; nonetheless, even for these criteria, the threshold values were consistently different. Conclusion(s): The variability regarding the definition of poor ovarian responders appears to be striking. Although the Bologna criteria developed by European Society for Human Reproduction and Embryology consensus in 2011 aim to define a consistent group of patients, their applicability needs to be tested through clinical trials. Meanwhile, meta-analyses of the currently available trials should be strongly discouraged because they may lead to the adoption of interventions of ambiguous value. (Fertil Steril (R) 2011;96:1058-61. (C) 2011 by American Society for Reproductive Medicine.)