Commentary: Management Strategies for POSEIDON Groups 3 and 4.

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This commentary reviews management strategies for POSEIDON groups 3 and 4, highlighting that personalized stimulation with recombinant FSH and LH improves oocyte yield and pregnancy rates in poor ovarian response patients.

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This commentary evaluates management strategies for patients with poor ovarian response, specifically focusing on POSEIDON groups 3 and 4. It highlights that while the Bologna criteria failed to fully stratify this heterogeneous population, the POSEIDON classification better integrates oocyte quantity and quality based on age. The author reviews evidence supporting specific interventions, such as long GnRH agonist protocols, recombinant FSH combined with LH supplementation, and androgen pretreatment, noting their potential to improve live birth rates in these challenging cases. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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References

1. HaahrTDosoutoCAlviggiCEstevesSCHumaidanP. Management strategies for POSEIDON groups 3 and 4. Front Endocrinol. (2019) 10:614. 10.3389/fendo.2019.00614 2. PolyzosNPDevroeyP. A systematic review of randomized trials for the treatment of poor ovarian responders: is there any light at the end of the tunnel?. Fertil Steril. (2011) 96:1058–61.e7. 10.1016/j.fertnstert.2011.09.048 3. FerrarettiAPLa MarcaAFauserBCTarlatzisBNargundGGianaroliLet al. ESHRE working group on Poor Ovarian Response Definition. Hum Reprod. (2011) 26:1616–24. 10.1093/humrep/der092 4. AlviggiCConfortiASantiDEstevesSCAndersenCYHumaidanPet al. Clinical relevance of genetic variants of gonadotrophins and their receptors in controlled ovarian stimulation: a systematic review and meta-analysis. Hum Reprod Update. (2018) 24:599–614. 10.1093/humupd/dmy019 5. BlumenauerVCzerominUFehrDFiedlerKet al. DIR annual 2017. J Reproduktionsmed Endokrinol. (2018) 15:216–49. 6. EstevesSCRoqueMBedoschiGMConfortiAHumaidanPAlviggiC. Defining low prognosis patients undergoing assisted reproductive technology: POSEIDON criteria-the why. Front Endocrinol. (2018) 9:461. 10.3389/fendo.2018.00461 7. CoboAGarridoNCrespoJJoséRPellicerA. Accumulation of oocytes: a new strategy for managing low-responder patients. Reprod Biomed Online. (2012) 24:424–32. 10.1016/j.rbmo.2011.12.012 8. BühlerKFFischerR. Recombinant human LH supplementation versus supplementation with urinary hCG-based LH activity during controlled ovarian stimulation in the long GnRH-agonist protocol: a matched case-control study. Gynecol Endocrinol. (2012) 28:345–50. 10.3109/09513590.2011.633128 9. RahmanAFrancomanoDSagnellaFLisiFMannaC. The effect on clinical results of adding recombinant LH in late phase of ovarian stimulation of patients with repeated implantation failure: a pilot study. Eur Rev Med Pharmacol Sci. (2017) 21:5485–90. 10. FerrarettiAPGianaroliLMotrenkoTFelicianiETabanelliCMagliMC. LH pretreatment as a novel strategy for poor responders. Biomed Res Int. (2014) 2014:926172. 10.1155/2014/926172 11. von WolffMStutePEisenhutMMartiUBitterlichNBersingerNA. Serum and follicular fluid testosterone concentrations do not correlate, questioning the impact of androgen supplementation on the follicular endocrine milieu. Reprod Biomed Online. (2017) 35:616–23. 10.1016/j.rbmo.2017.07.012 Summary

Keywords

POR, POSEIDON IV, classification, GnRH analog, gonadotrophins, adjuvants, Rec-FSH, rec-LH Citation Bühler KF (2020) Commentary: Management Strategies for POSEIDON Groups 3 and 4. Front. Endocrinol. 10:920. doi: 10.3389/fendo.2019.00920 Received 07 October 2019 Accepted 17 December 2019 Published 24 January 2020 Volume 10 - 2019 Edited by Yang Xu, Peking University First Hospital, China Reviewed by Alessandro Conforti, University of Naples Federico II, Italy Updates Copyright © 2020 Bühler. 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: Klaus F. Bühler [email protected] This article was submitted to Reproduction, a section of the journal Frontiers in Endocrinology Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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