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Minerva Ginecologica 2018 February;70(1):89-98

DOI: 10.23736/S0026-4784.17.04132-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Prognosis and cost-effectiveness of IVF in poor responders according to the Bologna Criteria

Andrea BUSNELLI 1, 2 , Edgardo SOMIGLIANA 1, 2

1 Unit of Infertility, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 2 Università degli Studi di Milano, Milan, Italy


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Poor ovarian response (POR) to controlled ovarian hyperstimulation for in vitro fertilization (IVF) is one of the most challenging issue in the field of reproductive medicine. However, even if improving IVF outcome in poor responders (PORs) represents a main priority, the lack of a unique definition of POR has hampered research in this area. In order to overcome this impediment, an ESHRE Campus Workshop was organized in Bologna in 2010 and reached a consensus on the criteria for the diagnosis of POR (“Bologna Criteria”). In this review we aimed to estimate the prognostic potential of the ESHRE definition, to elucidate its possible weaknesses and to analyze the economic aspects of IVF in a population of poor responders (PORs). Available evidence confirmed that the Bologna criteria are able to select a population with a poor IVF prognosis thus supporting their validity. Nonetheless, different aspects of the definition have been criticized. The main points of debate concern the homogeneity of the population identified, the cut-off values chosen for the ovarian reserve tests and the risks factors other than age associated with POR. Data concerning the economic profile of IVF in PORs are scanty. The only published study on the argument showed that IVF in these cases is not cost-effective. However, considering the potential substantial impact of cost-effectiveness analyses on public health policies, there is the need for further and independent validations.


KEY WORDS: Fertilization in vitro - Prognosis - Cost-benefit analysis

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