Despite recent striking advances in assisted reproductive technology (ART), poor ovarian response (POR) diagnosis and treatment is still considered challenging. Poor responders constitute a heterogeneous cohort with the common denominator of under-responding to controlled ovarian stimulation. Inevitably, respective success rates are significantly compromised. As POR pathophysiology entails the elusive factor of compromised ovarian function, both diagnosis and management fuel an ongoing heated debate depicted in the literature. From the criteria employed for diagnosis to the plethora of strategies and adjuvant therapies proposed, the conundrum of POR still puzzles the practitioner. What is more, novel treatment approaches from stem cell therapy and platelet-rich plasma intra-ovarian infusion to mitochondrial replacement therapy have emerged, albeit not claiming clinical routine status yet. The complex and time sensitive nature of this subgroup of infertile patients indicates the demand for a consensus on a horizontally accepted definition, diagnosis and subsequent effective treating strategy. This critical review analyzes the standing criteria employed in order to diagnose and aptly categorize POR patients, while it proceeds to critically evaluate current and novel strategies regarding their management. Discrepancies in diagnosis and respective implications are discussed, while the existing diversity in management options highlights the need for individualized management.

The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first‐trimester pregnancies complicated by threatened abortion (TACP) and its relevance to obstetric outcome. Serum levels of Th1‐type cytokines interleukin‐1β (IL‐1β), tumor necrosis factor alpha (TNF‐alpha), and Th2‐type cytokine interleukin 6 (IL‐6) were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A) and compared with the corresponding levels of 31 gestational age‐matched women with TACP and successful outcome at admission (group B1) and discharge (group B2) and 22 gestational age‐matched women with first‐trimester uncomplicated pregnancy (group C) who served as controls. Mann‐Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL‐1β and TNF‐alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL‐6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first‐trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL‐1β, TNF‐alpha, and unaltered IL‐6 levels, is relevant to a negative obstetric outcome.

Purpose: To analyze laparoscopically treated cases of adenomyosis based on intraoperative and histopathology findings and to correlate different types with patients’ presenting symptoms and characteristics, as well as with the surgical approach. Materials and Methods: Sixtyeight women who underwent laparoscopic treatment of adenomyosis at a referral center for gynecological laparoscopy. Results: Four distinct types of adenomyosis could be identified: diffuse, sclerotic, nodular, and cystic (54.5%, 13%, 28%, and 4.5% of cases, respectively). Menorrhagia as the main presenting symptom was significantly more frequent in patients with the diffuse type (84%) compared to those with sclerotic (44%) and nodular (37%) types (p = 0.025 and p = 0.001, respectively). All cases of cystic and nodular adenomyosis were treated by laparoscopic excision of the lesion. Eighty-nine percent of patients with sclerotic adenomyosis were treated with wide laparoscopic excision of the abnormal tissue. Eighty-one percent of patients with diffuse adenomyosis were treated with laparoscopic hysterectomy. Conclusions: Adenomyosis can be classified in four distinct types with differences in the presenting symptoms, as well as in the ideal surgical approach.