抗逆转录病毒疗法中预后不良的患者:德尔菲共识,以确定潜在的临床意义并衡量 POSEIDON 标准的影响。

IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Carlo Alviggi, Peter Humaidan, Robert Fischer, Alessandro Conforti, Michael H Dahan, Antonio La Marca, Raoul Orvieto, Nikolaos P Polyzos, Matheus Roque, Sesh K Sunkara, Filippo Maria Ubaldi, Lan Vuong, Hakan Yarali, Thomas D'Hooghe, Salvatore Longobardi, Sandro C Esteves
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引用次数: 0

摘要

背景:目前,对于抗逆转录病毒疗法中低度预后妇女的最佳管理尚未达成共识。在此次德尔菲共识中,国际专家小组就一系列有文献支持的共识声明提供了真实世界的临床观点,这些声明涉及 POSEIDON 标准对 ART 中预后不良妇女的总体相关性:采用德尔菲共识框架,12 位专家和两位科学协调员讨论并修正了科学协调员提出的声明和支持性参考文献(第一轮)。声明通过在线调查分发给由 53 位专家组成的扩大小组,其中 36 位专家采用六点李克特量表(1 = 完全同意;2 = 非常同意;3 = 同意;4 = 不同意;5 = 非常不同意;6 = 完全不同意)对每项声明的同意或不同意程度进行匿名投票(第二轮)。如果超过 66% 的参与者同意或不同意,则达成共识:扩大小组对十七项声明进行了投票,并根据相关性对其进行了细分。除一项声明外,所有声明均在第一轮达成共识;其余声明在重新措辞后达成共识。声明按照影响、低预后验证、结果和患者管理进行了分类。POSEIDON 标准既及时又符合临床实际。首选的成功衡量标准是累积活产,关键的管理策略包括使用重组 FSH 制剂、补充 r-hLH、增加剂量以及通过玻璃化进行卵母细胞/胚胎积累。可考虑使用 ART 计算器和卵泡-卵母细胞指数等工具。现在需要在每个 POSEIDON 组别中开展大型前瞻性研究,以验证现有的回顾性数据:本德尔菲共识概述了专家对 POSEIDON 标准对卵巢刺激低预后女性临床意义的看法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patients with low prognosis in ART: a Delphi consensus to identify potential clinical implications and measure the impact of POSEIDON criteria.

Background: Currently, there is no consensus on the optimal management of women with low prognosis in ART. In this Delphi consensus, a panel of international experts provided real-world clinical perspectives on a series of literature-supported consensus statements regarding the overall relevance of the POSEIDON criteria for women with low prognosis in ART.

Methods: Using a Delphi-consensus framework, twelve experts plus two Scientific Coordinators discussed and amended statements and supporting references proposed by the Scientific Coordinators (Round 1). Statements were distributed via an online survey to an extended panel of 53 experts, of whom 36 who voted anonymously on their level of agreement or disagreement with each statement using a six-point Likert-type scale (1 = Absolutely agree; 2 = More than agree; 3 = Agree; 4 = Disagree; 5 = More than disagree; 6 = Absolutely disagree) (Round 2). Consensus was reached if > 66% of participants agreed or disagreed.

Results: The extended panel voted on seventeen statements and subcategorized them according to relevance. All but one statement reached consensus during the first round; the remaining statement reached consensus after rewording. Statements were categorized according to impact, low-prognosis validation, outcomes and patient management. The POSEIDON criteria are timely and clinically sound. The preferred success measure is cumulative live birth and key management strategies include the use of recombinant FSH preparations, supplementation with r-hLH, dose increases and oocyte/embryo accumulation through vitrification. Tools such as the ART Calculator and Follicle-to-Oocyte Index may be considered. Validation data from large, prospective studies in each POSEIDON group are now needed to corroborate existing retrospective data.

Conclusions: This Delphi consensus provides an overview of expert opinion on the clinical implications of the POSEIDON criteria for women with low prognosis to ovarian stimulation.

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来源期刊
Reproductive Biology and Endocrinology
Reproductive Biology and Endocrinology 医学-内分泌学与代谢
CiteScore
7.90
自引率
2.30%
发文量
161
审稿时长
4-8 weeks
期刊介绍: Reproductive Biology and Endocrinology publishes and disseminates high-quality results from excellent research in the reproductive sciences. The journal publishes on topics covering gametogenesis, fertilization, early embryonic development, embryo-uterus interaction, reproductive development, pregnancy, uterine biology, endocrinology of reproduction, control of reproduction, reproductive immunology, neuroendocrinology, and veterinary and human reproductive medicine, including all vertebrate species.
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