Įndocrine variations among infertile patients primarily appear to be connected with the decline in feedback from extra- and intra-ovarian factors at the hypothalamic-pituitary-ovarian axis. Exclusively, genome-wide association studies have identified several linked loci of small genetic variations which determines the fetal antral follicle development and the progressive decline of the residual follicle pool over the course of the human reproductive span. Iatrogenic procedures such as surgical removal of endometriomas and cysts are also responsible for the diminished ovarian reserve (DOR). Moreover, advanced maternal age increased the risk of chromosomal abnormalities along with adverse maternal-perinatal outcomes such as fetal loss through miscarriages, obstetrical complications, severe maternal morbidities and coping with difficult management of pregnancy. The poor ovarian response is a substantial limiting factor amplified with higher maternal age and associated with a considerably lower likelihood of pregnancy. Although several prospective population-based studies have investigated possible links between female age and infertility, however, the overall management of poor responders remains controversial during controlled ovarian stimulation.
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