Ovarian Activation Surgical Techniques for Women with Premature Ovarian Insufficiency or Poor Ovarian Response: A Systematic Review

Background: In vitro fertilization (IVF) with egg donation often stands as the sole treatment option for women with premature ovarian insufficiency (POI) or poor ovarian response (POR); for this reason, alternative techniques are being developed, among which stand surgical techniques for ovarian activation. The aim of the present study was to evaluate the effectiveness of surgical techniques for ovarian activation in patients affected by POI or POR. Materials and Methods: In this systematic review study, a comprehensive search of the literature was carried out on the principal databases. Only original studies reporting the treatment of POI or POR using surgical techniques for ovarian activation in human subjects were deemed eligible for inclusion in this qualitative analysis. Results: Overall, 187 patients with POI and 65 patients with POR were treated with experimental surgical techniques. Among the POI patients, 10 pregnancies and 8 live births were achieved. In the POR group, 18 pregnancies were reported with 14 live births. Conclusion: Ovarian fragmentation (OF) appears to be a promising method for treating POI, although large sample randomized controlled trials (RCTs) are necessary to confirm this hypothesis. Regarding POR, surgical techniques do not improve IVF outcomes, and thus should not be proposed, although they may lead to a slight increase in ovarian reserve markers as compared with before treatment. Both clinical and basic science studies are highly demanded to better understand the molecular mechanisms underlying some partially promising results, with the aim of improving currently available techniques.