{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:40:30Z","timestamp":1791758430126,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Poor ovarian response (POR) complicates a substantial proportion of in\u00a0vitro fertilization (IVF) cycles, frequently causing cycle cancellation and suboptimal reproductive outcomes. Conventional follicular\u2010phase ovarian stimulation (FPOS) protocols often yield limited results, prompting the evaluation of alternative strategies such as luteal\u2010phase ovarian stimulation (LPOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study assesses whether LPOS presents similar efficacy in terms of assisted reproductive technology (ART) outcomes compared with stimulation in the conventional follicular phase in women with POR according to Bologna criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Comprehensive electronic searches were performed up to July 2024 across MEDLINE (via PubMed), EMBASE, SCOPUS, LILACS, SciELO, CINAHL, PsycINFO, AMED,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link>\n                      , WHO ICTRP, and Cochrane databases, with additional hand\u2010searching of reference lists and gray literature. Inclusion criteria were comparative studies evaluating LPOS versus FPOS in poor ovarian responders undergoing IVF\/intracytoplasmic sperm injection. Studies involving DuoStim protocols, lacking control groups, or with incomplete data were excluded. Study selection, data extraction, and quality assessments (RoB 2 for randomized clinical trial (RCTs); ROBINS\u2010I for observational studies) were conducted independently by multiple reviewers. Meta\u2010analysis utilized random\u2010effects models to generate pooled mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE methodology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five studies (312 patients; 114 LPOS vs. 198 FPOS) met the inclusion criteria. LPOS resulted in a non\u2010significant increase in cumulus\u2013oocyte complexes retrieved (MD 0.56; 95% CI \u20130.12 to 1.23) and mature (MII) oocytes (MD 0.061; 95% CI \u20130.04 to 0.126), with moderate heterogeneity. The number of embryos reaching day 3 was significantly higher with LPOS (MD 0.77; 95% CI 0.29 to 1.25). No significant differences were found for clinical pregnancy rate (RR 1.26; 95% CI 0.78 to 2.02), fertilization rate (RR 1.04; 95% CI 0.91 to 1.20), pregnancy loss rate (RR 0.97; 95% CI 0.27 to 3.43), or cancellation rate (RR 0.89; 95% CI 0.34 to 2.30). Stimulation duration was significantly longer in LPOS, while total gonadotropin dose and serum estradiol on trigger day did not differ significantly. The overall certainty of evidence ranged from low to very low; therefore, findings should be interpreted as preliminary and might change as additional studies become available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Luteal\u2010phase ovarian stimulation appears to be an effective alternative to conventional FPOS for poor responders, demonstrating similar reproductive outcomes with possible quantitative benefits in embryo yield. However, the evidence is limited, and research is ongoing; therefore, results are pending and further large\u2010scale randomized controlled trials are required to confirm these findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:styled-content style=\"fixed-case\">PROSPERO<\/jats:styled-content>\n                      Registration\n                    <\/jats:title>\n                    <jats:p>This review was prospectively registered in PROSPERO (ID: CRD420251010075; registration date: 12\/05\/2025).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70883","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T20:33:33Z","timestamp":1773002013000},"page":"608-620","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Luteal phase stimulation versus follicular phase stimulation in poor ovarian responders: A systematic review and a meta\u2010analysis"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5291-3693","authenticated-orcid":false,"given":"Vittorio","family":"Agrifoglio","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo  Palermo Italy"},{"name":"Cliniques Universitaires Saint\u2010Luc Universit\u00e9 Catholique de Louvain  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"D'Amato","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, Unit of Obstetrics and Gynecology University of Bari, \u201cAldo Moro,\u201d Policlinico of Bari  Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano Catello","family":"Di Donna","sequence":"additional","affiliation":[{"name":"Unit of Gynecologic Oncology National Cancer Institute  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika","family":"Marino","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences Sant'Anna Hospital, University of Torino  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Simone","family":"Lagan\u00e0","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo  Palermo Italy"},{"name":"Unit of Obstetrics and Gynecology \u201cPaolo Giaccone\u201d Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Venezia","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo  Palermo Italy"},{"name":"Unit of Obstetrics and Gynecology \u201cPaolo Giaccone\u201d Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Vinci","sequence":"additional","affiliation":[{"name":"Department of Woman, Child and General and Specialized Surgery University of Campania \u201cLuigi Vanvitelli,\u201d  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Riemma","sequence":"additional","affiliation":[{"name":"Department of Woman, Child and General and Specialized Surgery University of Campania \u201cLuigi Vanvitelli,\u201d  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Etrusco","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo  Palermo Italy"},{"name":"Cliniques Universitaires Saint\u2010Luc Universit\u00e9 Catholique de Louvain  Brussels 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