{"id":114,"title":"Why have four decades of research into decreased ovarian reserve (DOR) failed to improve live birth rates?","title_zh":"四十年卵巢储备减退（DOR）研究为何未能改善活产率","url":"https://pubmed.ncbi.nlm.nih.gov/42970091","doi":"10.1007/s00404-026-08550-9","pmid":"42970091","journal":"Arch Gynecol Obstet","kind":"paper","lang":"en","published_at":"2026-08-05T00:00:00+00:00","fetched_at":"2026-11-08T03:43:53+00:00","authors":["Rafael ZB","Orvieto R"],"primary_topic":"oocyte","topics":[{"slug":"oocyte","score":6.0,"hits":["oocyte","ovarian","ovarian reserve"]},{"slug":"art-clinical","score":5.0,"hits":["live birth","ovarian stimulation"]},{"slug":"repro-endo","score":4.0,"hits":["dor"]},{"slug":"pgt","score":1.0,"hits":["euploidy"]},{"slug":"repro-aging","score":1.0,"hits":["advanced maternal age"]}],"topic_score":6.0,"preference_score":5.0,"preference_labels":["可转化到 ART 实验室的发现"],"llm_score":76.0,"final_score":81.0,"score_dims":{"novelty":62,"rigor":72,"impact":74,"relevance":94,"translation":76},"recommend_reason":"以批判性视角重新审视 DOR 研究长期停滞的生物学与方法学根源，提出的年龄分层、重复反应标准和真终点优先建议，对临床研究设计、患者咨询和避免无效附加干预有直接参考价值；不过它属于叙述性综述，不含新数据。","keywords":["卵巢储备减退","活产率","年龄分层","替代终点","卵巢刺激","研究设计"],"selected":1,"story_id":470,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-art","source_name":"PubMed · 辅助生殖临床","source_tier":1,"mention_count":2,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"该综述系统回顾了四十年来卵巢储备减退（DOR）领域的研究与临床创新，指出 DOR 患者的活产率仍不理想。作者认为原因有两方面：一是确凿的生物学现实，即随母亲年龄增长，卵母细胞整倍体率呈指数下降；二是持续存在的方法学缺陷，包括临床试验纳入高度异质队列、未按年龄等关键变量充分分层、以替代终点取代活产、忽视周期间与操作者变异。现有证据显示，尚无任何卵巢刺激方案、辅助治疗或实验室附加技术能稳定改善结局。作者主张按窄年龄区间分层、采用重复反应标准并以真实终点优先，才能推动该领域进展，并提供基于证据的现实咨询。","summary":"Despite forty years of intense research and multitudinous clinical innovations, live birth rates (LBR) among women diagnosed with decreased ovarian reserve (DOR) remain disappointingly poor. Is this because a solution has not yet been discovered, or are we searching in the wrong way? This persistent failure is probably the product of both undisputable biological realities, the exponential decline in oocyte euploidy with advanced maternal age, and persistent methodological flaws, most notably the inclusion of highly heterogeneous cohorts in clinical trials and inadequate stratification by critical variables, such as age. No ovarian stimulation protocol, adjuvant therapy, or laboratory add-on has consistently improved outcomes. The grouping of young and older DOR women in clinical studies, the focus on surrogate endpoints over live birth, and failure to account for cycle-to-cycle and operator variability further obscure valid conclusions and mislead both clinicians and patients. In this review, we delineate the evolution of DOR research, drilling down to the biological, technical, and methodological roots of failed progress. We argue that only by rigorously stratifying study populations by narrow age bands, repeated response criteria and prioritizing true endpoints, can future research genuinely advance the field and provide realistic, evidence based counseling. Clinical humility and research rigor are prerequisites for sparing patients needless interventions and false hope.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}