Background To determine whether a minimal stimulation (MS) or high-dose stimulation (HDS) protocol is a better option for patients classified as poor ovarian responders (POR) in terms of reproductive and pregnancy outcomes. Materials and methods A database search for evaluation of the study outcome by using meta-analysis method was carried out. The primary outcome was the clinical pregnancy (CP) rate for each of two groups, namely, the MS and HDS groups. The secondary outcomes were the gonadotropin dose used, duration of stimulation, cancellation rate, number of oocytes retrieved, number of fertilized oocytes, number of embryos transferred and live birth rates. Results Across five databases, 4670 potential studies for further screening were selected. But ultimately only six studies, three RCTs and three retrospective or case control studies were selected that meet the Bologna criteria for POR. In all there were 624 cycles. Our meta-analysis indicated that the CP rates, cycle cancellation rates, durations of stimulation, numbers of oocytes fertilized and numbers of embryos transferred were not statistically significant. Clearly, the number of oocytes retrieved in the MS group was significantly lower than in the HDS group, while the HDS group consumed significantly higher doses of gonadotropins than the MS group. The live birth rates were significantly higher in the MS group than in the HDS group. Conclusion MS should be the first-line protocol for managing POR because the live birth rate is significantly higher, even with fewer oocytes retrieved.
BacKGroUnd: the aim of this study was to evaluate the ivF/icSi outcome in endometriosis patient who received Gnrh analog as downregulation prior control ovarian stimulation (coh). MethodS: a retrospective study involving 86 women with endometriosis who had undergone ivF at our center between January 2015 till december 2017. the clinical pregnancy rate analyzed as the primary endpoint. other outcomes measured include the total dose gonadotropin, the duration of stimulation, the number of oocytes retrieved, the number of Mii oocytes, the number of grade 1 embryo, number of embryo transfer and frozen, fertilization and cancellation cycle rate. reSUltS: three groups were analyzed including stage ii (n.=26), stage iii (n.=27) and stage iv (n.=31). the clinical pregnancy rate higher in stage ii compares to stage iii and iv (69.2% vs. 37% vs. 38.7%). Surprisingly, they also had more follicles, oocytes retrieved and MII oocytes. The number of grade 1 embryo also significant seen in stage II compared to stage iii and iv with p-value 0.006 (3.15±2.3 vs. 2±1.49 vs. 1.63±1.40). Women with stage iii and iv endometriosis required a higher dose of endometriosis significantly (2781.94±835.57 and 2708.73±962.07) compared to stage ii (2052.40±620.79). the duration of stimulation is almost similar in all stages of endometriosis. there was a similar result seen in the number of embryos transferred. A more frozen embryo is seen in stage II endometriosis significantly. conclUSionS: Gnrh analogue integrated with coh protocol is recommended as a proper stimulation protocol for endometriosis especially in stage ii endometriosis.
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