A controlled trial of natural cycle versus microdose gonadotropin-releasing hormone analog flare cycles in poor responders undergoing in vitro fertilization

Morgia, Francesco; Sbracia, Marco; Schimberni, Mauro; Giallonardo, Annalise; Piscitelli, Claudio; Giannini, Pierluigi; Aragona, Cesare

doi:10.1016/j.fertnstert.2003.11.031

Cited by 130 publications

(73 citation statements)

References 31 publications

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“…The aim of controlled ovarian hyperstimulation is to reduce the cycle cancellation rate, increment the number of oocytes and top-quality embryos and ensure better results in terms of pregnancy rates [2][3][4][5]. However, in different clinical situations such as reduced ovarian reserve, previous oncologic or estrogen-dependent disease the natural cycle continue to be considered the method of choice for IVF treatment [6][7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study

Greco

Litwicka

Arrivi

et al. 2013

J Assist Reprod Genet

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Purpose To evaluate the role of co-transfer of embryos derived from vitrified oocytes accumulated during the previous modified natural cycles and an embryo developed from the last one as an alternative to repetitive single embryo transfer in a fresh modified natural cycle. Methods Thirty-six patients underwent ICSI procedure with three frozen natural oocytes supplemented by a fresh one obtained from the fourth modified natural cycle. Thirty-one controls received at least three consecutive single embryo transfer in a fresh modified natural cycle. Results In the study group the oocyte retrieval, survival and total fertilization rate were 73.0 %, 78.1 %, and 64.5 %, respectively. Fifty-two embryos were transferred in 29 transfers. In the control group the oocyte retrieval and fertilization rate was 77.4 % and 83.7 %, respectively. Fifty single embryo transfers were performed. Of a total 14 pregnancies obtained in the study group 10 were defined as clinical and 4 as abortions. In the control group a total of 8 single clinical pregnancies and 2 miscarriages were encountered. The overall (20.0 % vs 48.2 %) and the clinical (16.0 % vs 34.4 %) pregnancy rate were significantly higher in the study group having cumulative embryo transfer following the oocyte accumulation. Conclusions These data demonstrate that the co-transfer of embryos derived from vitrified oocytes accumulated during the previous modified natural cycles and an embryo developed from the last fresh modified natural cycle assure an excellent clinical outcome with the overall and clinical pregnancy rate significantly higher compared to the repetitive single embryo transfer in a fresh modified natural cycle.

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Section: Introductionmentioning

confidence: 99%

Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study

Greco

Litwicka

Arrivi

et al. 2013

J Assist Reprod Genet

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show abstract

“…It has been reported that cumulative ongoing pregnancy rate was 34.0% after three cycles of minimal stimulation IVF [21], 43% and 42% after three and five natural oocyte pickup cycles [22,23] and 46% after four started natural cycles [3]. Previous studies also found that the natural cycle works at least as well as the COH in poor responder women who failed previous ovarian hyperstimulation [9,24]. In the present case report, the case 1 was successfully pregnant at her first natural IVF/IVM cycle.…”

Section: Discussionmentioning

confidence: 99%

Natural cycle IVF/IVM may be more desirable for poor responder patients after failure of stimulated cycles

Zhou

et al. 2011

J Assist Reprod Genet

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Objective To describe pregnancies and live births resulted from natural cycle IVF combined with in-vitro maturation (natural-cycle IVF/IVM) for three poor responder women after failure of stimulated cycles. Methods For case 1 and 2, the mature oocytes from aspirated follicles were inseminated by intracytoplasmic sperm injection (ICSI) immediately; immature oocytes were matured in vitro, and the embryos from mature and immature oocytes transferred on day 3 after oocyte retrieval. For case 3, 3 consecutive natural cycles were performed, in which the matured oocytes from in vivo or in vitro were vitrified in the first and second cycle, and warmed on the retrieval day of the third fresh cycle. Then the embryos resulted from vitrified-warmed and fresh oocytes were transferred. Results A total of 15 oocytes were obtained from the 7 retrieval cycles for the three cases. The case 1 was successfully pregnant at her first natural cycle, and case 2 was pregnant after two consecutive cycles. The two cases had successfully delivered and case 3 was in her ongoing pregnancy at the time of submission. Conclusion These results demonstrate that natural-cycle IVF/IVM might be a reasonable and efficient treatment alternative for poor responder patients when stimulated cycle has failed.

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“…In a study done in comparison with microdose protocol, it was seen that natural cycle can be as effective as controlled ovarian stimulation, especially in young patients with DOR and higher implantation rate is seen. 47 In patients with DOR, the implantation rates are similar in natural as well as stimulated cycles. Hence, natural cycle is preferred in view of low cost as well as more patient friendly approach.…”

Section: Managementmentioning

confidence: 98%

Diminished Ovarian Reserve, Causes, Assessment and Management

Arora¹,

Kaur²

2013

International Journal of Infertility &Amp; Fetal Medicine

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Diminished ovarian reserve predicts diminished ovarian response to stimulation but does not predict cycle fecundity. It has been recently defined by ESHRE, the Bologna's criteria, according to which at least two of the following three features should be present: (1) Age >40 years/any other risk factor for DOR, (2) abnormal ovarian reserve test, i.e. antral follicle count, AMH, (3) poor ovarian response in a previous stimulated cycle, i.e. less than three follicles after standard gonadotropin stimulation. Poor response to maximal stimulation on two previous occasions also defines DOR.The treatment options are limited. Avoiding the GnRH agonist long protocol and stimulation with microdose flare or antagonist protocol yields better results. Adjuvant therapy with LH, DHEAS and growth hormone shows some benefit in improving the oocyte yield. It is advisable to perform ICSI for all obtained oocytes and some advocate assisted hatching. Pregnancy rates are, however, poor and often these patients require ovum donation. Developing tests that will diagnose DOR in a low-risk population will allow women to plan their reproductive careers early.

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A controlled trial of natural cycle versus microdose gonadotropin-releasing hormone analog flare cycles in poor responders undergoing in vitro fertilization

Cited by 130 publications

References 31 publications

Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study

Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study

Natural cycle IVF/IVM may be more desirable for poor responder patients after failure of stimulated cycles

Diminished Ovarian Reserve, Causes, Assessment and Management

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