Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

Lazer, Tal; Dar, Shir; Shlush, Ekaterina; Kudmani, Basheer S. Al; Quach, Kevin; Sojecki, Agata; Glass, Karen; Sharma, Priya Vrat; Baratz, Ari; Librach, Clifford L.

doi:10.1155/2014/581451

Cited by 32 publications

(22 citation statements)

References 24 publications

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“…Previous work by our group has shown that an aromatase inhibitor improves ovarian response to FSH in patients undergoing ovulation induction and intrauterine insemination [ 4 ]. Later, Lazer et al [ 5 ] in a retrospective study, compared poor responders treated with letrozole and low dose gonadotropins vs. poor responders treated with only high dose gonadotropins during IVF cycles. They found a higher clinical pregnancy rate and a higher live birth rate in the group of patients treated with letrozole and low dose gonadotropins.…”

Section: Introductionmentioning

confidence: 99%

Does daily co-administration of letrozole and gonadotropins during ovarian stimulation improve IVF outcome?

Haas

Bassil

Meriano

et al. 2017

Reprod Biol Endocrinol

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BackgroundFor the last year we have been treating normal responders with gonadotropins and letrozole during the whole stimulation in order to improve response to FSH by increasing the intrafollicular androgen concentration, and to reduce circulating estrogen concentrations. The aim of this study was to compare the IVF outcome of normal responders treated with letrozole and gonadotropins during ovarian stimulation with patients treated with gonadotropins only.MethodsA single centre retrospective cohort study of 174 patients (87 in each group).ResultsThe age of the patients was comparable between the groups. Estradiol levels were significantly higher in the control group (6760 pmol/L vs. 2420 pmol/L respectively, p < 0.01), and the number of follicles ≥15 mm at the trigger day was significantly lower in the control group (7.9 vs. 10, p = 0.02). The number of retrieved oocytes (10 vs. 14.5, p < 0.01), MII oocytes (7.9 vs. 11.2, p < 0.01) and blastocysts (2.7 vs. 4.0, p = 0.02) was significantly higher in the study group. We found no significant differences in the cumulative pregnancy outcome between the two groups (65.2% vs 58.3% p = NS).ConclusionsWe conclude that co-treatment with letrozole improves the IVF outcome in normal responders in terms of increased number of blastocysts obtained without increasing the pregnancy rate or the risk of OHSS.

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Section: Introductionmentioning

confidence: 99%

Does daily co-administration of letrozole and gonadotropins during ovarian stimulation improve IVF outcome?

Haas

Bassil

Meriano

et al. 2017

Reprod Biol Endocrinol

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“…In addition, lower FSH receptor expression levels in granulosa cells may also be found in this group of patients. 2 Minimal stimulation usually refers to stimulation protocols that yield a maximum of five oocytes. This concept was first introduced by Corfman.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with POR, often characterized by advanced maternal age, have a higher cycle cancellation rate, a higher miscarriage rate, and a significantly reduced live birth rate per cycle relative to patients without POR. 2 The management of POR is highly controversial. There is currently no consensus regarding the "ideal" protocol and, as of yet, no treatment protocol has proven to be superior for this group.…”

Section: Introductionmentioning

confidence: 99%

Conventional IVF versus modified natural IVF for poor ovarian reserve patients

Mh¹,

Endeley²,

Mostafa³

2019

MOJWH

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Key Message:In the treatment of patients with a markedly reduced ovarian reserve who prefer fresh embryo transfer, conventional IVF (antagonist protocol) is associated with more follicles, retrieved and fertilized oocytes, and clinical pregnancies than Modified Natural Cycle IVF. We, therefore, recommend conventional IVF over MNC in the treatment of this patient population. AbstractPurpose: Women with diminished ovarian reserve have low live birth rates following assisted reproduction treatment. In this study, we investigate whether modified natural cycle IVF (MNC), involving Clomiphene Citrate and low dose gonadotrophins, can enhance clinical pregnancy rate (CPR) over conventional IVF for diminished ovarian reserve patients who prefer fresh embryo transfer. Methods:We conducted a retrospective analysis to compare conventional IVF (GnRH antagonist protocol) versus MNC in the treatment of 72 patients with markedly diminished ovarian reserve.Results: 46 patients had conventional IVF and 26 patients had MNC. Patients with conventional IVF had significantly more follicles: 5.5 (1-11) vs 2.5 (1-6), P<0.0001; more retrieved oocytes: 4 (0-8) vs 1.68 (0-5), P<0.0001; and more fertilized oocytes: 2.4 (0-8) vs 0.8 (0-4), P<0.0001. No oocytes were retrieved in 5 (10.9%) patients in the conventional group, compared with 13 (50%) in the MNC group, P=0.0005. CPR per embryo transfer in the conventional group was 43.2%, while none of the patients in the MNC group achieved pregnancy. Within the conventional group, there was no significant difference between the total FSH used in pregnant and non-pregnant patients (3129±307 IUs vs 2984±497 IUs, P=0.3933). Conclusions:This study demonstrates that using conventional IVF in the treatment of markedly reduced ovarian reserve patients who prefer fresh embryo transfer is associated with more follicles; more retrieved and fertilized oocytes, a higher CPR and a lower chance of cycle cancellation compared with MNC.

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“…An older, non-randomized study compared minimal stimulation to high-dose COH for POR patients in IVF cycle (86). The clinical PR and the LBR were significantly higher in the mild stimulation protocol compared to the high COH protocol, P = 0.007 and P = 0.034, respectively (86).…”

Section: Type Of Coh: Natural/modified Natural Cycle or High Dose Cohmentioning

confidence: 99%

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

Blumenfeld

2020

Front. Endocrinol.

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The infertile patients with aging ovaries-also sometimes referred to as impending premature ovarian insufficiency (POI), impending premature ovarian failure (POF), or poor ovarian responders (POR), constitute a significant and increasing bulk of the patients appealing to IVF/ART. Different causes have been cited in the literature, among the identified etiologies, including chromosomal and genetic etiology, metabolic, enzymatic, iatrogenic, toxic, autoimmune, and infectious causes. Although the most successful and ultimate treatment of POI/POF/POR patients is egg donation (ED), many, if not most, of these infertile women are reluctant to consent to ED upon the initial diagnostic interview, requesting alternative solutions despite the low odds for success. Despite anecdotal case reports, no unequivocal treatment proved to be successful for these patients in prospective randomized controlled trials. Nevertheless, the addition of growth hormone (GH) to ovarian stimulation in POR with GH deficiency may improve the results of controlled ovarian hyperstimulation (COH) and the IVF success. In patients with autoimmune etiology for POR/POI, the combination of glucocorticosteroids, pituitary-ovarian suppression, and COH may be successful in achieving the desired conception.

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Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

Cited by 32 publications

References 24 publications

Does daily co-administration of letrozole and gonadotropins during ovarian stimulation improve IVF outcome?

Does daily co-administration of letrozole and gonadotropins during ovarian stimulation improve IVF outcome?

Conventional IVF versus modified natural IVF for poor ovarian reserve patients

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

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