Comparison of modified agonist, mild-stimulation and antagonist protocols for in vitro fertilization in patients with diminished ovarian reserve

Abstract

ObjectiveTo compare the efficacy of three protocols for ovarian stimulation in patients with diminished ovarian reserve during in vitro fertilization (IVF) treatment.MethodsThis prospective randomized study enrolled patients with diminished ovarian reserve who underwent cycles of IVF or intracytoplasmic sperm injection. The patients were randomly divided into three groups: a modified gonadotrophin releasing hormone (GnRH) agonist protocol (group A); (ii) a mild stimulation protocol (group B); or (iii) an antagonist protocol (group C). Demographic characteristics, clinical variables and pregnancy outcomes were compared between the groups.ResultsA total of 116 patients were enrolled in the study: 54 in group A, 52 in group B and 60 in group C. Group B (32.69%) had a significantly higher cycle cancellation rate compared with groups A (11.11%) and C (16.67%). The early abortion rate of group C (44.44%) was significantly higher than group A (12.50%), but not significantly different from group B (16.67%). There were no significant differences in the clinical pregnancy rates and live birth rates among the three groups.ConclusionA modified GnRH agonist protocol achieved a comparable pregnancy rate to those of the mild stimulation protocol and antagonist protocol, whilst having lower cycle cancellation and early abortion rates.

Fresh and cumulative live birth rates in mild versus conventional stimulation for IVF cycles in poor ovarian responders: a systematic review and meta-analysis

“…A potential explanation for this discrepancy may be the inferior clinical prognosis of patients included in the eligible RCTs, taking into account that even among poor responders, not all patients have a similar prognosis ( Polyzos and Popovic-Todorovic, 2020 ). Overall, the mean number of oocytes retrieved in both arms was disappointingly low, with only five studies reporting a mean of more than five oocytes in any of the two groups ( Karimzadeh et al , 2011 ; Abdel Mohsen and Ezz El Din, 2013 ; Youssef et al , 2017 ; van Tilborg et al , 2017 ; Yu et al , 2018 ). Consequently, it could be hypothesized that low prognosis poor responders are highly unlikely to have better outcomes, even when a more intense stimulation protocol is implemented.…”

Mild versus conventional ovarian stimulation for IVF in poor, normal and hyper-responders: a systematic review and meta-analysis

“…Seven included studies were multi-centre trials ( Out et al , 2004 ; Tan et al , 2005 ; Heijnen et al , 2007 ; Ragni et al , 2012 ; Oudshoorn et al , 2017 ; van Tilborg et al , 2017 ; Youssef et al , 2018 ), the rest were from a single centre. Four trials conducted three-arm comparison ( Harrison et al , 1994 ; Ashrafi et al , 2005 ; Bastu et al , 2016 ; Yu et al , 2018 ), one was a four-arm trial ( Martinez et al , 2003 ), the rest were two-arm studies. Sample size calculation was done in six trials among poor responders: two for oocyte number ( Revelli et al , 2014 ; Bastu et al , 2016 ), one for CPR ( Yu et al , 2018 ), one for OPRs ( Youssef et al , 2017 ), one for LBR ( Ragni et al , 2012 ) and two for cumulative live birth ( van Tilborg et al , 2017 ; Liu et al , 2020 ).…”

Corifollitropin alfa for ovarian stimulation in in vitro fertilization in women of advanced maternal age

“…Таким образом, для пациенток данной группы могут быть рекомендованы накопление эмбрионов в последовательных циклах [18], двойная стимуляция яичников в одном и том же цикле [17,19,20]. Логичнее всего использовать у данных пациенток стимуляцию с непрямыми индукторами овуляции [21,22] с последующим проведением преимплантационного генетического тестирования и криопереносом. При желании пациентки провести свежий перенос, с учетом одинаковой эффективности, следует использовать мягкую стимуляцию [21].…”