Comparison of ‘poor’ responders with ‘good’ responders using a standard buserelin/human menopausal gonadotrophin regime for in-vitro fertilization

Abstract

This study identifies a group of 87 patients, who demonstrated a 'poor' response to a standard buserelin/human menopausal gonadotrophin (HMG) regime. The subsequent outcome in 61 of these 'poor' responders when treated with a higher dose of HMG to achieve a satisfactory response was compared with 250 patients, who showed a 'good' response to the standard regime. 'Poor' responders were significantly older than 'good' responders (P less than 0.001), but no significant difference was demonstrated in the indication for in-vitro fertilization (IVF). Even on higher doses of HMG, 'poor' responders took longer for their follicles to achieve maturity than the 'good' responders (P less than 0.01). 'Poor' responders produced 8.9 oocytes per oocyte collection compared to 11.8 in the 'good' responders (P less than 0.01). The fertilization rate was significantly lower in the 'poor' responders compared to the 'good' responders (P less than 0.01). Although there was no significant difference in morphometric grading between 'poor' responder embryos and 'good' responder embryos, the rate of cell division was significantly slower in embryos of the 'poor' responders than the 'good' responders (P less than 0.01). The pregnancy rate per oocyte retrieval was 9% in the 'poor' responders compared to 29% in the 'good' responders (P less than 0.01). The implantation rate in the 'poor' responders was 4.4% compared to 16.1% in the 'good' responders (P less than 0.001).

Effect of micro-vibration culture system on embryo development

“…Some poor responders received 3 embryos, depending on their clinical history (i.e., repeat failures or old age). Generally, the cell division rate in poor responders is slower than in good responders because of the poor-quality oocytes and sub-optimal number of collected oocytes in the former [24]. Therefore, based on the report by Ziebe et al [34]., the embryos were divided into 3 grades.…”

“…Because the better quality of oocytes and embryos in normal responders, the positive effect on embryonic development could be observed more easily. In poor responders, large doses of stimulant medication, sub-optimal numbers of oocytes, poor-quality embryos, old age and a defective endometrium are the various factors that influence a poor prognosis [23][24][25]. The human embryo development rate were improved to a limited extent, suggesting that it is difficult to improve the cell division rate in poor responders because of their poorquality oocytes and sub-optimal numbers of collected oocytes.…”

“…Poor responders exhibit advanced age, previous ovarian surgery or pelvic adhesions [24,25], all of which can contribute to a reduced oocyte and embryo quality in comparison with normal responders. To improve the pregnancy rate in poor responders, various approaches have been attempted, but a satisfactory solution has not been reached [26,27].…”

Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients

“…Currently the percentage of poor responders, out of all infertile patients undergoing IVF-ET programs, is varies from 9% to 24% [2,3]. Poor responders include women in whom a previous cycle yielded three or fewer oocytes or was cancelled because of observations of three or fewer follicles 16 mm or greater, a single dominant follicle or a peak serum estradiol less than 500 pg/ml.…”

Rearrangement of extracellular matrix during cluster formation by human luteinising granulosa cells in culture

“…Briefly, the patient protocol involved pituitary downregulation with gonadotrophin releasing hormone agonist and stimulation of follicular growth with human menopausal gonadotrophin. Final matu-ration of follicles was initiated by hCG and eggs were collected 34 h later (Jenkins et al 1991). All follicles over 15 mm in diameter were aspirated.…”