Conventional IVF versus modified natural IVF for poor ovarian reserve patients

Abstract

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.