Evaluating different strategies for poor ovarian response management: a retrospective cohort study and literature review

Abstract

This retrospective study compares four different strategies for managing poor ovarian response (POR), namely, conventional stimulation (300 IUs) IVF-fresh embryo transfer (CONVF), mild stimulation (150 IUs) IVF-fresh embryo transfer (MILDF), mild stimulation embryo banking (MILDB), and embryo banking in natural cycles (NATB). In total, 796 POR patients were considered eligible. Statistical analysis revealed a shorter duration of stimulation and a lower required amount of gonadotropins in MILDF compared with CONVF (9.34 ± 1.17 versus 10.37 ± 1.14; 1402 ± 176 versus 3110 ± 343, P < 0.001). Comparing MILDF and MILDB, a higher number of available oocytes and embryos was observed in MILDB (2.36 ± 1.15 versus 6.58 ± 1.11; 1.72 ± 1.02 versus 3.51 ± 0.61, P < 0.001). Moreover, the MILDB presented with a lower number of required oocyte retrievals and a higher number of oocytes per oocyte retrieval compared with NATB (3.90 ± 1.56 versus 7.15 ± 1.80; 1.95 ± 0.74 versus 0.89 ± 0.20, P < 0.001). Data indicate that MILDF is equally efficient and associated with a shorter duration of stimulation and a lower required amount of gonadotropins compared with CONVF. Embryo accumulation may be more efficient compared with a fresh embryo transfer. MILDB may be a more efficient approach compared with NATB. To conclude, embryo accumulation following mild stimulation appears to form the optimal strategy for POR management. More studies are needed to verify these conclusions.

Increased starting doses of exogenous gonadotropins do not improve IVF-ET outcomes in expected poor ovarian responders

“…It has been proposed that gonadotropins support only the population of follicles that respond to stimulation and do not regenerate follicles in patients with POR. Therefore, the Gn starting dose is not a signi cant factor in determining live birth rates [15][16][17][18][19][20]. A systematic review identi ed no evidence of differences in pregnancy outcomes between low-dose Gn or Gn combined oral agents and high-dose Gn in ovarian stimulation protocols for patients with low ovarian reserve.…”

Assessment of The Results of Short Agonist Stop Ovarian Stimulation Protocol in Poor Responder Patients Undergoing ICSI Cycles

“…Poor ovarian response (POR) is defined as the collection of three or fewer oocytes in two prior ovarian stimulation cycles, or collection of three or fewer oocytes in a single stimulation cycle from a woman who is over 40 years of age, or collection of three or fewer oocytes in a single stimulation cycle and an abnormal ovarian reserve test (ORT: antral follicle count less than five to seven follicles or anti-mullerian hormone (< 0.5-1.1 ng/mL), or presence of an abnormal ORT in a woman over 40 years of age [1,2] . Patients identified as "poor responders" are an increasing population representing 10 to 24% of women involved in assisted reproductive technology (ART) [3] .…”

Is Autologous Platelet Activation the Key Step in Ovarian Therapy for Fertility Restoration and Menopause Reversal?

“…This diverse signaling fund was untapped for IVF until Pantos et al [6] reported the first PRP success in a human fertility context. Since there are several ways to process and administer PRP [7][8][9] it is not surprising that diverse responses have accompanied its use in reproductive practice. However, much can be learned from allied clinical and laboratory experience where PLT handling has been better standardized.…”