Gonadotropins and glucocorticoid therapy for “low responders”—A controlled study

Bider, David; Blankstein, Joseph; Levron, Jacob; Tur-Kaspa, Ilan

doi:10.1007/bf02765836

Cited by 19 publications

(13 citation statements)

References 15 publications

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“…Glucocorticoid treatment for patients with low ovarian response was applied to increase the number of mature oocytes in IVF cycles. There was no improvement in any clinical aspect (Bider et al, 1997). Accordingly, follicular fluid concentrations of cortisol showed no correlation with oocyte number or quality (Bider et al, 1998).…”

Section: Discussionmentioning

confidence: 84%

Poor responder–high responder: the importance of soluble vascular endothelial growth factor receptor 1 in ovarian stimulation protocols

Neulen

Wenzel²,

Hornig³

et al. 2001

Human Reproduction

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This study was designed to detect vascular endothelial growth factor (VEGF) and its soluble receptor (sVEGFR-1) in follicular fluid specimens and to evaluate the importance of sVEGFR-1 with respect to ovarian response to gonadotrophin stimulation. A total of 69 patients was treated for IVF with recombinant human follicle stimulating hormone (FSH). Concentrations of VEGF and sVEGFR-1 were quantified in follicular fluids from oocyte retrievals. Patients were designated to three groups with respect to the number of harvested oocytes: group A, 1-5 oocytes; group B, 6-10 oocytes; group C, >10 oocytes. In group A, 1133 +/- 870 pg VEGF/ml follicular fluid per oocyte were quantified, in group B 426 +/- 262 pg VEGF/ml per oocyte, and in group C 274 +/- 179 pg VEGF/ml per oocyte. Soluble VEGFR-1 concentrations resulted in 1200 +/- 523 pg/ml follicular fluid per oocyte in group A, 255 +/- 193 pg/ml per oocyte in group B, and 79 +/- 69 pg/ml per oocyte in group C. No free sVEGFR-1 could be detected in any follicular fluid. An index to estimate the biological activity of VEGF by dividing VEGF/sVEGFR-1 revealed an increasing availability of VEGF with higher ovarian response to gonadotrophin therapy. In group A this index was 1.03, in group B 1.71, and in group C 3.21. A delicate balance between VEGF and sVEGFR-1 is necessary to allow an adequate ovarian reaction to gonadotrophin therapy. Excess of bio-active VEGF increases the risk for ovarian hyperstimulation syndrome. Excess of sVEGFR-1 results in poor response and goes in parallel with reduced chances for conception.

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Section: Discussionmentioning

confidence: 84%

Poor responder–high responder: the importance of soluble vascular endothelial growth factor receptor 1 in ovarian stimulation protocols

Neulen

Wenzel²,

Hornig³

et al. 2001

Human Reproduction

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“…Different approaches in the treatment of poor responders have been developed 2,5 for a better outcome with no impressive or clear results: various ovulation induction protocols 6,18,23–27 with or without adjuvant therapy to COH, include growth hormone, 28,29 glucocorticoids, 30,31 oral contraceptives, 24,32 nitric oxide donors, 33 IUI, 34 natural cycle, 35–38 transfer at blastocyst stage, 39 assisted hatching, 40 intracytoplasmic sperm injection, 41 as well as other forms of special treatment like co‐culture, 42 cytoplasm, and nuclear transfer, 43,44 and in vitro maturation of immature oocytes 45,46 …”

Section: Discussionmentioning

confidence: 99%

“…19 A poor response is often associated with ovarian reserve depletion or with older age. [20][21][22] Different approaches in the treatment of poor responders have been developed 2,5 for a better outcome with no impressive or clear results: various ovulation induction protocols 6,18,[23][24][25][26][27] with or without adjuvant therapy to COH, include growth hormone, 28,29 glucocorticoids, 30,31 oral contraceptives, 24,32 nitric oxide donors, 33 IUI, 34 natural cycle, [35][36][37][38] transfer at blastocyst stage, 39 assisted hatching, 40 intracytoplasmic sperm injection, 41 as well as other forms of special treatment like co-culture, 42 cytoplasm, and nuclear transfer, 43,44 and in vitro maturation of immature oocytes. 45,46 Different classifications have been suggested for a better management of poor responders 47,48 with no significant improvement in their response to ovarian hyperstimulation protocols.…”

Section: Discussionmentioning

confidence: 99%

Poor Responders in IVF

Baka

Makrakis

Tzanakaki

et al. 2006

Annals of the New York Academy of Sciences

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Management of women with a poor response to controlled ovarian hyperstimulation during IVF remains a frustrating challenge. The present study included 96 cycles from an equal number of women with a poor ovarian response and successful oocyte retrieval. Poor response was defined by the presence of at least one of the following characteristics: three or fewer oocytes on retrieval, serum estradiol level less than 500 pg/mL on the day of hCG administration, and serum FSH levels less than 20 IU/L. The same patients had a previous cycle cancelled because of a poor ovarian response whereas in the second cycle they preferred to continue the treatment despite the poor prognosis. We obtained 241 oocytes in the 96 IVF cycles. The fertilization rate was 60.2%. Three oocytes per cycle were retrieved in 56 cycles (58.3%), two oocytes per cycle in 33 cycles (34.4%), and one oocyte per cycle in 7 cycles (7.3%). In 19 cycles (19.8%) no fertilization was achieved. An embryo transfer was finally performed in 74 out of 96 cycles. Pregnancy rate was 12.5% per cycle and 16.2% per transfer. Among the 12 pregnancies achieved, 7 were in the 3-oocyte cycles and 5 in the 2-oocyte cycles. No pregnancies were achieved in the 1-oocyte cycles. Our data demonstrate that continuation of therapy in poor responders undergoing IVF can be an option despite the low pregnancy rates. The prognosis of these patients is not affected by a poor response in the first cycle and for some of them the outcome can be favorable.

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“…Kemeter et al (36) reported in 1986 that prednisolone improved IVF outcomes, while subsequent reviews noted no such positive effects (37). Bider et al (38) reported that in animals, stimulation by corticosteroids is effective in facilitating the ovulatory responses. He suggested two modes of action: direct action of glucocorticoids on the ovaries and suppressive effects on the adrenal androgens.…”

Section: Figurementioning

confidence: 96%

Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment

Magarelli

Cridennda²,

Cohen

2009

Fertility and Sterility

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Gonadotropins and glucocorticoid therapy for “low responders”—A controlled study

Cited by 19 publications

References 15 publications

Poor responder–high responder: the importance of soluble vascular endothelial growth factor receptor 1 in ovarian stimulation protocols

Poor responder–high responder: the importance of soluble vascular endothelial growth factor receptor 1 in ovarian stimulation protocols

Poor Responders in IVF

Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment

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