Interventions for 'poor responders' to controlled ovarian hyperstimulation (COH) in in-vitro fertilisation (IVF)

Shanbhag, Smruta; McTavish, Alison; Bhattacharya, Siladitya; Hamilton, Mark A.; Mollison, Jill

doi:10.1002/14651858.cd004379

Cited by 21 publications

(26 citation statements)

References 25 publications

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“…In the last years, the most frequently used COH regimen for expected poor responders has been the "long" protocol with a high daily Gn dose (300-450 IU/d) [4]. Unfortunately, however, despite the higher number of retrieved oocytes this regimen failed to improve the final IVF success rate, implying, on the other side, a relevant increase of economical costs of IVF procedure [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Most COH regimens currently used for expected poor responders are based on using a high daily dose (300-450 IU/die) of exogenous gonadotropins (Gn): the most popular worldwide is still the "long" GnRH-agonist protocol, in which the pituitary is blocked in the luteal phase of the run-in cycle and Gn are given after the pituitary block has been achieved [4,5]. Giving a high Gn dose obviously increases the cost of IVF, a consequence that would be acceptable if paralleled by an improvement in IVF outcome.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

“Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial

Revelli

Chiadò

Dalmasso³

et al. 2014

J Assist Reprod Genet

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Background This large prospective, randomized study was designed to compare the "mild" protocol with clomiphene citrate, low-dose gonadotropins and a GnRH-antagonist (CC/Gn/GnRH-ant protocol) with the "long" protocol with a GnRH-agonist and high-dose Gn for the controlled ovarian hyperstimulation (COH) of patients with expected poor ovarian responsiveness undergoing IVF. Materials and Methods A total of 695 women with clinical, endocrine and ultrasound characteristics suggesting a low ovarian reserve and a poor responsiveness to COH were recruited and randomly assigned to receive the CC/Gn/ GnRH-ant "mild" protocol (mild group, n=355) or the "long" protocol with high-dose Gn (long group, n=340). Results The "mild" stimulation led to significantly shorter follicular phase, lower consumption of exogenous Gn and lower peak estradiol level than the "long" regimen. With the "long" protocol, significantly less cycles were cancelled due to the lack of ovarian response; further, it obtained significantly more oocytes, more mature oocytes, more embryos, and a thicker endometrium. As for the final IVF outcome, however, the two stimulation regimens obtained comparable implantation rate, clinical pregnancy rate, and ongoing pregnancy rate at 12 weeks. Conclusions In conclusion, the "mild" CC/Gn/GnRH-ant stimulation protocol is a valid alternative to the long protocol with high Gn dose as it obtains a comparable success rate and requires significantly less medications, with an obvious economical advantage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial

Revelli

Chiadò

Dalmasso³

et al. 2014

J Assist Reprod Genet

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“…The pregnancy rates in these women with ovum donation are as good as normal responders. 57 Unfortunately, it is not widely available in many parts of the world due to cultural and social reasons. Assisted hatching involves artificial breach in the zona pellucida and has been proposed to be a technique to improve the implantation and pregnancy rates.…”

Section: Managementmentioning

confidence: 99%

Diminished Ovarian Reserve, Causes, Assessment and Management

Arora¹,

Kaur²

2013

International Journal of Infertility &Amp; Fetal Medicine

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Diminished ovarian reserve predicts diminished ovarian response to stimulation but does not predict cycle fecundity. It has been recently defined by ESHRE, the Bologna's criteria, according to which at least two of the following three features should be present: (1) Age >40 years/any other risk factor for DOR, (2) abnormal ovarian reserve test, i.e. antral follicle count, AMH, (3) poor ovarian response in a previous stimulated cycle, i.e. less than three follicles after standard gonadotropin stimulation. Poor response to maximal stimulation on two previous occasions also defines DOR.The treatment options are limited. Avoiding the GnRH agonist long protocol and stimulation with microdose flare or antagonist protocol yields better results. Adjuvant therapy with LH, DHEAS and growth hormone shows some benefit in improving the oocyte yield. It is advisable to perform ICSI for all obtained oocytes and some advocate assisted hatching. Pregnancy rates are, however, poor and often these patients require ovum donation. Developing tests that will diagnose DOR in a low-risk population will allow women to plan their reproductive careers early.

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“…This hormonal dysregulation will, in turn, accelerate the loss of follicles at the advanced age. 2 The aim of this study was to increase the number of oocyte in each cycle. 3,4 Ovulation is one of the most fundamental processes for successful reproduction.…”

Section: Introductionmentioning

confidence: 99%

PMSG and HCG hormones effect on the development and growth of ovarian follicles

Zolbin

Nematin

Daghigh

et al. 2018

J. contemp. med. sci.

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Objective Gonadotropins are generally used in animals and humans to stimulate ovulation and increase the number of available oocytes for techniques such as in vitro fertilization. Ovulation-inducing drugs are used to achieve multiple oocytes in one cycle, thereby increasing the chances of pregnancy in patients with infertility. The aim of this study was to evaluate the effect of gonadotropins on stimulation of ovulation and their inductive role on the growth and development of follicles in the ovary. Methods To determine the effect of human chronic gonadotrophin (HCG) and pregnant mare serum gonadotrophin (PMSG) on ovary, this study used 20 rats that were randomly divided to experimental and control groups. Rats were subsequently euthanized 48 h after injection and the ovaries were fixed and stained with H&E. Data were analyzed with Tukey's multiple comparisons with one-way ANOVA test in GraphPad Prism software. Result Our analysis demonstrated that HCG and PMSG hormones will significantly increase the number of stimulated oocyte in the ovary but it does not have any significant role on the ovary weight and volume (P < 0.05). Conclusion This study's results confirmed the inductive role of PMSG and HCG hormones on folliculogenesis.

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Interventions for 'poor responders' to controlled ovarian hyperstimulation (COH) in in-vitro fertilisation (IVF)

Cited by 21 publications

References 25 publications

“Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial

“Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial

Diminished Ovarian Reserve, Causes, Assessment and Management

PMSG and HCG hormones effect on the development and growth of ovarian follicles

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