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

Shanbhag, Smruta; Aucott, Lorna; Bhattacharya, Siladitya; Hamilton, Mark A.; McTavish, Alison

doi:10.1002/14651858.cd004379.pub2

Cited by 41 publications

(24 citation statements)

References 51 publications

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“…The ovarian response to gonadotrophin stimulation depends primarily on the woman's ovarian reserve (Broekmans et al ., 2006) and is a major determinant of the success of IVF (van der Gaast et al ., 2006; Shanbhag et al ., 2007). …”

Section: Individualized Pretreatment Assessmentmentioning

confidence: 99%

“…There is little convincing evidence to indicate the most appropriate treatment regimen for patients with an expected or proven poor response to ovarian stimulation (Shanbhag et al ., 2007). Indeed, prospective, randomized studies have shown little benefit from daily doses of rhFSH of ≥300 IU to induce follicular development (Tarlatzis et al ., 2003; Kailasam et al ., 2004).…”

Section: Individualized Ovarian Stimulationmentioning

confidence: 99%

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Approaches to improve the diagnosis and management of infertility

Devroey¹,

Fauser

Diedrich

2009

Human Reproduction Update

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BACKGROUNDRecent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26–27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts.METHODSSpecialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge.RESULTSIt was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches.CONCLUSIONSGreater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.

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Section: Individualized Pretreatment Assessmentmentioning

confidence: 99%

Section: Individualized Ovarian Stimulationmentioning

confidence: 99%

Approaches to improve the diagnosis and management of infertility

Devroey¹,

Fauser

Diedrich

2009

Human Reproduction Update

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“…Shanbhag et al [18] examined, as part of a Cochrane review, a number of different interventions for 'poor' responders. They examined nine randomised trials.…”

Section: Discussionmentioning

confidence: 99%

“…There have been a number of randomised controlled trials that have examined this and no particular stimulation protocol has been found to be superior. The stimulation regimens that have been investigated have been comparisons between Boost or Flare protocols with down regulation (DR) protocols and antagonist (Ant) protocols with boost and DR protocols [summarized in [15][16][17][18]. Most studies have defined poor responders in different ways making it difficult to compare trials and there have been inadequate numbers in the trials with therefore a lack of power to show a positive treatment response [19].…”

Section: Introductionmentioning

confidence: 99%

Is there an ideal stimulation regimen for IVF for poor responders and does it change with age?

Vollenhoven

Osianlis

Catt

2008

J Assist Reprod Genet

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Purpose To determine whether there is a superior treatment modality for 'poor' responders. Method Retrospective analysis of three stimulation regimens, with patients stratified based on age, stimulation regime and response in previous cycles ("poor' responder or "non poor" responder). Fertilisation, embryo utilisation and clinical pregnancy rates were assessed. There were a total of 1,608 cycles in the 'poor' responder and 8,489 cycles in the 'non poor' responder groups. Results In 'poor' responders there was no significant difference in fertilisation rate, nor utilisation rate between the three stimulation regimes and no differences in the pregnancy rate/initiated cycle irrespective of age and stimulation regimen in any of the groups. 'Non poor' responders had a significantly greater pregnancy rate/ initiated cycle for all stimulation regimens in both age groups compared with 'poor' responders.Conclusion This large retrospective study of 'poor' responders has not shown a difference in pregnancy rates/initiated cycle between stimulation regimens.

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“…Although no clear definition has been agreed, poor ovarian response in the context of in vitro fertilization (IVF) treatment is usually defined as failure to achieve ≥3 oocytes or a certain estradiol concentration in response to ovarian stimulation. The incidence in a population undergoing assisted reproduction treatment is estimated to be 9–24% (1,2). Over the years, numerous techniques and therapies have been developed in an effort to improve success in the poor responders, but few have met with success (3,4)…”

Section: Introductionmentioning

confidence: 99%

Effect of pretreatment with transdermal testosterone on poor ovarian responders undergoing IVF/ICSI: A meta-analysis

Luo

et al. 2014

Experimental and Therapeutic Medicine

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In order to identify and describe the effectiveness of transdermal testosterone pretreatment on poor ovarian responders, MEDLINE, EMBASE, the Cochrane library and the Chinese biomedical database were searched for randomized controlled trials (RCTs). Three RCTs, which compared the outcomes of female pretreatment with transdermal testosterone prior to in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with those of control groups, were included in the present review. The three RCTs enrolled a total of 221 randomized subjects. The meta-analysis revealed that females who received transdermal testosterone treatment prior to their IVF/ICSI cycle had a two-fold increase in live birth rate [risk ratio (RR)=2.01, 95% confidence interval (CI) 1.03–3.91], clinical pregnancy rate (RR=2.09, 95% CI 1.14–3.81) and a significantly more oocyte retrieved [mean difference (MD)=1.36, 95% CI 0.82–1.90]. The current findings provide evidence that pretreatment with transdermal testosterone may improve the clinical outcomes for poor ovarian responders undergoing IVF/ICSI. However, the results should be interpreted with caution due to the small sample size of the studies used and the heterogeneities. Further good quality RCTs would be needed to reach further conclusions.

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

Cited by 41 publications

References 51 publications

Approaches to improve the diagnosis and management of infertility

Approaches to improve the diagnosis and management of infertility

Is there an ideal stimulation regimen for IVF for poor responders and does it change with age?

Effect of pretreatment with transdermal testosterone on poor ovarian responders undergoing IVF/ICSI: A meta-analysis

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