Low dosing of gonadotropins in in vitro fertilization cycles for women with poor ovarian reserve: systematic review and meta-analysis

Youssef, Mohamed; Wely, Madelon van; Mochtar, Monique H.; Fouda, Usama M.; Eldaly, Ashraf; Abidin, Eman Zein El; Elhalwagy, Ahmed; Abdallah, Ahmed Abdel Mageed; Zaki, Sherif Mohamed; Ghafar, Mohamed Sayed Abdel; Mohesen, Mohamed N.; Veen, Fulco van der

doi:10.1016/j.fertnstert.2017.10.033

Cited by 33 publications

(17 citation statements)

References 45 publications

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“…Regarding the secondary outcomes of this study, the aforementioned systematic review and meta-analysis found significant lower ovarian stimulation days and significantly more treatment cycles were cancelled due to poor ovarian response in women who underwent MS-IVF than in women who underwent C-IVF, while we found no significant difference (Youssef et al, 2018). They also found no significant differences between groups in the SA1: sensitivity analysis 1, the pregnancy rate per embryo transfer as primary effect outcome (i.e., the number of cycles in which embryos were transferred into the uterus were included in the denominator).…”

Section: Comparison With Other Effectiveness Studiesmentioning

confidence: 44%

“…number of oocytes retrieved, the number of MII oocytes, and the number of embryos obtained, while we found significant lower numbers of oocytes retrieved and embryos for the MS-IVF treatment protocol compared to the C-IVF (Youssef et al, 2018). These differences might be related to differences in medication dosages and other differences in populations, such as the underlying causes of infertility.…”

Section: Comparison With Other Effectiveness Studiesmentioning

confidence: 59%

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Effectiveness and Cost-effectiveness of Minimal Ovarian Stimulation in-vitro Fertilization versus Conventional Ovarian Stimulation in Poor Responders: Economic Evaluation Alongside a Propensity Score Adjusted Prospective Observational Study

Souza¹,

Ben²,

Dongen³

et al. 2022

JBRA

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Objective: Information on the pregnancy rate after successive in-vitro fertilization (IVF) cycles and their associated costs is relevant for couples undergoing assisted reproduction treatments (ARTs). This study, therefore, sought to investigate the effectiveness and the costeffectiveness of two ARTs, the minimal ovarian stimulation IVF (MS-IVF) compared to the conventional ovarian stimulation IVF (C-IVF) from the payer's perspective.Methods: A 10-months follow-up prospective observational study was conducted in a sample of couples who sought ARTs in a private clinic in Southern Brazil. Women had to satisfy the Bologna Criteria and be older than 35 years. The effect outcome was pregnancy rate per initiated cycle. Medication costs were based on medical records. Costs and effect differences were estimated using seemingly unrelated regressions adjusted for the propensity score estimated based on women's characteristics.Results: All 84 eligible women who agreed to participate received a total of 92 IVF cycles (MS-IVF, n=27[35 cycles]; C-IVF n=57[57 cycles]. The effect difference between MS-IVF and C-IVF was -5.1% (95%CI, -13.2 to 5.2). Medication costs of MS-IVF were significantly lower than C-IVF by €-1260 (95%CI, -1401 to -1118). The probabilities of MS-IVF being cost-effective compared to C-IVF ranged from 1 to 0.76 for willingness-to-pay of €0 to €15,000 per established pregnancy, respectively.Conclusions: Even though there were no positive effect differences between groups, MS-IVF might be costeffective compared to C-IVF from the payer's perspective due to its relatively large cost savings compared to C-IVF. However, further investigation is needed to confirm these findings in a larger sample.

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Section: Comparison With Other Effectiveness Studiesmentioning

confidence: 44%

Section: Comparison With Other Effectiveness Studiesmentioning

confidence: 59%

Effectiveness and Cost-effectiveness of Minimal Ovarian Stimulation in-vitro Fertilization versus Conventional Ovarian Stimulation in Poor Responders: Economic Evaluation Alongside a Propensity Score Adjusted Prospective Observational Study

Souza¹,

Ben²,

Dongen³

et al. 2022

JBRA

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“…23 In our clinic, we use the NC-IVF stimulations for women at risk of OHSS or when the women prefer less hormone or lower price for IVF. The evidence on cycle cancellation is conflicting and some metaanalyses of RCTs showed higher cumulative pregnancy rate with mild IVF [24][25][26][27] while other meta-analyses found no difference. 23,28 One study outlines that affordable ART with low dose stimulation provide a more patient-friendly treatment for many women undergoing fresh IVF treatment cycles because they cause less stress and are more convenient for the patient.…”

Section: Discussionmentioning

confidence: 99%

Two modified natural in vitro fertilisation (IVF) protocols compared to conventional IVF treatment: Retrospective data from one Danish Fertility Centre

Almind¹,

Abraham-Zadeh²,

Faerch³

et al. 2021

OGIJ

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Aim of study: Over the last decade, laboratory procedures in in vitro fertilisation (IVF) have improved. Hyperstimulated ovaries cause an overload of surplus embryos. The present study was designed to evaluate the efficiency of two different modified IVF cycle protocols trying to reduce the load of medication used for IVF: simple IVF (S-IVF), Tamoxifen 40 mg daily from day 2 in the cycle to ovulation induction) and mild IVF (M-IVF), Tamoxifen 40 mg daily and every secondary 150 IU Gonal F until ovulation induction. The study aims to evaluate their efficiency compared with our conventional IVF (C-IVF) using a short antagonist protocol. Methods: A retrospective cohort study including all patients admitted to IVF for unexplained infertility, tubal factor, and male factor. In all stimulated cycles patients aimed at having fresh embryos transferred and surplus good embryos cryopreserved. All patients were recruited in the same period and allocated to the different treatments on their own request. The study was conducted between June 2019 and February 2021. Results: In total the study included 976 IVF cycles. 651 cycles from C-IVF, 145 cycles from S-IVF and 180 cycles from M-IVF. Mean age in the groups were comparable. Mean number of eggs retrieved was 6.1 (C-IVF), 1.2 (S-IVF) and 3.0 (M-IVF). Pregnancy rate per fresh transfer was found to be 29% for C-IVF, 26% in the S-IVF group and for the M-IVF 20%. Conclusion: Modified IVF stimulation protocols may be an important step towards a simpler assisted reproductive technology (ART) approach. More tolerable for women, easier and cheaper for patients and society they maintain acceptable clinical pregnancy rates. Large prospective studies need to be performed in the future.

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“…The recent available evidence suggests that, in POR patients, mild OS regimens (low-dose gonadotropins with/without oral agents), when compared with traditional OS protocols, offer comparable reproductive outcome albeit lower cost. 45 , 46 Across all the available studies on DS/DuoStim, different OS protocols have been described for FPS and LPS. Regarding FPS, luteal estrogen priming may be used to promote synchronization and coordination of follicular growth.…”

Section: How To Perform Double/dual Stimulation?mentioning

confidence: 99%

Double or dual stimulation in poor ovarian responders: where do we stand?

Polat

Mümüşoğlu

Ozbek

et al. 2021

Clin Med�Insights�Reprod�Health

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Recent advances in our recognition of two to three follicular waves of development in a single menstrual cycle has challenged the dogmatic approach of ovarian stimulation for in vitro fertilization starting in the early follicular phase. First shown in veterinary medicine and thereafter in women, luteal phase stimulation–derived oocytes are at least as competent as those retrieved following follicular phase stimulation. Poor ovarian responders still remain a challenge for many decades simply because they do not respond to ovarian stimulation. Performing follicular phase stimulation and luteal phase stimulation in the same menstrual cycle, named as double stimulation/dual stimulation, clearly increases the number of oocytes, which is a robust surrogate marker of live birth rate in in vitro fertilization across all female ages. Of interest, apart from one study, the bulk of evidence reports significantly higher number of oocytes following luteal phase stimulation when compared with follicular phase stimulation; hence, performing double stimulation/dual stimulation doubles the number of oocytes leading to a marked decrease in patient drop-out rate which is one of the major factors limiting cumulative live birth rates in such poor prognosis patients. The limited data with double stimulation/dual stimulation-derived embryos is reassuring for obstetric and neonatal outcome. The mandatory requirement of freeze-all and lack of cost-effectiveness data are limitations of this novel approach. Double stimulation/dual stimulation is an effective strategy when the need to obtain oocytes is urgent, including patients with malignant diseases undergoing oocyte cryopreservation and patients of advanced maternal age or with reduced ovarian reserve.

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Low dosing of gonadotropins in in vitro fertilization cycles for women with poor ovarian reserve: systematic review and meta-analysis

Abstract: CRD42016041301.

Cited by 33 publications

References 45 publications

Effectiveness and Cost-effectiveness of Minimal Ovarian Stimulation in-vitro Fertilization versus Conventional Ovarian Stimulation in Poor Responders: Economic Evaluation Alongside a Propensity Score Adjusted Prospective Observational Study

Effectiveness and Cost-effectiveness of Minimal Ovarian Stimulation in-vitro Fertilization versus Conventional Ovarian Stimulation in Poor Responders: Economic Evaluation Alongside a Propensity Score Adjusted Prospective Observational Study

Two modified natural in vitro fertilisation (IVF) protocols compared to conventional IVF treatment: Retrospective data from one Danish Fertility Centre

Double or dual stimulation in poor ovarian responders: where do we stand?

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