Ovarian stimulation protocols for poor ovarian responders: a network meta-analysis of randomized controlled trials

Di, Man; Wang, Xiaohong; Wu, Jing; Yang, Hongya

doi:10.1007/s00404-022-06565-6

Cited by 5 publications

(8 citation statements)

References 55 publications

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“…There are many reports describing the efficiency of a delayed-start GnRH antagonist protocol in patients with a low ovarian response (3, 7-10, 12, 13). In particular, the delayed-start GnRH antagonist with an estrogen priming protocol, first described by Cakmak et al (7), seems effective based on a recent meta-analysis (13). However, the European Society of Human Reproduction and Embryology guidelines (21) considered the delayed-start GnRH protocol as a conditional low recommendation.…”

Section: Discussionmentioning

confidence: 99%

“…Although the recommendation of the European Society of Human Reproduction and Embryology guidelines is low, the delayed-start GnRH protocol, compared with other conventional COS, may be effective for poor responders to increase retrieved oocytes and clinical pregnancy rate and decrease the cancellation rate (3, 4, 7-10, 12, 13), which is similar to the result in this study. Administration of GnRH antagonists in the early follicular phase is thought to suppress follicle-stimulating hormone levels, which allows growth of smaller antral follicles and halts the time for larger antral follicles (13,22,23). Suppression of early luteinizing hormone (LH) rise in patients with poor ovarian response may play a role in the improvement of outcomes (3).…”

Section: Discussionmentioning

confidence: 99%

“…Low COS response is a crucial concern in poor responders and patients with poor-quality embryos. To overcome this problem, several COS protocols have been reported, including delayed-start gonadotropin-releasing hormone (GnRH) antagonists (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13), microdose GnRH agonists (14)(15)(16), and long GnRH agonists (17,18). Among these, a current meta-analysis recommended a delayed-start GnRH antagonist protocol (13) for poor responders.…”

Section: Introductionmentioning

confidence: 99%

“…To overcome this problem, several COS protocols have been reported, including delayed-start gonadotropin-releasing hormone (GnRH) antagonists (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13), microdose GnRH agonists (14)(15)(16), and long GnRH agonists (17,18). Among these, a current meta-analysis recommended a delayed-start GnRH antagonist protocol (13) for poor responders. In addition to the improvement in the number of mature oocytes, the clinical pregnancy rate was increased significantly (relative risk: 2.90, [95% confidence interval: 1.52-5.51], P = 0.001) (11).…”

Section: Introductionmentioning

confidence: 99%

“…In addition to the improvement in the number of mature oocytes, the clinical pregnancy rate was increased significantly (relative risk: 2.90, [95% confidence interval: 1.52-5.51], P = 0.001) (11). The delayed-start GnRH antagonist protocol seems effective for poor responders (3,4,(7)(8)(9)(10)(11)(12)(13), but there are insufficient data on whether it is also effective for patients with poor-quality embryos and low rates of good blastocyst formation. The delayed-start GnRH antagonist protocol has some variations, such as the combination with estrogen or progesterone and the frequency of GnRH antagonist administration as a pretreatment.…”

Section: Introductionmentioning

confidence: 99%

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Original delayed-start ovarian stimulation protocol with a gonadotropin-releasing hormone antagonist, medroxyprogesterone acetate, and high-dose gonadotropin for poor responders and patients with poor-quality embryos

Takeuchi,

Orita,

Iwakawa

et al. 2023

Front. Endocrinol.

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IntroductionThe delayed-start gonadotropin-releasing hormone antagonist protocol seems effective for patients who are poor ovarian responders, but there are insufficient data on whether it is also effective for patients with poor-quality embryos and low rates of good blastocyst formation. Specifically, the effectiveness of delayed-start gonadotropin-releasing hormone antagonists with progesterone has not been adequately investigated. Therefore, we compared the efficacy of the original delayed-start gonadotropin-releasing hormone antagonist protocol using medroxyprogesterone acetate (MPA) and high-dose gonadotropin in patients with poor ovarian response.MethodsOverall, 156 patients with recurrent assisted reproductive technology failure who underwent the original protocol were included. They received cetrorelix acetate (3 mg) and MPA (10 mg) on cycle day 3, and high-dose gonadotropin was initiated on day 11. When the leading follicle reached 14 mm, ganirelix acetate (0.25 mg) was administered until the trigger day. The number of oocytes retrieved, metaphase II (MII) oocytes, two pronuclear (2PN) zygotes, and good blastocysts and live birth rates were compared between the previous (Cycle A) and original (Cycle B) cycles in three groups (Group A, all patients; Group B, poor responders; and Group C, patients with poor-quality embryos).ResultsIn Group A (n=156), the number of MII oocytes (3.6 ± 3.3 versus 4.5 ± 3.6), 2PN zygotes (2.8 ± 2.9 versus 3.8 ± 3.1), good blastocysts (0.5 ± 0.9 versus 1.2 ± 1.6), and live birth rates (0.6 versus 24.4) significantly increased in Cycle B. Similar results were obtained in Group B (n=83; 2PN zygotes [1.7 ± 1.7 versus 2.3 ± 1.8], good blastocysts [0.4 ± 0.7 versus 0.9 ± 1.3], live birth rates [0 versus 18.1]) and Group C (n=73; MII oocytes [5.1 ± 3.8 versus 6.6 ± 4.0], 2PN zygotes [4.0 ± 3.4 versus 5.4 ± 3.4], good blastocysts [0.7 ± 1.1 versus 1.6 ± 1.9], and live birth rates [1.4 versus 31.5]).ConclusionThis original protocol increased the number of MII oocytes retrieved, 2PN zygotes, good blastocysts, and live birth rates in both poor responders and in patients with poor-quality embryos.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Original delayed-start ovarian stimulation protocol with a gonadotropin-releasing hormone antagonist, medroxyprogesterone acetate, and high-dose gonadotropin for poor responders and patients with poor-quality embryos

Takeuchi,

Orita,

Iwakawa

et al. 2023

Front. Endocrinol.

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Comparison of DNA damage in granulosa cells of women undergoing controlled ovarian stimulation in in vitro fertilization protocols with the recombinant human follicle-stimulating hormones Corneumon®, Gonal-F®, Pergoveris® and Puregon®: a randomized trial

Alcalá-Sánchez,

Cuapio-Padilla,

Salazar-López

et al. 2024

Arch Gynecol Obstet

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Comparative efficacy of different growth hormone supplementation protocols in improving clinical outcomes in women with poor ovarian response undergoing assisted reproductive therapy: a network meta-analysis

Xu,

Tong,

Yang

et al. 2024

Sci Rep

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Growth hormone (GH) has a long-standing history of use as an adjunctive therapy in the treatment of poor ovarian response (POR), but the optimal dosage and timing remains unclear. The aim of this study was to evaluate and compare the efficacy of different GH supplementation protocols through a network meta-analysis (NMA) and determine the optimal treatment protocol. This study was reported based on the Preferred Reporting Items for Systematic Reviews for Network Meta-Analysis (PRISMA-NMA) statement. Databases including PubMed, Web of Science, Cochrane Library and Embase were searched until June 2023. A total of 524 records were retrieved in our search, and 23 clinical studies comprising 4889 cycles were involved. Seven different GH protocols were identified. Results showed that compared to the control group, daily administration of 4–8 IU of GH during the follicular phase of the stimulation cycle had the best comprehensive therapeutic effects on improving the number of retrieved oocytes, mature oocytes, endometrial thickness, and reducing gonadotropin requirements in POR patients undergoing assisted reproductive therapy, with a relatively brief treatment duration and a moderate total GH dose. Subgroup analysis demonstrated that this protocol could significantly improve the clinical pregnancy rate of POR patients in the randomized controlled trials (RCT) subgroup and the African subgroup. Therefore, its clinical application is suggested. Besides, the potential advantages of long-term GH supplementation protocol (using GH for at least 2 weeks before oocyte retrieval) has merit for further research. Rigorous and well-designed multi-arm RCTs are needed in the future to confirm the conclusions drawn from this study.

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Ovarian stimulation protocols for poor ovarian responders: a network meta-analysis of randomized controlled trials

Cited by 5 publications

References 55 publications

Original delayed-start ovarian stimulation protocol with a gonadotropin-releasing hormone antagonist, medroxyprogesterone acetate, and high-dose gonadotropin for poor responders and patients with poor-quality embryos

Original delayed-start ovarian stimulation protocol with a gonadotropin-releasing hormone antagonist, medroxyprogesterone acetate, and high-dose gonadotropin for poor responders and patients with poor-quality embryos

Comparison of DNA damage in granulosa cells of women undergoing controlled ovarian stimulation in in vitro fertilization protocols with the recombinant human follicle-stimulating hormones Corneumon®, Gonal-F®, Pergoveris® and Puregon®: a randomized trial

Comparative efficacy of different growth hormone supplementation protocols in improving clinical outcomes in women with poor ovarian response undergoing assisted reproductive therapy: a network meta-analysis

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