DOI QR코드

DOI QR Code

Comparison of mild ovarian stimulation with conventional ovarian stimulation in poor responders

  • Yoo, Ji-Hee (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Cha, Sun-Hwa (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Park, Chan-Woo (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Kim, Jin-Young (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Yang, Kwang-Moon (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Song, In-Ok (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Koong, Mi-Kyoung (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Kang, Inn-Soo (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Kim, Hye-Ok (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine)
  • Received : 2011.07.13
  • Accepted : 2011.08.30
  • Published : 2011.09.30

Abstract

Objective: To compare the IVF outcomes of mild ovarian stimulation with conventional ovarian stimulation in poor responders. Methods: From 2004 to 2009, 389 IVF cycles in 285 women showed poor responses (defined as either a basal FSH level ${\geq}$12 mIU/mL, or the number of retrieved oocytes ${\leq}$3, or serum $E_2$ level on hCG day <500 pg/mL) were analyzed, retrospectively. In total, 119 cycles with mild ovarian stimulation (m-IVF) and 270 cycles with conventional ovarian stimulation (c-IVF) were included. Both groups were divided based on their age, into groups over and under 37 years old. Results: The m-IVF group was lower than the c-IVF group in the duration of stimulation, total doses of gonadotropins used, serum $E_2$ level on hCG day, the number of retrieved oocytes, and the number of mature oocytes. However, there was no significant difference in the number of good embryos, the number of transferred embryos, the cancellation rate, or the clinical pregnancy rate. In the m-IVF group over 37 years old, the clinical pregnancy rate and live birth rate were higher when compared with the c-IVF group, but this result was not statistically significant. Conclusion: In poor responder groups, mild ovarian stimulation is more cost effective and patient friendly than conventional IVF. Therefore, we suggest that mild ovarian stimulation could be considered for poor responders over 37 years old.

Keywords

References

  1. Garcia JE, Jones GS, Acosta AA, Wright G Jr. Human menopausal gonadotropin/human chorionic gonadotropin follicular maturation for oocyte aspiration: phase II, 1981. Fertil Steril 1983;39:174-9.
  2. Loutradis D, Drakakis P, Milingos S, Stefanidis K, Michalas S. Alternative approaches in the management of poor response in controlled ovarian hyperstimulation (COH). Ann N Y Acad Sci 2003;997:112-9. https://doi.org/10.1196/annals.1290.013
  3. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L, et al. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011;26:1616-24. https://doi.org/10.1093/humrep/der092
  4. Kyrou D, Kolibianakis EM, Venetis CA, Papanikolaou EG, Bontis J, Tarlatzis BC. How to improve the probability of pregnancy in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis. Fertil Steril 2009;91:749-66. https://doi.org/10.1016/j.fertnstert.2007.12.077
  5. Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, et al. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod 2007;22:980-8. https://doi.org/10.1093/humrep/del484
  6. Devroey P, Bourgain C, Macklon NS, Fauser BC. Reproductive biology and IVF: ovarian stimulation and endometrial receptivity. Trends Endocrinol Metab 2004;15:84-90. https://doi.org/10.1016/j.tem.2004.01.009
  7. Kolibianakis E, Zikopoulos K, Camus M, Tournaye H, Van Steirteghem A, Devroey P. Modified natural cycle for IVF does not offer a realistic chance of parenthood in poor responders with high day 3 FSH levels, as a last resort prior to oocyte donation. Hum Reprod 2004;19:2545-9. https://doi.org/10.1093/humrep/deh452
  8. De Vries MJ, De Sutter P, Dhont M. Prognostic factors in patients continuing in vitro fertilization or intracytoplasmic sperm injection treatment and dropouts. Fertil Steril 1999;72:674-8. https://doi.org/10.1016/S0015-0282(99)00334-9
  9. Sharma V, Allgar V, Rajkhowa M. Factors influencing the cumulative conception rate and discontinuation of in vitro fertilization treatment for infertility. Fertil Steril 2002;78:40-6. https://doi.org/10.1016/S0015-0282(02)03160-6
  10. Land JA, Yarmolinskaya MI, Dumoulin JC, Evers JL. High-dose human menopausal gonadotropin stimulation in poor responders does not improve in vitro fertilization outcome. Fertil Steril 1996;65:961-5. https://doi.org/10.1016/S0015-0282(16)58269-7
  11. Pelinck MJ, Vogel NE, Hoek A, Arts EG, Simons AH, Heineman MJ. Minimal stimulation IVF with late follicular phase administration of the GnRH antagonist cetrorelix and concomitant substitution with recombinant FSH: a pilot study. Hum Reprod 2005;20:642-8. https://doi.org/10.1093/humrep/deh685
  12. Verberg MF, Macklon NS, Nargund G, Frydman R, Devroey P, Broekmans FJ, et al. Mild ovarian stimulation for IVF. Hum Reprod Update 2009;15:13-29.
  13. Gougeon A, Ecochard R, Thalabard JC. Age-related changes of the population of human ovarian follicles: increase in the disappearance rate of non-growing and early-growing follicles in aging women. Biol Reprod 1994;50:653-63. https://doi.org/10.1095/biolreprod50.3.653
  14. Weghofer A, Margreiter M, Bassim S, Sevelda U, Beilhack E, Feichtinger W. Minimal stimulation using recombinant follicle-stimulating hormone and a gonadotropin-releasing hormone antagonist in women of advanced age. Fertil Steril 2004;81:1002-6. https://doi.org/10.1016/j.fertnstert.2003.09.050
  15. Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97. https://doi.org/10.1093/humrep/deg311
  16. Dickey RP, Olar TT, Taylor SN, Curole DN, Harrigill K. Relationship of biochemical pregnancy to pre-ovulatory endometrial thickness and pattern in patients undergoing ovulation induction. Hum Reprod 1993;8:327-30. https://doi.org/10.1093/oxfordjournals.humrep.a138045

Cited by

  1. Luteal phase ovarian stimulation for poor ovarian responders vol.22, pp.3, 2011, https://doi.org/10.5935/1518-0557.20180045
  2. Assisted reproductive technique in women of advanced fertility age vol.70, pp.6, 2018, https://doi.org/10.23736/s0026-4784.18.04247-8