Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above

Serour, Gamal I.; Mansour, Ragaa; Serour, A.; Amin, Yehia; Kamal, O.; Al-Inany, Hesham; Aboulghar, Mohamed

doi:10.1016/j.fertnstert.2009.09.044

Cited by 52 publications

(32 citation statements)

References 30 publications

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“…These lower pregnancy rates in older women are in accordance with previous studies claiming pregnancy rates less than 10% in women of advanced age, which may be related to poor oocyte quality [19][20][21]. Our findings further support this, given that although women 40 years old treated with CFA followed by hpHMG in the long agonist setting had a very low cycle cancellation rate (3.1%) and experienced high CPRs, half of the pregnancies ended in a miscarriage, leading to an OPR of 12.5%.…”

Section: Discussionsupporting

confidence: 92%

Corifollitropin alfa followed by hpHMG in GnRH agonist protocols. Two prospective feasibility studies in poor ovarian responders

Polyzos

Corona

Vijver

et al. 2015

Gynecological Endocrinology

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In two prospective uncontrolled feasibility trials, we examined the effect of corifollitropin alfa (CFA) followed by highly purified human menopausal gonadotrophin (hpHMG) in a short flare-up gonadotropin-releasing hormone (GnRH) agonist and a long GnRH agonist protocol for women with poor ovarian response. Overall, 45 patients were treated with short flare-up and 47 patients with the long agonist protocol. All patients received a single dose of 150 μg CFA, followed by 300 IU hpHMG 7 days later, triggering with 10 000 IU hCG, CSI and day 3 embryo transfer. Ongoing pregnancy rates (OPRs) did not differ between the short 15.6% and the long 17% agonist protocol (p = 0.85). Among patients treated with the short flare-up protocol, OPRs were 20% for younger patients (<40 years old) and 12% in older women (≥40 years old), p = 0.68. Similarly, in patients treated with the long agonist protocol younger women had an OPR of 26.7% versus 12.5% in older women, p = 0.23. Among patients treated with the short flare-up, live births rate were 15% and 4.3% for younger (<40 years old) and older patients (≥40 years old), respectively, p = 0.32. Similarly, in patients treated with the long agonist protocol, live births rate were 25% and 12.9% for younger (<40 years old) and older patients (≥40 years old), respectively, p = 0.41. None of the patients reported any serious adverse event related to treatment. According to our results, CFA followed by hpHMG in a short flare-up or long GnRH agonist protocol appears to be a feasible option for poor ovarian responders. Large phase III trials are mandatory prior to introduction in clinical practice.

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Section: Discussionsupporting

confidence: 92%

Corifollitropin alfa followed by hpHMG in GnRH agonist protocols. Two prospective feasibility studies in poor ovarian responders

Polyzos

Corona

Vijver

et al. 2015

Gynecological Endocrinology

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“…A previous study with 2386 IVF cycles in women aged ≥40 years showed that overall clinical pregnancy rate was 13.4% and live birth rate was 6.7% per cycle [18]. They also found that the cancellation rate was 16% per cycle, and the cancellation rate increased significantly in patients at 45 years old and above.…”

Section: Resultsmentioning

confidence: 87%

Mild Ovarian Stimulation has Similar Live Birth Rates as Compared with Hyper Stimulation for Treatment of Poor Responding IVF Patients of Advanced Maternal Age

Yang

2017

JFB

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The number of patients with poor ovarian response (POR) for in vitro fertilization (IVF) varies from 9 to 25%, especially high in patients of advanced maternal age. Although various stimulation protocols have been developed to improve clinical outcomes in patients with POR, a typical and effective protocol remains improvement. Some physicians prefer a mild stimulation protocol, while others like hyper stimulation protocol to obtain more eggs. This study was designed to compare the efficiency of a mild stimulation protocol with hyper stimulation protocol in patients with POR, particularly focused on live birth rate after IVF. Data were collected from 30 poor responders (over 39 years old). Patients were assigned to 2 protocols at the start of ovarian stimulation: Patients in group A were treated with a hyper stimulation (GnRH-antagonist) protocol and patients in group B were treated with a mild stimulation protocol. The ovarian stimulation characteristics, gonadotropin doses, number of eggs collected, number of high quality embryos, clinical pregnancy rates and live birth rates were compared between two groups. Although number of eggs, number of high quality embryos, clinical pregnancy rates were significantly higher in group A than in group B, miscarriage rate was also higher in group A than group B, which eventually resulted in a similar live birth rate (6.7%) in both groups. However, dosages of gonadotropins were smaller and stimulation days were shorter in group B than in group A. When poorly responding patients were treated for IVF, similar live birth rates were observed with mild stimulation protocol and hyper-stimulation protocol. After considering the higher dosages of gonadotropins and longer stimulation days in patients with hyper-stimulation protocol, it is suggested that poor responders may benefit with the mild stimulation protocol for IVF.

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“…Live birth rates were 7.4% for women 40 to 42 years of age, and only 1.1% for women ≥ 43 years. Miscarriage rates were 43.1% in the younger age group and 65.2% in the older age group [47].…”

Section: Treatment Of Age-related Infertilitymentioning

confidence: 89%

Advanced Reproductive Age and Fertility

Liu

Case

Cheung

et al. 2011

Intl J Gynecology & Obste

117

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Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above

Cited by 52 publications

References 30 publications

Corifollitropin alfa followed by hpHMG in GnRH agonist protocols. Two prospective feasibility studies in poor ovarian responders

Corifollitropin alfa followed by hpHMG in GnRH agonist protocols. Two prospective feasibility studies in poor ovarian responders

Mild Ovarian Stimulation has Similar Live Birth Rates as Compared with Hyper Stimulation for Treatment of Poor Responding IVF Patients of Advanced Maternal Age

Advanced Reproductive Age and Fertility

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