Do poor-responder patients undergoing IVF benefit from splitting and increasing the daily gonadotropin dose?

Ezra, Osnat; Haas, Jigal; Nahum, Ravit; Maman, Ettie; Cohen, Yoram; Segev-Zahav, Aliza; Orvieto, Raoul

doi:10.1080/09513590.2019.1608520

Cited by 5 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although reports suggest that MOS is a relatively preferable strategy for POR, we believe that controlled ovarian hyperstimulation with daily high gonadotropin doses in the GnRH-antagonist protocol should be commonly offered to poor responders. Our observations are in accordance with research that suggests that raising FSH levels during stimulation by high-dose FSH reduces cancellation and improves clinical success ( 23 ), and mild ovarian stimulation is inferior to conventional regimen in POR in terms of retrieved cumulus oocyte complexes ( 22 , 24 ). In addition, there are several studies comparing MOS and other ovarian stimulation protocols applied in POR including some RCTs ( 12 , 15 , 25 – 28 ).…”

Section: Discussionsupporting

confidence: 92%

Cumulative Live Birth Rate and Cost-Effectiveness Analysis of Gonadotropin Releasing Hormone-Antagonist Protocol and Multiple Minimal Ovarian Stimulation in Poor Responders

Liu

2021

Front. Endocrinol.

View full text Add to dashboard Cite

BackgroundThe overall cumulative live birth rate (CLBR) of poor ovarian responders (POR) is extremely low. Minimal ovarian stimulation (MOS) provides a relatively realistic solution for ovarian stimulation in POR. Our study aimed to investigate whether multiple MOS strategies resulted in higher CLBR compared to conventional gonadotropin releasing hormone (GnRH) antagonists in POR.MethodsThis retrospective study included 699 patients (1,058 cycles) from one center, who fulfilled the Bologna criteria between 2010 and 2018. Overall, 325 women (325 cycles) were treated with one-time conventional GnRH antagonist ovarian stimulation (GnRH-antagonist). Another 374 patients (733 cycles) were treated with multiple MOS including natural cycles. CLBR and time-and-cost-benefit analyses were compared between these two groups of women.ResultsGnRH antagonists provided more retrieved oocytes, meiosis II oocytes, fertilized oocytes, and more viable embryos compared to both the first MOS (p < 0.001) and the cumulative corresponding numbers in multiple MOSs (p < 0.001). For the first in vitro fertilization (IVF) cycle, GnRH antagonists resulted in higher CLBR than MOS [12.92 versus 4.54%, adjusted OR (odds ratio) 2.606; 95% CI (confidence interval) 1.386, 4.899, p = 0.003]. The one-time GnRH-antagonist induced comparable CLBR (12.92 versus 7.92%, adjusted OR 1.702; 95% CI 0.971, 2.982, p = 0.063), but a shorter time to live birth [9 (8, 10.75) months versus 11 (9, 14) months, p = 0.014] and similar financial expenditure compared to repeated MOS [20,838 (17,953, 23,422) ¥ versus 21,261.5 (15,892.5, 35,140.25) ¥, p = 0.13].ConclusionBoth minimal ovarian stimulation (MOS) and GnRH-antagonists provide low chances of live birth in poor responders. The GnRH antagonist protocol is considered a suitable choice for PORs with comparable CLBR, shorter times to live birth, and similar financial expenditure compared to repeated MOS.

show abstract

Section: Discussionsupporting

confidence: 92%

Cumulative Live Birth Rate and Cost-Effectiveness Analysis of Gonadotropin Releasing Hormone-Antagonist Protocol and Multiple Minimal Ovarian Stimulation in Poor Responders

Liu

2021

Front. Endocrinol.

View full text Add to dashboard Cite

show abstract

“…We think controlled ovarian hyperstimulation with high daily gonadotropin doses in GnRHantagonist protocol should be commonly offered to poor responders. Our observations are in accordance with researches that raising FSH levels during stimulation by high-dose FSH reduced cancelations and improved clinical successful results [22]. In the context of laboratory performance, the need for a large number of oocytes via ovarian stimulation is an integral part of successful IVF treatment, since the number of oocytes and viable embryos are independent factors that increase CLBR [23].…”

Section: Discussionsupporting

confidence: 90%

Cumulative live birth rate and cost-effectiveness analysis between GnRH-antagonist protocol and multiple minimal ovarian stimulation in poor responder

Liu

2020

Preprint

View full text Add to dashboard Cite

Background The overall cumulative live birth rate (CLBR) of poor ovary responders (POR) is extremely low. Minimal ovarian stimulation (MOS) suggested a relative realistic solution in ART for POR. Our study aimed to investigate whether multiple MOS strategy results in higher CLBR compared to GnRH antagonist protocol and the cost-effectiveness analysis in POR. Methods This retrospective study involved 699 patients (1058 cycles) who fulfilled the Bologna criteria in one center performed from 2010–2018. Specifically, 325 women (325 cycles) were treated with one time conventional GnRH antagonist ovarian stimulation (GnRH-antagonist). Another 374 patients (733 cycles) were treated with multiple minimal ovarian stimulations (MOS) including natural cycles. CLBR and cost-effectiveness analysis were performed comparing these two groups of women. Results GnRH- antagonist leads to more oocytes retrieved, more fertilized oocytes and more viable embryos compared to first MOS (p < 0.001) and the cumulative corresponding ones in multiple MOS (p < 0.001). For the first IVF cycle, GnRH- antagonist results in higher CLBR than MOS (12.92% versus 4.54%, Adjusted OR 2.606; 95%CI 1.386, 4.899, p = 0.003). However, GnRH-antagonist induces comparable CLBR with multiple MOS (12.92% versus 7.92%, Adjusted OR 1.702; 95%CI 0.971, 2.982, p = 0.063), but absolutely shorter time to live birth (9 (8, 10.75) months versus 11 (9, 14) months, p = 0.014) and similar financial expenditure compared to repeated MOS (20838 (17953, 23422) ¥ versus 21261.5 (15892.5, 35140.25) ¥, p = 0.13). Conclusion Both MOS and GnRH-antagonist provide low chance of live birth for poor responders. GnRH antagonist protocol is a sound choice for POR with comparable CLBR, shorter time to live birth and similar financial expenditure.

show abstract

Section: Type Of Coh: Natural/modified Natural Cycle or High Dose Cohmentioning

confidence: 95%

“…Conversely, Ezra et al (85), reported different results. These investigators retrospectively compared increasing the gonadotropin daily dose from 450 U/day to 300 U twice daily in poor responders (85). They included 23 consecutive poor responders in IVF COH who had previously been treated with 450 U of gonadotropins, followed by an additional IVF cycle using 300 U twice a day, were included (85).…”

Section: Type Of Coh: Natural/modified Natural Cycle or High Dose Cohmentioning

confidence: 95%

“…These investigators retrospectively compared increasing the gonadotropin daily dose from 450 U/day to 300 U twice daily in poor responders (85). They included 23 consecutive poor responders in IVF COH who had previously been treated with 450 U of gonadotropins, followed by an additional IVF cycle using 300 U twice a day, were included (85). This study reported that patients receiving daily gonadotropin 300 IU twice daily reached higher maximal estradiol levels (P < 0.03), higher number of follicles >15 mm in diameter on day of hCG administration (P < 0.03) and more oocytes retrieved (P < 0.02) with 5% live birth rate (85).…”

Section: Type Of Coh: Natural/modified Natural Cycle or High Dose Cohmentioning

confidence: 99%

See 1 more Smart Citation

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

Blumenfeld

2020

Front. Endocrinol.

View full text Add to dashboard Cite

The infertile patients with aging ovaries-also sometimes referred to as impending premature ovarian insufficiency (POI), impending premature ovarian failure (POF), or poor ovarian responders (POR), constitute a significant and increasing bulk of the patients appealing to IVF/ART. Different causes have been cited in the literature, among the identified etiologies, including chromosomal and genetic etiology, metabolic, enzymatic, iatrogenic, toxic, autoimmune, and infectious causes. Although the most successful and ultimate treatment of POI/POF/POR patients is egg donation (ED), many, if not most, of these infertile women are reluctant to consent to ED upon the initial diagnostic interview, requesting alternative solutions despite the low odds for success. Despite anecdotal case reports, no unequivocal treatment proved to be successful for these patients in prospective randomized controlled trials. Nevertheless, the addition of growth hormone (GH) to ovarian stimulation in POR with GH deficiency may improve the results of controlled ovarian hyperstimulation (COH) and the IVF success. In patients with autoimmune etiology for POR/POI, the combination of glucocorticosteroids, pituitary-ovarian suppression, and COH may be successful in achieving the desired conception.

show abstract

Do poor-responder patients undergoing IVF benefit from splitting and increasing the daily gonadotropin dose?

Cited by 5 publications

References 17 publications

Cumulative Live Birth Rate and Cost-Effectiveness Analysis of Gonadotropin Releasing Hormone-Antagonist Protocol and Multiple Minimal Ovarian Stimulation in Poor Responders

Cumulative Live Birth Rate and Cost-Effectiveness Analysis of Gonadotropin Releasing Hormone-Antagonist Protocol and Multiple Minimal Ovarian Stimulation in Poor Responders

Cumulative live birth rate and cost-effectiveness analysis between GnRH-antagonist protocol and multiple minimal ovarian stimulation in poor responder

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

Contact Info

Product

Resources

About