Outcome of in vitro fertilization in women with low response to ovarian stimulation

Pellicer, A.; Lightman, Abraham; Diamond, Michael P.; Russell, Jeffrey Burton; DeCherney, Alan H.

doi:10.1016/s0015-0282(16)59170-5

Cited by 107 publications

(46 citation statements)

References 9 publications

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“…However, it has been suggested that women who respond poorly to exogenous gonadotrophins may be good candidates for natural cycle IVF (Schimberni et al 2008). Approximately, 10% of women undergoing ovarian stimulation for IVF will demonstrate a poor response defined as the production of fewer than four follicles (Pellicer et al 1987), and a low level of serum OE 2 (Hanoch et al 1998). Although more frequent in older women (40 years old or more), poor ovarian response can also occur unexpectedly in younger women.…”

Section: Current Regimens For Ovarian Stimulationmentioning

confidence: 99%

The impact of ovarian stimulation for IVF on the developing embryo

Santos¹,

Kuijk²,

Macklon³

2010

Reproduction

175

128

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The use of assisted reproductive technologies (ART) has been increasing over the past three decades, and, in developed countries, ART account for 1-3% of annual births. In an attempt to compensate for inefficiencies in IVF procedures, patients undergo ovarian stimulation using high doses of exogenous gonadotrophins to allow retrieval of multiple oocytes in a single cycle. Although ovarian stimulation has an important role in ART, it may also have detrimental effects on oogenesis, embryo quality, endometrial receptivity and perinatal outcomes. In this review, we consider the evidence for these effects and address possible underlying mechanisms. We conclude that such mechanisms are still poorly understood, and further knowledge is needed in order to increase the safety of ovarian stimulation and to reduce potential effects on embryo development and implantation, which will ultimately be translated into increased pregnancy rates and healthy offspring.

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Section: Current Regimens For Ovarian Stimulationmentioning

confidence: 99%

The impact of ovarian stimulation for IVF on the developing embryo

Santos¹,

Kuijk²,

Macklon³

2010

Reproduction

175

128

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“…asimon@md.huji.ac.il by a poor response to ovulation induction and high cancellation and failure rates, thus influencing significantly the overall IVF success rates, as well as its costeffectiveness (1). Efforts to improve ovarian response in these patients vary and include the application of almost all the currently known stimulation protocols.…”

Section: Ivf Unit Department Of Obstetrics and Gynecology Hebrewmentioning

confidence: 99%

Gonadotropin-Releasing Hormone (GnRH)-Antagonist Versus GnRH-Agonist in Ovarian Stimulation of Poor Responders Undergoing IVF

Fasouliotis

Laufer

Sabbagh-Ehrlich

et al. 2003

J Assist Reprod Genet

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Purpose : The objective of this study was to compare the efficacy of GnRH-antagonists to GnRH-agonists in ovarian stimulation of poor responders undergoing IVF. Methods : Retrospective analysis of our data revealed that 56 patients underwent treatment with a GnRH-agonist according to the flare-up protocol. Patients failing to achieve an ongoing pregnancy (n = 53) were subsequently treated in the next cycle with a GnRH-antagonist according to the multiple-dose protocol. Main outcome measures included the clinical pregnancy and implantation rates. Results : While ovulation induction characteristics and results did not differ between the two protocols, the number of embryos transferred was significantly higher (P = 0.046) in the GnRH-antagonist than in the GnRH-agonist stimulation protocol (2.5 ± 1.6 vs. 2.0 ± 1.4, respectively). The clinical pregnancy and implantation rates per transfer in the GnRH-antagonist group appeared higher than in the GnRH-agonist, but did not differ statistically (26.1 and 10.7 compared with 12.2 and 5.9%, respectively). However, the ongoing pregnancy rate per transfer was statistically significantly higher (P = 0.03) in the GnRH-antagonist than in the GnRH-agonist group (23.9 vs. 7.3%, respectively). Conclusion : Applying GnRH-antagonists to ovarian stimulation protocols may offer new hope for IVF poor responder patients. However, further controlled randomized prospective studies with larger sample sizes are required to establish these results.

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“…1 Flow diagram of participated women in the trial growth and steroidogenesis [2]. In a normal menstrual cycle the endogenous LH is necessary to produce theca cell androgens which are subsequently transformed into estrogens in granulose cells under the action of FSH, and exert positive effects on oocyte and embryo maturation [8,29,30].…”

Section: Discussionmentioning

confidence: 99%

“…Poor response to controlled ovarian hyperstimulation is one of the greatest challenges in assisted reproduction which may occur in 9-24 % of the women undergoing IVF [1,2]. Although no definite cause has been shown, various factors such as advanced age [3], history of previous ovarian surgery [3], serious endometriosis [4] and pelvic infections [5] could be attributed to a poor response to COH.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of low dose hCG on oocyte maturity for ovarian stimulation in poor responder women undergoing intracytoplasmic sperm injection cycle: a randomized controlled trial

Madani

Yeganeh

Khodabakhshi

et al. 2012

J Assist Reprod Genet

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Purpose To investigate the effect of late follicular administration of low dose hCG on oocyte maturity in poor responding women undergoing intracytoplasmic sperm injection (ICSI). Materials and methods This prospective randomized pilot trial was performed on 73 poor responders undergoing ICSI, in Reproductive Biomedicine Research Center, Royan Institute, Tehran, Iran. All eligible patients underwent a GnRH-a long protocol and were randomly allocated into three study groups for ovarian stimulation: groupA received recombinant FSH alone, group B received recombinant FSH supplemented by 100 IU hCG. Group C received recombinant FSH supplemented by 200 IU hCG. The main endpoint was the number of metaphase II oocytes retrieved. Results Of 78 poor responding patients entered to this study, 73 women were considered eligible for enrolment. Of these, 26 women were allocated to receive only recombinant FSH, 24 patients allocated to receive recombinant FSH and 100 IU hCG and 23 patients were assigned to receive recombinant FSH and 200 IU hCG. Number of oocytes retrieved were significantly higher in group B compared to group A (6.5±3.3 versus 4.0±2.3; P0.03). Other cycle and clinical outcomes were comparable between three groups. Conclusions The present study demonstrated that adding 100 IU hCG to rFSH in a GnRH agonist cycle in poor responders improve response to stimulation whereas the number of metaphase II oocytes remains comparable between groups.

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Outcome of in vitro fertilization in women with low response to ovarian stimulation

Cited by 107 publications

References 9 publications

The impact of ovarian stimulation for IVF on the developing embryo

The impact of ovarian stimulation for IVF on the developing embryo

Gonadotropin-Releasing Hormone (GnRH)-Antagonist Versus GnRH-Agonist in Ovarian Stimulation of Poor Responders Undergoing IVF

Efficacy of low dose hCG on oocyte maturity for ovarian stimulation in poor responder women undergoing intracytoplasmic sperm injection cycle: a randomized controlled trial

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