Last chance before egg donation: modified natural cycle in vitro fertilization in poor responder patients; the role of follicle diameter on the day of hCG administration in order to improve results

Abstract

OBJECTIVE: Modified Natural Cycle (MNC) IVF may represent an easy, friendly as well as a cheap approach to treat poor responder patients. Aim: To investigate the efficacy of MNC in poor responders undergoing IVF treatment and to determinate the proper follicle diameter for hCG administration in order to improve results.DESIGN: Retrospective analysis.MATERIALS AND METHODS: We evaluated 72 cycles of 45 poor responder patients who were treated with MNC (ISMAAR classification) protocol between 1.1.2007-3.1.2009, following the follicle developed spontaneously, using a GnRH-antagonist together with gonadotrophins in the late follicular phase only. All patients were regular menstruating and had at least three IVF failure (range 3-8), developing in previous stimulated cycles < 4 follicles and estradiol (E2) levels <500 pg/ml on the day of hCG administration. Monitoring was performed by measuring follicle growth by TVS on day 5-7 of the cycle and every 2-3 days until it reached >16mm diameter, then LH, E2 and progesterone levels were assessed. HCG was administered according to standard criteria. Oocyte collection, fertilization and cleavage rates were analyzed in regards to follicle diameter ≥17 ≤19 mm or≥19.5mm on the day of hCG administration.RESULTS: Egg collection was performed in 64 out of 72 cycles (88.8%). In 46 cycles (72%) at least one oocyte was obtained. Fertilization rate was 54% and cleaving embryos for transfer were obtained in 50% of cycles. When the follicle diameter was ≥17 ≤19 mm, at least one oocyte was obtained in 73% of those cycle with fertilization rate of 64% as compared to 60% oocyte retrieval and 48% fertilization rate with a follicle ≥19.5mm. Pregnancy was achieved in 6 cases.CONCLUSIONS: For many couples the use of donor oocytes is precluded for different reasons. For these patients modified natural IVF cycle is a feasible alternative with low cost and low risk despite of high cancellation rate, before being referred to egg donation. Administration of hCG at a follicle≤19mm, may improve the results. OBJECTIVE: Modified Natural Cycle (MNC) IVF may represent an easy, friendly as well as a cheap approach to treat poor responder patients. Aim: To investigate the efficacy of MNC in poor responders undergoing IVF treatment and to determinate the proper follicle diameter for hCG administration in order to improve results. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We evaluated 72 cycles of 45 poor responder patients who were treated with MNC (ISMAAR classification) protocol between 1.1.2007-3.1.2009, following the follicle developed spontaneously, using a GnRH-antagonist together with gonadotrophins in the late follicular phase only. All patients were regular menstruating and had at least three IVF failure (range 3-8), developing in previous stimulated cycles < 4 follicles and estradiol (E2) levels <500 pg/ml on the day of hCG administration. Monitoring was performed by measuring follicle growth by TVS on day 5-7 of the cycle and every 2-3 days until it reached >16mm diameter, then LH, E2 and progesterone levels were assessed. HCG was administered according to standard criteria. Oocyte collection, fertilization and cleavage rates were analyzed in regards to follicle diameter ≥17 ≤19 mm or≥19.5mm on the day of hCG administration. RESULTS: Egg collection was performed in 64 out of 72 cycles (88.8%). In 46 cycles (72%) at least one oocyte was obtained. Fertilization rate was 54% and cleaving embryos for transfer were obtained in 50% of cycles. When the follicle diameter was ≥17 ≤19 mm, at least one oocyte was obtained in 73% of those cycle with fertilization rate of 64% as compared to 60% oocyte retrieval and 48% fertilization rate with a follicle ≥19.5mm. Pregnancy was achieved in 6 cases. CONCLUSIONS: For many couples the use of donor oocytes is precluded for different reasons. For these patients modified natural IVF cycle is a feasible alternative with low cost and low risk despite of high cancellation rate, before being referred to egg donation. Administration of hCG at a follicle≤19mm, may improve the results.