Abstract
ObjectiveTo compare the clinical outcomes of follicular versus luteal phase ovarian stimulation in women with poor ovarian response (Bologna criteria) undergoing IVF.MethodsThis retrospective study investigated 446 patients submitted to 507 cycles in three groups. First, the two larger cohorts were examined: 154 patients treated with luteal phase ovarian stimulation (Group Lu); and 231 patients administered follicular phase ovarian stimulation (Group Fo). Then the clinical outcomes of 61 patients submitted to double ovarian stimulation were analyzed. Clinical outcomes included number of retrieved oocytes, fertilization rate, cleavage rate, top-quality embryo rate, clinical pregnancy rate (CPR), and live birth rate (LBR).ResultsLonger stimulation, higher dosages of HMG, and higher MII oocyte rates were achieved in Group Lu (p<0.001). There were no significant differences in CPR and LBR between the two groups offered frozen-thawed embryo transfer (28.4% vs. 33.0%, p=0.484; 22.9% vs. 25.5%, p=0.666). In the double ovarian stimulation group, the number of oocytes retrieved in the luteal phase stimulation protocol was higher (p=0.035), although luteal phase stimulation yielded a lower rate of MII oocytes (p=0.031). CPR and LBR were not statistically different (13.8% vs. 21.4%, p=0.525; 10.3% vs. 14.3%, p=0.706).ConclusionLuteal phase ovarian stimulation may be a promising protocol to treat women with POR, particularly for patients unable to yield enough viable embryos through follicular phase ovarian stimulation or other protocols.
Highlights
Ovarian stimulation improves the outcome of assisted reproductive technology (ART) treatments by increasing the number of oocytes and viable embryos
Patients with at least two of the following findings were diagnosed with poor ovarian response (POR): (i) advanced maternal age (≥40 years) or any other risk factor for POR; (ii) previous POR (≤3 oocytes from a conventional stimulation protocol); (iii) abnormal ovarian reserve test (i.e., antral follicle count (AFC)
Comparisons between groups Lu and Fo There were no differences in Antral follicle count (AFC), BMI or baseline hormone levels (FSH, LH and E2) of the patients in the two groups (p>0.05)
Summary
Ovarian stimulation improves the outcome of assisted reproductive technology (ART) treatments by increasing the number of oocytes and viable embryos. The incidence of poor ovarian response (POR) ranges from 9% to 24% in women undergoing ovarian stimulation for ART (Ubaldi et al, 2005). There is no perfect predictive test available to assess ovarian response or screening test for POR. Women with POR have the poorest prognosis for ovarian stimulation. One of the limitations in interpreting the relevant literature is the huge discrepancy in the definitions of POR (Polyzos & Devroey, 2011). The ESHRE Working Group has proposed a definition for POR. Though various ovarian stimulation protocols have been applied to improve ovarian response, POR is still a challenging condition for patients and clinicians (Venetis et al, 2010; Kryou et al, 2007)
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