Natural Cycle Results in Lower Implantation Failure than Ovarian Stimulation in Advanced-Age Poor Responders Undergoing IVF: Fertility Outcomes from 585 Patients

Maria Paola De Marco,Giulia Montanari,Donatella Caserta,Laura Rienzi,Matteo Schimberni,Filippo Maria Ubaldi,Annalise Giallonardo,Ilary Ruscito,Mauro Schimberni,Mauro Schimberni,Flavia Costanzi

doi:10.1007/s43032-020-00455-5

Maria Paola De Marco, Giulia Montanari + Show 9 more

Open Access

https://doi.org/10.1007/s43032-020-00455-5

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Abstract

To compare pregnancy rate and implantation rate in poor responder women, aged over 40 years, who underwent natural cycle versus conventional ovarian stimulation. This is a retrospective single-center cohort study conducted at the GENERA IVF program, Rome, Italy, between September 2012 and December 2018, including only poor responder patients, according to Bologna criteria, of advanced age, who underwent IVF treatment through Natural Cycle or conventional ovarian stimulation. Between September 2012 and December 2018, 585 patients were included within the study. Two hundred thirty patients underwent natural cycle and 355 underwent conventional ovarian stimulation. In natural cycle group, both pregnancy rate per cycle (6.25 vs 12.89%, respectively, p = 0.0001) and pregnancy rate per patient101 with at least one embryo-transfer (18.85 vs 28.11% respectively, p = 0.025) resulted significant reduced. Pregnancy rate per patient managed with conventional ovarian stimulation resulted not significantly different compared with natural cycle (19.72 vs 15.65% respectively, p = 0.228), but embryo implantation rate was significantly higher in patients who underwent natural cycle rather than patient subjected to conventional ovarian stimulation (13 vs 8.28% respectively, p = 0.0468). No significant difference could be detected among the two groups in terms of abortion rate (p = 0.2915) or live birth pregnancy (p = 0.2281). Natural cycle seems to be a valid treatment in patients over 40 years and with a low ovarian reserve, as an alternative to conventional ovarian stimulation.

Highlights

Poor ovarian response (POR) remains a challenge of scientific and clinical relevance for in vitro fertilization (IVF) treatment because of the increased failure rate and the negative influence on the patients
The two study groups were homogeneous with regard to median age, Body mass index (BMI), FSH, menarche, previous pregnancies, Antral Follicle Count (AFC), and smoke status
At the present with 585 patients studied, this is the largest study in the literature with a comparison of natural cycle (NC), intended as a natural follicle selection and recruitment without medical treatment, with conventional IVF (cIVF) in POR patients older than 40 years

Summary

Introduction

Poor ovarian response (POR) remains a challenge of scientific and clinical relevance for in vitro fertilization (IVF) treatment because of the increased failure rate and the negative influence on the patients. Many treatments have been suggested with a high quantity of gonadotropins, poor responder patients are refractory to stimulation protocols with very low chance of pregnancy, resulting in less than 10% for oocyte retrieval [1]. Societal changes have imposed women to achieve educational goals and established careers before programming a pregnancy. In this context the age of women seeking pregnancy has increased, and this is progressively pointing out a worldwide social problem impacting future sustainability [3]. Many studies proposed different treatment protocols to attempt for these patients, with discordant results [9] In this scenario, the best treatment option for poor responders is still needed to be clarified. Natural cycle is defined as IVF treatment without any gonadotrophin administration: the biological rationale for this approach, is to obtain the natural follicle recruitment and selection and subsequent in vitro fertilization and embryo culture [11]

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