Outcome of ICSI cycles with single oocyte retrieval. Does ovarian stimulation with gonadotropins have any impact?

Abstract

OBJECTIVE: Poor ovarian response to ovarian stimulation protocols for assisted conception is increasing and a challenge to practicing physicians. In some circumstances multifollicular development during ovarian stimulation can be out of consideration The aim of this study is to evaluate the efficiency of utilizing exogenous gonadotropins in women undergoing single oocyte retrieval compared to women with natural cycle.DESIGN: Retrospective.MATERIALS AND METHODS: Cycles in which one follicle developed and ended up by single oocyte retrieval between 2003 November and 2006 November were included into the study. Multiple GnRH antagonist protocol with recombinant or urinary gonadotropins were used for ovarian stimulation together with FSH treatment (induced cycles) in 134 (2.2%) women and those in which no gonadotropin was administered (natural cycles) in 41 (0.7%) women among 5918 women undergoing oocyte retrieval during the assessed period. Follicular aspiration was performed at 35 hours after hCG administration. ICSI was the method of insemination in all cycles and embryos were transferred at day 2. The luteal phase was supported 100 mg progesterone in oil i.m.RESULTS: Both groups carried out similar characteristics in terms of age and previous ART trial number. In induced cycles mean number of gonadotropins (75 IU each) was 54.0 ±21.9 ampoules and mean number of GnRH antagonist was (0.25mg each) was 2.6 ±1.2 ampoules. Embryo transfer cancellation was not significantly different in induced cycles compared to natural cycles (44.0% vs 43.9%). Fertilization rates in induced group was 57.4%, while in natural group it was 70.7% (p>0.1). Implantation and clinical pregnancy rates per oocyte retrieval and embryo transferred cycle were 8.2 % and 18.6 % in induced cycles and 17.0% and 30.4% in natural cycles respectively and were not statistically different (p>0.3 and p>0.1). Live birth rate in induced cycles per oocyte retrieval and ET were 5.2% and 11.8% and in natural cycles were 7.3% and 13.0%, respectively.CONCLUSIONS: Our study demonstrated the performance of inevitable single embryo transfers among a group of poor responder patients. In view of our findings, it can be concluded that exogeneous gonadotropin administration did not result by better outcome compared to women undergoing oocyte retrieval without ovarian stimulation. On the other hand, high cancellation probability and increased early pregnancy loss should be informed to this specific group of patients. OBJECTIVE: Poor ovarian response to ovarian stimulation protocols for assisted conception is increasing and a challenge to practicing physicians. In some circumstances multifollicular development during ovarian stimulation can be out of consideration The aim of this study is to evaluate the efficiency of utilizing exogenous gonadotropins in women undergoing single oocyte retrieval compared to women with natural cycle. DESIGN: Retrospective. MATERIALS AND METHODS: Cycles in which one follicle developed and ended up by single oocyte retrieval between 2003 November and 2006 November were included into the study. Multiple GnRH antagonist protocol with recombinant or urinary gonadotropins were used for ovarian stimulation together with FSH treatment (induced cycles) in 134 (2.2%) women and those in which no gonadotropin was administered (natural cycles) in 41 (0.7%) women among 5918 women undergoing oocyte retrieval during the assessed period. Follicular aspiration was performed at 35 hours after hCG administration. ICSI was the method of insemination in all cycles and embryos were transferred at day 2. The luteal phase was supported 100 mg progesterone in oil i.m. RESULTS: Both groups carried out similar characteristics in terms of age and previous ART trial number. In induced cycles mean number of gonadotropins (75 IU each) was 54.0 ±21.9 ampoules and mean number of GnRH antagonist was (0.25mg each) was 2.6 ±1.2 ampoules. Embryo transfer cancellation was not significantly different in induced cycles compared to natural cycles (44.0% vs 43.9%). Fertilization rates in induced group was 57.4%, while in natural group it was 70.7% (p>0.1). Implantation and clinical pregnancy rates per oocyte retrieval and embryo transferred cycle were 8.2 % and 18.6 % in induced cycles and 17.0% and 30.4% in natural cycles respectively and were not statistically different (p>0.3 and p>0.1). Live birth rate in induced cycles per oocyte retrieval and ET were 5.2% and 11.8% and in natural cycles were 7.3% and 13.0%, respectively. CONCLUSIONS: Our study demonstrated the performance of inevitable single embryo transfers among a group of poor responder patients. In view of our findings, it can be concluded that exogeneous gonadotropin administration did not result by better outcome compared to women undergoing oocyte retrieval without ovarian stimulation. On the other hand, high cancellation probability and increased early pregnancy loss should be informed to this specific group of patients.