Abstract
Previously anecdotally observed rebounds in follicle growth after interruption of exogenous gonadotropins in absolute non-responders were the impetus for here reported study. In a prospective cohort study, we investigated 49 consecutive patients, absolutely unresponsive to maximal exogenous gonadotropin stimulation, for a so-called rebound response to ovarian stimulation. A rebound response was defined as follicle growth following complete withdrawal of exogenous gonadotropin stimulation after complete failure to respond to maximal gonadotropin stimulation over up to 5–7 days. Median age of study patients was 40.5 ± 5.1 years (range 23–52). Women with and without rebound did not differ significantly (40.0 ± 6.0 vs. 41.0 ± 7.0 years, P = 0.41), with 24 (49.0%) recording a rebound and 25 (51.0%) not. Among the former, 21 (87.5%) reached retrieval of 1–3 oocytes and 15 (30.6%) reached embryo transfer. A successful rebound in almost half of prior non-responders was an unsuspected response rate, as was retrieval of 1–3 oocytes in over half of rebounding patients. Attempting rebounds may, thus, represent another incremental step in very poor prognosis patients before giving up on utilization of autologous oocytes. Here presented findings support further investigations into the underlying physiology leading to such an unexpectedly high rebound rate.
Highlights
Anecdotally observed rebounds in follicle growth after interruption of exogenous gonadotropins in absolute non-responders were the impetus for here reported study
Whether in association with advanced female age and/or low functional ovarian reserve (LFOR), complete failure to respond to maximal ovarian hyperstimulation with gonadotropins in poor prognosis patients is a common
* Correspondence: ngleicher@thechr.com; ngleicher@rockefeller.edu 1The Center for Human Reproduction, 10021 New York, NY, USA 2Foundation for Reproductive Medicine, 10021 New York, NY, USA Full list of author information is available at the end of the article stimulation, exhibited spontaneously follicle growth and rises in estradiol. At those moments, exogenous gonadotropin stimulation was reinstated, follicles responded, and cycles often reached egg retrieval. In this manuscript describe under the term “rebound” the practice of completely interrupting in women with absolute failure to respond to maximal dosage of exogenous gonadotropin stimulation all gonadotropin stimulation for 3–5 days
Summary
Anecdotally observed rebounds in follicle growth after interruption of exogenous gonadotropins in absolute non-responders were the impetus for here reported study. In a prospective cohort study, we investigated 49 consecutive patients, absolutely unresponsive to maximal exogenous gonadotropin stimulation, for a so-called rebound response to ovarian stimulation. A rebound response was defined as follicle growth following complete withdrawal of exogenous gonadotropin stimulation after complete failure to respond to maximal gonadotropin stimulation over up to 5–7 days. We, in this manuscript describe under the term “rebound” the practice of completely interrupting in women with absolute failure to respond to maximal dosage of exogenous gonadotropin stimulation (i.e., absence of even a single growing follicle and absence of rising estradiol titers) all gonadotropin stimulation for 3–5 days. Reported prospective study summarizes our, at times, very surprising findings
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