Abstract
Objective: To study whether the unexpected poor ovarian responders optimization of uterine receptivity with a flexible controlled ovarian hyper stimulation protocol based on the Biophysical Profile of the Uterus, has an impact on their reproductive performance. Design: Observational Prospective study. Setting(s): i) General hospital-IVF and Infertility Centre; ii) University hospital. Patient(s): 44 normogonadotrophic young women (26 - 38 yrs) with previous “unexpected” poor ovarian response underwent IVF/ICSI treatment on a protocol based on the Biophysical Profile of their uterus (Group A). The same patients were used as controls in a preceded IVF cycle on the conventional stimulation protocol. Intervention(s): None. Main outcome measure(s): Pregnancy, miscarriage and home take baby rates, amount and duration of gonadotropins required, number and quality of embryos resulted, Biophysical Profile of the Uterus score. Result(s). Treatment in Group A in comparison to Group B resulted in significantly larger number of eggs retrieved per patient, and improved fertilization rates and higher number of embryos/ET (p = 0.011, 0.010 and 0.034 respectively). Group A also demonstrated a trend for higher rates of clinical pregnancy (29.5% v.s. 15.9%), viable stage pregnancies ≥ 24 weeks (33.3% v.s. 20%) and home take babies (26.6% v.s. 16%). The amount of gonadotropins used per patient (IU) was similar in the two groups (p = 0.264). Cancellation, implantation and miscarriage rates as well as embryos quality, although superior in the treatment Group A, showed no significant difference. The number of pregnancies achieved in Group A, were directly related with the score in the Biophysical Profile of the Uterus 12 point scale. Conclusion(s): Unexpected Poor Ovarian Responders on the flexible IVF/ICSI protocol (Group A), adjusting the management according to the Biophysical Profile of their uterus (duration of stimulation, day of HCG and day of embryo transfer), had a significantly better performance in comparison to the Group B managed on the conventional protocol in this difficult to manage and so far, rather understudied population.
Highlights
Despite the enormous number of studies on poor ovarian responders published in the last 30 years, their management remains one of the biggest challenges and most controversial topics in Assisted Reproduction with less than satisfactory progress
Treatment based on the biophysical profile of the uterus (Group A) increased the number of oocytes retrieved per patient, improved fertilization rates and number of embryos transferred per embryo transfer (ET) (p = 0.011, 0.01 and 0.034 respectively), embryo quality was similar in both treatment cycles (Grade A embryos: p = 0.285)
Treatment based on the biophysical profile of the uterus increased the number of oocytes retrieved per patient, and improved fertilization rates and number of embryos/ET significantly
Summary
Despite the enormous number of studies on poor ovarian responders published in the last 30 years, their management remains one of the biggest challenges and most controversial topics in Assisted Reproduction with less than satisfactory progress. According to the ESHRE consensus in a first real attempt to find a common definition of “poor responders” [3], early detection of the problem with different methods of assessment of ovarian reserves, is of particular importance in order to select the most appropriate method of treatment. The AFC (Andral Follicle Count) or AMH (Anti-Mullerian Hormone) measurement is recommended to predict ovarian response [4] [5], with the latter presenting as an excellent and promising test [6] [7]. For scientific purposes according to the 2011 ESHRE consensus, more than one criterion should be contemporaneously presented
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
