Pregnancy Rates In Poor Responders Research Articles

Double stimulation (Duo Stim) versus conventional controlled ovarian hyperstimulation in improving pregnancy rate in poor responders undergoing ICSI..

Double stimulation (Duo Stim) versus conventional controlled ovarian hyperstimulation in improving pregnancy rate in poor responders undergoing ICSI..

Growth hormone for in vitro fertilisation (IVF).

Growth hormone for in vitro fertilisation (IVF).

Comparative study between single versus dual trigger for poor responders in GnRH-antagonist ICSI cycles: A randomized controlled study.

To investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) can improve the number of retrieved oocytes and clinical pregnancy rate in poor responders undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles using a GnRH-antagonist protocol. A randomized controlled trial included poor ovarian responders indicated for ICSI using a GnRH-antagonist protocol. They were divided equally into two groups: group I received 10000 units of hCG plus 0.2mg of triptorelin while group II received 10000 units of hCG only for triggering of ovulation. The primary outcome parameter was the number of oocytes retrieved. Secondary outcomes included metaphase II oocytes number, cancellation rate, number of obtained embryos, chemical and clinical pregnancy rates. One hundred and sixty women were included in the study, with 80 women in each treatment group. Dual triggering was associated with higher number of retrieved oocytes (5.3±1.9 vs 4.5±2.4, P=0.014), metaphase II oocytes (3.8±1.4 vs 3.1±1.7, P=0.004), total and grade 1 embryos (2.7±1.1 and 2.3±1.0 vs 1.9±1.2 and 1.1±0.2, P=0.001 and 0.021 respectively), and transferred embryos (2.2±0.9 vs 1.6±0.9, P=0.043, and lower cancellation rate (7.5% vs 20%, P=0.037) compared with single triggering. There were significantly higher chemical (25% vs 11.3%, P=0.039) and clinical (22.5% vs 8.8%, P=0.028) pregnancy rates in women with dual triggering compared with those with single triggering. Dual triggering is associated with better IVF outcome in poor responders compared with single trigger. Clinical trial registration NCT04008966.

Dehydroepiandrosterone supplementation improves ovarian reserve and pregnancy rates in poor responders.

We investigated whether DHEA supplementation had an impact on ovarian reserve parameters and pregnancy rates in patients with poor ovarian response (POR) and primary ovarian insufficiency (POI). A total of 34 people, 6 patients with POI and 28 patients with POR, were included in the study. The patients in the POR group consisted of two different groups: diminished ovarian reserve (DOR) and premature ovarian failure (PMOF). Patients in the POI and POR group were given 50 mg DHEA supplementation daily for 5 months. The primary outcome was to determine spontaneous clinical pregnancy rates. The monthly changes in the serum hormone levels and AFC were recorded for five months. AMH levels were also measured before and after treatment. The total follow-up time was 152 cycles. The number of pregnancies during the follow-up period was 9. The ratio of pregnancies to the number of patients was 26.5% and the rate per cycle was 5.9%. While 8 of 9 pregnancies resulted in a live birth, one resulted in a miscarriage. The rate of abortion was 11.1%. The mean AFC was 0 to 5 before treatment. Following DHEA administration, a significant increase was detected in 30.8% of the patients. There was an increase in AMH levels after DHEA, but this was not significant. The live birth rate and pregnancy rate per cycle were significantly higher in POR patients than those in POF. Patients with POF had no pregnancy. Although the PMOF patients were younger than the DOR patients, the rate of pregnancy (36% vs. 29%), and pregnancy rates per cycle (8.5% vs. 6.35%) were higher in the DOR group. The rates of live birth were the same in the PMOF and DOR groups (29% vs. 29%). Oral DHEA supplementation improves both ovarian reserve and pregnancy rates in women with POR.

Effect of myo-inositol supplementation on ICSI outcomes among poor ovarian responder patients: A randomized controlled trial

PurposeThis study has evaluated the use of myo-inositol supplementation for improving reproductive outcomes in poor responders undergoing intracytoplasmic sperm injection (ICSI). MethodsOne hundred and twelve poor responder patients were included in the study and randomly categorized into two groups using a permuted block randomization method. Group A included 56 patients who received myo-inositol (4 g) and folic acid (400 μg) daily from one month before starting the ICSI cycle continuing until the ovulation triggering day. Group B included 56 patients consuming only folic acid (400 μg) daily for the same period. The outcome measures were the number of retrieved oocytes, embryo quality, Ovarian Sensitivity Index (OSI: number of oocytes retrieved/total Gonadotropins units × 1000), fertilization, implantation, and ongoing pregnancy rates. ResultsNo significant difference was observed between the two groups regarding the total dose of gonadotropin used, OSI, and the number of total retrieved and mature oocytes. Grad A embryos and fertilization rate were significantly increased in group A. Implantation and pregnancy rates showed statistically insignificant changes. ConclusionTreatment of poor responders with myo-inositol from one month before starting ICSI cycle continuing until ovulation trigger can improve fertilization rate and embryo quality, and may enhance the cumulative pregnancy rate in poor responders.

Growth Hormone (GH) Improvement of Ovarian Responses and Pregnancy Outcome in Poor Ovarian Responders: A Randomized Study.

Recent evidence has emphasized growth hormone benefits in increasing the ovarian response and improving the pregnancy rate in poor responders (POR), caused by aging, ovarian surgery, chemotherapy and other reasons, undergoing IVF/ICSI. The most important factor in the treatment of POR patients is the quality and quantity of oocytes following ovarian stimulation; thus, efforts should be made to provide opportunities for young patients to improve their fertility and ovarian responses. The use of GH in these patients may offer a promising aid to successful fertility.In the present single-blinded clinical trial, POR patients were randomly assigned to receive one of three regimens: (A) Gonadotropin, a GnRH antagonist and GH from the eighth day of the cycle for about 5 days (n = 34); (B) Gonadotropin, a GnRH antagonist and GH from the third day of the previous cycle for about 20 days (n = 32); and (C) Gonadotropin, a GnRH antagonist, and a placebo from the eight day of the cycle for about 5 days (n = 26). Oocyte quality and pregnancy rates were compared across the three groups. A significantly lower number of collected oocytes, MII oocytes, fertilized oocytes, transferred embryos, and clinical pregnancy rate in the placebo group was noted as compared to the two experimental groups receiving GH. Live clinical pregnancies in B group were significantly greater than in the other groups. Our results together indicate that GH may play an important role in recruitment of dominant follicles and enhance follicular survival and the cell proliferation leading to high- quality embryos. Accordingly, administration of GH can considerably elevate the ovarian response in patients with POR planned to undergo IVF.

Impact of the Duration of Controlled Ovarian Stimulation on Assisted Reproduction Cycle Outcomes

Objective: To investigate the impact of duration of controlled ovarian stimulation on vitro fertilization outcomes.Study Design: Medical records of 3194 IVF and ICSI cycles from the assisted reproduction unit of a tertiary hospital were retrospectively analyzed using a computer based database. Characteristics of cycles with duration of stimulation ≤ 8 days (group I), 9 to 12 days (group II) or ≥13 days (group III) were studied retrospectively. Subgroup analysis was also done for poor responders, patients with polycystic ovary syndrome and normoresponders.Results: Estradiol on trigger day, number of retrieved oocytes, mature oocytes and fertilized oocytes were significantly higher in group II compared to the other two groups when all cycles were analyzed (p<0.001). No significant difference was observed regarding clinical and ongoing pregnancy rates between groups. Regarding poor responders, the number of mature oocytes and the number of fertilized oocytes were higher in group II compared to the other groups (p=0.028, p=0.038, respectively). Ongoing pregnancy rates were significantly lower in group III compared to other groups (p= 0.041). In patients with polycystic ovary syndrome, number of retrieved oocytes was significantly lower in group III compared to group II (p=0.047) and number of mature oocytes was significantly lower in group III compared to the other groups (p=0.005). No significant difference was found in the clinical and ongoing pregnancy rates. Number of retrieved oocytes, clinical and ongoing pregnancy rates were comparable between three groups for normoresponders.Conclusion: Prolonged cycles have a detrimental effect only on ongoing pregnancy rates in poor responders.

Whether poor responses have worse perinatal prognosis (retrospective analysis of assisted reproductive technologies cycle)

The prevalence of poor ovarian response is 5.6–35.1% in women undergoing controlled ovarian stimulation in ART cycles. The frequency of delivery of poor responders after ART is on average from 9.9% to 23.8%. In clinical practice, the vast majority of poor responders are older women, which may have an effect on perinatal outcomes, respectively. Although numerous studies have reported that the fertility rate after ART in women of this age group is quite low, data on perinatal outcomes in this group of women is limited. Therefore, the aim of our study was to retrospectively analyze and compare perinatal outcomes in women with poor ovarian response to stimulation compared to control group (normal response to stimulation) in assisted reproductive technology programs. 278 women with infertility with a reduced response to stimulation (poor responders), who were the main group, were screened. Indications for the inclusion of women in the main group were the presence of at least two of the following criteria for a poor ovarian response according to the 2011 Bologna criteria and 93 infertile patients with a normal ovarian response to stimulation of the control group. Subsequently, retrospective study of perinatal effects such as preterm labor, low birth weight, gestational diabetes, preeclampsia in 50 women with infertility with reduced response to stimulation and 37 controls with normal response to stimulation in which pregnancy was diagnosed was performed. Variational-statistical processing of the results of the study was performed using the program “Statistica 6.0”. The study demonstrated a significantly lower pregnancy rate in poor responders compared with women from the control group — 50 (17.9%) vs. 37 (39.8%), respectively. Perinatal outcome were similar only to the statistically significant difference in the percentage of spontaneous abortions before 12 weeks of gestation — 9 (18%) vs. 4 (10.8%), respectively, in groups with no significant difference in the preterm labor frequency — 10 (20.8%) and 6 (18.1%) of the low weight of the child at birth — 9 (18.7%) versus 5 (15.1%), respectively, in poor responders patients and in women with normal ovarian response. The frequency of complications such as gestational diabetes and high blood pressure were not significantly different in both clinical groups — 3 (6.25%) versus 2 (6.1%) and 5 (10.4%) versus 3 (9.1%) respectively. Thus, he poor responders in ART programs have a significantly lower pregnancy rate and a higher incidence of pregnancy loss up to 12 weeks compared with women who had a normal response to ovarian stimulation without a significant difference in the rates of various complications of pregnancy and perinatal outcomes. Wide randomized multicentric trials are needed to find out the causal relationships with regard to the effect on pregnancy, miscarriage, perinatal effects of controlled ovarian stimulation regimens, embryotransfers in fresh or cryo cycles etc.

Ovarian Stimulation in Poor Responders: Have We Made Progress?

Poor ovarian responders (POR) pose a challenge to a physicians' ability to choose a stimulation protocol that maximizes the number of oocytes harvested and their chances of conception with multiple protocols aimed at improving pregnancy rates in this poor prognosis population. The Bologna criteria standardized the diagnosis of POR and allows for a more homogenous patient population in clinical trials. A structured review of the literature, which encompasses research on Bologna-defined POR, identified several proposed protocols to optimize pregnancy rates in poor responders. In addition, we reviewed the utility of utilizing oocyte quality enhancers such as luteal pre-treatment, coenzyme Q10 (CoQ10), dihydroepiandrosterone (DHEA), and growth hormone (GH). Controlled ovarian stimulation strategies with adjuvant aromatase inhibitors and clomiphene citrate have shown similar pregnancy outcomes to higher dose gonadotropin in GnRH antagonist protocols. While the standardization of Bologna defined POR has allowed for more comparable patient populations to study the effectiveness of different protocols for ovarian stimulation, there is currently no convincing data that has determined the ideal protocol for controlled ovarian stimulation in this patient population. Further research is needed to identify optimal treatment strategies.

Serum luteinizing hormone level on the third day after ovarian stimulation in GnRH agonist short protocol is predictive of outcome in poor responders but not in normal responders

Objectives: To identify whether prognostic value of LH measurement in normal responders (NR) is different from poor responders (POR).Methods: A retrospective, single-center study was conducted among patients who underwent ovarian stimulation with short protocol, with 300 NR and 101 POR, according to Bologna Consensus criteria. LH was measured on 3rd and 5th day after stimulation and HCG administration day.Results: There was significant difference in the clinical pregnancy rate per cycle initiated among those with LH level on the third day after stimulation (a) below the 25 centile (b) between the 25 and 75 centile and (c) above the 75 centile in women with POR (7.7%, 15.1% vs. 36.4%, p = 0.02) but not in NR. There was significant correlation between LH ranks and clinical pregnancy rate in POR (p = 0.02) but not in NR. Factors associated with clinical pregnancy rate in POR were age and LH on the third of stimulation, while factors in NR were age, AFC and FSH.Conclusion: LH level on the 3rd day of stimulation was predictive of clinical pregnancy in POR but not in NR.

Estrogen or anti-estrogen for Bologna poor responders?

The current study aims to compare cycle outcomes of two ovarian stimulation protocols in poor responders according to the Bologna criteria; luteal estrogen priming (LE) or letrozole (LZ) co-treatment in antagonist protocol. Following retrospective chart review of a single center, 162 cycles were found eligible for the comparison of two ovarian stimulation protocols. After interpreting data, significantly higher serum estradiol levels, longer duration of cycle, higher number of fertilized oocytes and good quality embryos were detected in patients who received LE. Despite any statistical significance, higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) per embryo transfer (ET) were detected with LE protocol compared with LZ (12.3% versus 18.2% and 9.6% versus 12.7%, respectively). Younger patients (<40 years) revealed higher CPR and OPR per started cycle compared with older patients (≥40 years) where only OPR was statistically significant. Multivariable analysis demonstrated that basal antral follicle count, peak serum estradiol levels and number of fertilized oocytes were independent variables significantly associated with clinical pregnancies (p < 0.05). In the current analysis, LE or LZ protocols revealed comparable but quite low pregnancy rates in poor responders according to the Bologna criteria. Younger patients were more likely to achieve pregnancy compared to older patients with both protocols.

Low-dose growth hormone supplementation increases clinical pregnancy rate in poor responders undergoing in vitro fertilisation

Poor ovarian response (POR) often means low success rates after in vitro fertilisation (IVF). We aim to study the impact of a low-dose growth hormone (GH) supplementation in pregnancy rates in poor responders in a prospective, self-controlled study of 64 poor responders to previous IVF cycles, who failed to achieve pregnancy and were supplemented with low-doses of GH in a subsequent cycle using the same gonadotropin dose and protocol. Our primary endpoint was the clinical pregnancy rate (CPR), considering secondary endpoints, the number of retrieved oocytes, embryos, embryo quality and the proportion of cycles with embryo transfer. CPR in the GH group was 34.4%. Significant differences were observed for the GH group both in the number of top quality embryos (0.64 ± 0.88 versus 1.03 ± 1.17, p < 0.05) and cryopreserved embryos (0.3 ± 0.81 versus 0.85 ± 1.49, p < 0.05). This is, to our knowledge, the first clinical trial to use a low dose of GH as a supplement for IVF in POR patients. Despite this low dose, we achieved excellent success rates in patients with a very poor prognosis, at a reasonable cost and without side effects, which makes this a safe and cost-effective alternative.

Role of dehydroepiandrosterone in improving oocyte and embryo quality in IVF cycles

The purpose of this study was to evaluate the role of dehydroepiandrosterone (DHEA) on the number and quality of oocytes and embryos in poor responders undergoing IVF cycles. A total of 50 patients with a history of poor ovarian response in the previous cycle(s) were enrolled in a prospective cohort study. They were treated with oral micronized DHEA 25mg three times a day for 4months. Oocyte and embryo number and quality were recorded before and after treatment. The results were analysed using Student’s paired t-test. After treatment with DHEA, a significant increase in number of mature follicles was seen in the post treatment period (⩽35years P<0.001; ⩾36years P=0.002). There were significant increases in numbers of oocytes retrieved, fertilization rates and, consequently, the total number of embryos available. More embryos were vitrified among patients ⩽35years (P<0.001) post treatment, and clinical pregnancy rate in this group was 26.7%. DHEA treatment resulted in a higher number of oocytes retrieved, oocytes fertilized, embryos overall and of grade-I embryos. It can help in increasing pregnancy rate in poor responders.This study was performed to evaluate the role of dehydroepiandrosterone (DHEA) treatment on the number and quality of oocytes and embryos in poor responders undergoing IVF cycles. Fifty patients with a history of poor ovarian response in the previous cycle(s) were enrolled in the study and a prospective cohort study was performed. Patients were prescribed oral micronized DHEA 25mg three times a day for 4months. Oocytes and embryos in terms of both number and quality were measured before and after treatment. A significant increase in mean number of mature follicles was seen in the post-treatment group. There was a significant increase in the number of oocytes retrieved, fertilization rates and, consequently, in the total number of embryos available after treatment with DHEA. More embryos were vitrified post treatment and the overall pregnancy rate was 20%. DHEA resulted in a significant improvement in the numbers of oocytes retrieved, oocytes fertilized, embryos and grade-I embryos. DHEA can help improve pregnancy rate in poor responders with history of previous failed IVF cycles.

Co-treatment with growth hormone (GH) may increase pregnancy rate in poor responders undergoing IVF/ET (phase II study)

Administration of growth hormone (GH) in IVF program has been employed to provide benefit among poor responders. In our phase I study, 0-264 ASRM 2012, the use of GH in poor responders was demonstrated to improve pregnancy rate. The aim of the consecutive study is to compare the efficacy of co-treatment with GH in poor responders and normal responder without co-treatment with GH.

Recombinant Luteinizing Hormone supplementation in poor responders undergoing IVF: a systematic review and meta-analysis

The results of several studies about the effectiveness of recombinant luteinizing hormone (rLH) supplementation in poor responder in vitro fertilization (IVF) patients were conflicting. To evaluate the current available data regarding the efficacy of rLH supplementation in poor responders, a meta-analysis was performed. A systemic search was performed without language limitation but restricted to randomized controlled trial (RCT). We mainly explored MEDLINE, EMBASE, CNKI and Cochrane Library for the relevant studies. Three studies were considered eligible for inclusion. The meta-analysis indicated that rLH supplementation did not increase the ongoing pregnancy rate in poor responders (OR 1.30, 95% CI: 0.80, 2.11). Furthermore, there was no significant difference in the number of oocytes retrieved, total dose of rFSH used, total duration of stimulation, number of retrieved metaphase II oocytes and cycle cancellation rate between the study and control groups. In conclusions, the available evidence does not support the addition of rLH in poor responders treated with rFSH and GnRHa for IVF. It was inconclusive. Future research should be based on strict criteria to define poor responders, and large, well-designed RCTs are necessary to definitively answer the important question of whether there was need to use rLH in poor responders undergoing IVF.

ICSI increases ongoing pregnancy rates in patients with poor response cycle: multivariate analysis of 2819 cycles

The objective of this study was to evaluate the prognosis of patients with a first treatment cycle that was defined as a poor ovarian response cycle according to the new ESHRE consensus criteria. The first documented cycle of poor response for a patient and all the cycles that followed were retrospectively analysed. Factors that were associated with ongoing pregnancy rates were assessed using multivariate analysis. In total, this study evaluated 1014 patients that underwent 2819 consecutive IVF cycles. As expected, patients with poor response cycles were older and had less oocytes retrieved and less embryos transferred. Multivariate analysis for ongoing pregnancy rates adjusted for patient and the cycle characteristics revealed that the intracytoplasmic sperm injection (ICSI) procedure was associated with a significant increase of 40% in ongoing pregnancy rate (adjusted success ratio 1.40, 95% CI 1.00–1.96). Age over 41years and additional cycles with poor response, were associated with significantly less ongoing pregnancy rate. However, the cumulative pregnancy rates were 29.5% and 36.4% following five and seven cycles, respectively. In conclusion, performing ICSI may improve the ongoing pregnancy rates in poor responders. Further studies are needed to establish the number of cycles recommended in these patients.Patients with poor ovarian response cycles are currently the most challenging group of fertility patients. We are yet far from understanding the factors which cause reduced ovarian response and further away from finding a solution to this painful problem. In this work, we present that with current available treatment modalities, the results can be improved. We show that performing intracytoplasmic sperm injection and implementation of additional number of treatment cycles may improve the ongoing pregnancy rates of patients with a first treatment cycle that is defined as a poor ovarian response cycle. In addition, we investigated the cumulative pregnancy rates in this group and the effect of performing a number of treatment cycles.

Co-treatment with growth hormone (GH) may increase pregnancy rate in poor responders undergoing IVF/ET

Criteria for poor responders include advanced age, previous cycle cancellation, or an abnormal ovarian reserve. The strategy proposed to improve the outcome of poor responders was growth hormone(GH). In order to verify the advantage of GH administration, we conducted a study to investigate the efficacy of co-treatment with GH in control ovarian stimulation(COS) of poor responders undergoing IVF/ET.

Effect of estrogen priming through luteal phase and stimulation phase in poor responders in in-vitro fertilization

To verify whether a novel protocol administering E(2) during the luteal phase of the preceding cycle and during ovarian stimulation in GnRH antagonist cycle could enhance follicular response and hence improve outcomes in poor responders. In this retrospective analysis, a total of 155 poor responder patients subjected to IVF/ICSI were analyzed. All the patients had history of more than one prior IVF cycle failure with poor response (less than 5 oocytes retrieved and/or maximal E₂ level less than 500 pg/mL) by using conventional long agonist or antagonist protocol. In luteal E2 treatment protocol (n = 86), oral estradiol valerate 4 mg/day was initiated on luteal day 21 and either stopped at menstrual cycle day 3 (Protocol A, n = 28) or continued during the period of ovarian stimulation until the day of hCG injection (Protocol B, n = 58). IVF parameters and pregnancy outcome of luteal E2 treatments group were compared with a standard GnRH antagonist protocol (n = 69) which the patients received no hormonal pretreatment. Compared to standard GnRH antagonist protocol, cancellation rate was lower with luteal E2 group (15.1% vs 37.7%, p < 0.01). Moreover, patients treated with luteal estrogen resulted in an increased number of oocytes retrieved (4.5 ± 2.9 vs 3.2 ± 1.9; p < 0.01). A trend toward increase in number of normally fertilized embryos (2.9 ± 2.1vs 2.3 ± 1.9; p = 0.043), and increased prevalence of good quality embryos (51.2% vs 25%; p = 0.047) were noted. Comparing protocol A and B, there were no significant difference between embryologic data, however there were slight increase in ongoing pregnancy rate in protocol B compared to A (27.1% vs 20%, p = 0.357), although statistical significance was not achieved. Estrogen priming through luteal phase and stimulation phase improved ovarian responsiveness and this may lead to an increase in pregnancy rate in poor responders with failed cycle.

The poor responder in IVF: is the prognosis always poor? A systematic review

BACKGROUND In IVF treatment a considerable proportion of women are faced with a low number of oocytes retrieved. These poor responders have reduced pregnancy rates compared with normal responders. However, this may not be applicable to all poor responders. This review aims at identifying patient characteristics and ovarian reserve tests (ORT) that will determine prognosis for pregnancy in poor responders. METHODS A systematic search was conducted in PubMed, Embase, Cochrane and SCOPUS databases in April 2010. Studies regarding patient characteristics or ORT in poor responders and their pregnancy prospects were included. All included papers were summarized in descriptive tables. RESULTS Nineteen studies were included. Pooled data of six studies comparing poor and normal responders demonstrated clearly lower pregnancy rates in poor responders (14.8 versus 34.5%). Ten studies indicated that older poor responders have a lower range of pregnancy rates compared with younger (1.5-12.7 versus 13.0-35%, respectively). Four studies showed that pregnancy prospects become reduced when fewer oocytes are retrieved (0-7% with 1 oocyte versus 11.5-18.6% with 4 oocytes). Five studies concerning pregnancy rates in subsequent cycles suggested a more favourable outcome in unexpected poor responders, and if ≥2 oocytes were retrieved. CONCLUSIONS Poor responders are not a homogeneous group of women with regards to pregnancy prospects. Female age and number of oocytes retrieved in particular will modulate the chances for pregnancy in current and subsequent cycles. Applying these criteria will allow the identification of couples with a reasonable prognosis and balanced decision-making on the management of poor responders.

Consistent success rates of recombinant follicle-stimulating hormone (rFSH)/GnRH antagonist treatment of IVF patients in different geographic regions: combined analysis of individual patient data

To compare and combine the clinical outcomes of ovarian stimulation with rFSH in a GnRH antagonist protocol in different global locations. Retrospective comparison of outcomes data from the rFSH/ganirelix arms of 4 randomized controlled trials (Engage N = 750, Ensure N = 128, Xpect N = 199, and Chinese ganirelix trial, N = 113) and combined analysis of individual data from 1190 patients originating from Europe (EU; 43.7%), North America (NA; 42.1%), and Asia (14.2%). Patients with regular menstrual cycles were treated with rFSH (starting dose 150 or 200 IU follitropin beta) and the GnRH antagonist ganirelix starting on day 5 or 6 of stimulation. Data are presented per started treatment cycle (intent-to-treat group). Patient characteristics were largely overlapping in the 4 trials, with a mean (SD) combined age of 31.3 (3.4) years, body mass index of 23.8 (3.1) kg/m2, and duration of infertility of 3.4 (2.4) years. The mean (SD) duration of stimulation was 9.2 (1.3) days (range between trials from 9.1–9.6 days) and the amount of rFSH was 1640 (329) IU (range between trials from 1321–1729 IU). The number of oocytes was consistent across trials, ranging from (10.6 ± 5.9) in the Ensure trial to (12.9 ± 6.9) in the Chinese ganirelix trial. The number of good-quality embryos at day 3 ranged between trials from 5.9 (4.1) to 9.1 (5.4). The mean (SD) number of embryos transferred was consistent across trials, ranging from (1.6 ± 0.6) in the Engage trial to (1.9 ± 0.7) in the Chinese Ganirelix trial. The combined ongoing pregnancy rate (PR) was 37.5% with a range from 34.4%–39.8% between trials. The combined ongoing pregnancy rate in poor responders (n = 163, <6 oocytes) and in high responders (n = 210, >18 oocytes) was 31.9% and 42.9%, respectively. Success rates of daily rFSH in a GnRH antagonist protocol were consistent across trials carried out in different parts of the world including Asia, EU, and NA.