scholarly journals Poor responders to ovarian hyperstimulation may benefit from an attempt at natural-cycle oocyte retrieval

1997 ◽  
Vol 14 (3) ◽  
pp. 174-176 ◽  
Author(s):  
S. R. Lindheim ◽  
A. Vidali ◽  
E. Ditkoff ◽  
M. V. Sauer ◽  
M. Zinger
Keyword(s):  
Oocyte Retrieval ◽  
Poor Responders ◽  
Ovarian Hyperstimulation ◽  
Natural Cycle

scholarly journals Procriação Medicamente Assistida em Ciclo Natural: Avaliação dos Resultados de um Departamento de Medicina da Reprodução

2019 ◽  
Vol 32 (1) ◽  
pp. 25
Author(s):  
Mariana Carlos Alves ◽  
Andreia Leitão Marques ◽  
Helena Barros Leite ◽  
Ana Paula Sousa ◽  
Teresa Almeida-Santos
Keyword(s):  
Embryo Transfer ◽  
Assisted Reproduction ◽  
Ovarian Stimulation ◽  
Lower Cost ◽  
Oocyte Retrieval ◽  
Clinical Pregnancy ◽  
Poor Responders ◽  
Natural Cycle ◽  
Medically Assisted Reproduction ◽  
The Mean

Introduction: Medically assisted reproduction in natural cycle has been investigated, especially in women with poor response to conventional ovarian stimulation, with endometrial receptivity improvement, lower cost and possibility of successive cycles. The disadvantages are: lower profitability per treatment cycle and higher cancellation rate. The aim of this study was to determine the rate of clinical pregnancy in infertile women subjected to medically assisted reproduction in natural cycle.Material and Methods: Retrospective study of 149 medically assisted reproduction without ovarian stimulation of 50 infertile women, between January/2011 and October/2014.Results: The mean age of women undergoing medically assisted reproduction in natural cycle was 36.1 years. Approximately half (46.0%) of the cycles were performed in poor responders. On the day of ovulation trigger, the mean diameter of the follicle was 17.5 mm. Twenty-three cycles (15.4%) were canceled prior to ovulation trigger. In 8 cycles (5.3%), ovulation occurred between ovulation trigger and oocyte retrieval. In the majority of cycles (n = 118; 79.2%) oocyte retrieval was executed, a medically assisted reproduction technique was performed in 71 (47.6%), mostly intracytoplasmic injection. The overall fertilization rate was 77.5%. In 40 cycles (26.8%) there was embryo transfer. The implantation rate and the clinical pregnancy rate by embryo transfer was 35.0% and 25.0%, respectively. Most pregnancies occurred in poor responders, according to Bologna criteria.Discussion: Although the pregnancy rate per cycle started was 6.7%, the rate of clinical pregnancy per embryo transfer is quite satisfactory, being a group of women with unfavorable responses in previous treatments. The relatively high rates of cycle cancellation are mitigated by the greater simplicity and lower cost of these cycles.Conclusion: The results obtained in this study demonstrate that Medically Assisted Reproduction in natural cycle may be an alternative treatment for ovarian stimulation in patients with poor prognosis, whose only alternative would be oocyte donation.

scholarly journals Evaluation of the Second Follicular Wave Phenomenon in Natural Cycle Assisted Reproduction: A Key Option for Poor Responders through Luteal Phase Oocyte Retrieval

Medicina ◽  
2019 ◽  
Vol 55 (3) ◽  
pp. 68 ◽  
Author(s):  
Konstantinos Sfakianoudis ◽  
Mara Simopoulou ◽  
Evangelos Maziotis ◽  
Polina Giannelou ◽  
Petroula Tsioulou ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Luteal Phase ◽  
Oocyte Retrieval ◽  
Fertilization Rate ◽  
Control Group ◽  
Poor Responders ◽  
Natural Cycle ◽  
Oocyte Maturity ◽  
Follicular Wave ◽  
Natural Cycles

Background: Emergence of Luteal Phase Oocyte Retrieval (LuPOR) may revolutionize the practice regarding the time-sensitive nature of poor responders ascertaining a higher number of oocytes, in a shorter amount of time. This may be especially important in view of employing the approach of natural cycles for Poor Responders. We suggest the acronym LuPOR describing the clinical practice of luteal phase oocyte retrieval. The aim of the study is to offer insight regarding the identity of LuPOR, and highlight how this practice may improve management of the special subgroup of poor responders. Materials and Methods: The present retrospective observational clinical study includes the collection and statistical analysis of data from 136 poor responders who underwent follicular oocyte retrieval (FoPOR) and subsequent LuPOR in natural cycles, during their In Vitro Fertilization (IVF) treatment, from the time period of 2015 to 2018. All 136 participants were diagnosed with poor ovarian reserve (POR) according to Bologna criteria. The 272 cycles were categorized as follows: 136 natural cycles with only FoPORs (Control Group) and 136 natural cycles including both FoPORs and LuPORs. Results: Our primary results indicate no statistically significant differences with regards to the mean number of oocytes, the maturation status, and fertilization rate between FoPOR and LuPOR in natural cycles. Secondarily, we demonstrate a statistically significant higher yield of oocytes (2.50 ± 0.78 vs. 1.25 ± 0.53), better oocyte maturity status (1.93 ± 0.69 vs. 0.95 ± 0.59) and higher fertilization rate (1.31 ± 0.87 vs. 0.61 ± 0.60) in natural cycles including both FoPOR and LuPOR, when compared to cycles including only FoPOR. Conclusion: Our study may contribute towards the establishment of an efficient poor responders’ management through the natural cycle approach, paving a novel clinical practice and ascertaining the opportunity to employ oocytes and embryos originating from a luteal phase follicular wave.

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

2021 ◽  
Author(s):  
Maria Paola De Marco ◽  
Giulia Montanari ◽  
Ilary Ruscito ◽  
Annalise Giallonardo ◽  
Filippo Maria Ubaldi ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Embryo Implantation ◽  
Implantation Rate ◽  
Poor Responder ◽  
Advanced Age ◽  
Poor Responders ◽  
Natural Cycle ◽  
Significant Difference ◽  
Over 40 Years

AbstractTo 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.

scholarly journals Complications Associated with Oocyte Retrieval: An Unusual Case of Hematuria and Recurrent Urinary Retention

2019 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Urinary Retention ◽  
Ovarian Hyperstimulation Syndrome ◽  
Acute Urinary Retention ◽  
Unusual Case ◽  
Urinary Catheter ◽  
Oocyte Retrieval ◽  
Ovarian Hyperstimulation ◽  
Management Options ◽  
Bladder Irrigation ◽  
Blood Clots

Background: Complications associated with oocyte retrieval include ovarian hyperstimulation syndrome, ovarian torsion, infection, bleeding, and even acute urinary retention. Case: A 29 year old female presented to the emergency department for dizziness and syncope following oocyte retrieval and was admitted for ovarian hyperstimulation syndrome. Her urinary catheter was obstructed by blood clots and relieved with bladder irrigated. The catheter was removed after twenty-four hours, and she was able to void spontaneously. Four days after discharge, she returned for urinary retention. She underwent cystoscopy and 10cc of blood clots was evacuated. The bladder appeared normal without intravesicular bleeding, and she was discharged home. Twelve hours later, the patient returned for urinary retention. Another cystoscopy was performed and 150cc of blood clots was evacuation. Her symptoms resolved. Conclusion: Hematuria and urinary retention are rare but serious complications of oocyte retrieval. Management options include a urinary catheter, bladder irrigation, urologic imaging, and cystoscopy

Severe ovarian hyperstimulation syndrome with GnRH agonist trigger during the COVID pandemic: lessons learned from an unusual case

2021 ◽  
Vol 5 (04) ◽  
pp. 01-04
Author(s):  
Bradley S Hurst ◽  
Evan Schrader ◽  
Tanner Hurley ◽  
Lariena Welch ◽  
Ying Ying ◽  
...  
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Hyperstimulation Syndrome ◽  
Unusual Case ◽  
Oocyte Retrieval ◽  
Lessons Learned ◽  
Ovarian Hyperstimulation ◽  
Gnrh Agonist Trigger ◽  
Severe Ovarian Hyperstimulation Syndrome ◽  
Agonist Trigger ◽  
Severe Ohss

Background: Injectable gonadotropins stimulate multi-follicular recruitment and allows retrieval of multiple oocytes for assisted reproduction. The widespread utilization of gonadotropin releasing hormone agonist (GnRHa) to induce oocyte maturation for oocyte retrieval has nearly eliminated the risk of severe ovarian hyperstimulation syndrome (OHSS), and only a few cases have been reported in the literature. The rarity of severe OHSS may lead to the mistaken conclusion that gonadotropin stimulation can be safely administered with limited monitoring, even in high-risk patients. We present an unusual case of a woman with limited monitoring due to the COVID pandemic who developed severe OHSS before GnRH agonist trigger and oocyte. Case Presentation: A 29-year-old nulliparous woman with polycystic ovarian syndrome (PCOS) initiated ovarian stimulation for oocyte retrieval. She had a robust initial response, and developed worsening abdominal pain, bloating, nausea, vomiting, and decreased appetite before retrieval. GnRH agonist was given to “trigger ovulation and retrieval scheduled due to the low reported incidence of severe OHSS. Symptoms progressed, and on the morning of retrieval, ultrasound demonstrated bilaterally enlarged ovaries >10cm and 48 oocytes were retrieved for a planned cryo-all cycle. She was hospitalized on the day of retrieval for severe OHSS and had two large-volume paracenteses. She was stable and discharged home by day 5, and symptoms markedly improved with the onset of menses. She has an ongoing pregnancy from her first frozen embryo transfer. Conclusion: We add a rare case of severe OHSS with a GnRHa trigger and cryo-all protocol with the onset of symptoms before GnRH agonist administration. Although rare, severe OHSS may still occur with a GnRHa trigger, and caution is needed when an initial robust response is identified. Here we also provide an opportunity to review the important patient risk factors for the development of OHSS and measures to reduce the risk in excessive responders.

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