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 Progestin-primed ovarian stimulation vs mild stimulation in women with advanced age above 40: a retrospective cohort study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Qian Peng ◽  
Xiang Cao ◽  
Jing Wang ◽  
Lin Wang ◽  
Jun Xu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnancy Rate ◽  
Retrospective Cohort Study ◽  
Ovarian Stimulation ◽  
Retrospective Cohort ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Advanced Age ◽  
Significant Difference ◽  
Mild Stimulation

Abstract Background Previous studies have demonstrated that progestin-primed ovarian stimulation (PPOS) protocol was a feasible and efficient method in in vitro fertilization (IVF) cycle. However, its application in women with advanced age has not been determined yet. The purpose of this study was to investigate its efficacy in women aged ≥40 years old. Methods This retrospective cohort study included patients with ages of ≥40 years old at the time of ovarian stimulation. The embryonic and clinical outcome of mild stimulation and PPOS were compared. Primary outcome was top-quality embryo rate on day 3, and secondary outcome was clinical pregnancy rate. Results Baseline characteristics of patients was similar in mild stimulation (122 cycles) and PPOS (47 cycles). No significant difference was found in the number of retrieved and mature oocytes and the fertilization and cleavage rates. Of interest, the rate of top-quality embryos was significantly higher in PPOS group (50.08% vs 33.29%, p = 0.015), with an increasing trend of viable embryo rate (73.55% vs 61.16%). A greater amount of gonadotropin was observed in PPOS group (2061.17 ± 1254.63 IU vs 1518.14 ± 547.25 IU, p < 0.05) in spite of comparable duration of stimulation. After FET cycle, no significant difference was found in the clinical pregnancy rates between mild stimulation (12.5%) and PPOS group (16.7%). Conclusions Higher percentage of top-quality embryos on Day 3 and comparable clinical pregnancy rate was obtained in PPOS protocol, which could be considered as a feasible ovarian stimulation protocol in women aged above 40 years old.

scholarly journals CC-Human Menopausal Gonadotropin Combined with Growth Hormone in Mini-stimulation Protocol could Improve Clinical Outcome in Poor Ovarian Responders

2016 ◽  
Author(s):  
Arie A Polim ◽  
Ivan R Sini ◽  
Indra NC Anwar ◽  
Aryando Pradana ◽  
Kurniawati Kurniawati ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pregnancy Rate ◽  
Group Versus ◽  
Poor Responders ◽  
Human Menopausal Gonadotropin ◽  
Ongoing Pregnancy ◽  
Stimulation Protocol ◽  
Ongoing Pregnancy Rate ◽  
Significant Difference ◽  
Poor Ovarian Responders

Objective: To investigate the role of CC-highly purified Human Menopausal Gonadotropin (hpHMG) and Growth Hormone (GH) in mini-stimulation protocol to improve outcome in poor ovarian responders (POR). Method: All patients were given clomiphene citrate 150 mg from day 3 to day 7 of menstrual cycle followed by 150 IU hpHMG daily from day 8 until ovulation trigger. Two groups were observed where one group received GH and the other arm did not. In the GH group, 8 IU of GH were given from day 1 of stimulation until stimulation was stopped. GnRH antagonist was used to suppress ovulation. Result: Among 51 eligible women, 29 patients with GH and 22 patients without GH, no difference was observed in the number of oocytes retrieved (2.21 versus 2.64) and the number of embryos transferred (1.24 versus 1.68) in the GH group versus the group without GH, respectively. Total clinical pregnancy rate was 17.6%. No significant difference in pregnancy and ongoing pregnancy rate in both groups (17.2% versus 18.2%) and (13.8% versus 13.6%), respectively. In patients older than 40 years old, GH showed a 4-fold likelihood in producing top quality embryos (44.8% vs 13.6%, OR=3.6, p=0.05). Conclusion: CC-HMG regimen in mini-stimulation protocol is an effective option in poor responders. Additional GH in ministimulation program provided a higher number of top quality embryos in women older than 40 years old, although there were no difference in clinical or ongoing pregnancy rate. Keywords: CC-HMG, growth hormone, IVF, mini-stimulation protocol, poor ovarian responders

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.

SAY NO to mild ovarian stimulation for all poor responders: it is time to realize that not all poor responders are the same

2020 ◽  
Vol 35 (9) ◽  
pp. 1964-1971 ◽  
Author(s):  
N P Polyzos ◽  
B Popovic-Todorovic
Keyword(s):  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Poor Responder ◽  
Treatment Modalities ◽  
Poor Responders ◽  
Mild Ovarian Stimulation ◽  
Mild Stimulation ◽  
Current Article ◽  
Poor Ovarian Responders ◽  
Intense Stimulation

ABSTRACT Over the last 25 years, a vast body of literature has been published evaluating different treatment modalities for the management of poor ovarian responders. Despite the evidence that maximizing ovarian response can improve the chances of live born babies in poor responders, there are still voices suggesting that all poor responders are the same, irrespective of their age and their actual ovarian reserve. This has resulted in the suggestion of adopting a mild ovarian stimulation approach for all poor responders, based on the results of several trials which failed to identity differences when comparing mild and more intense stimulation in predicted poor responders. The current article analyzes in detail these studies and discusses the shortcomings in terms of type of population included, outcomes and settings performed, which may actually be responsible for the belief that only mild stimulation should be used. In the era of individualization in medicine, it must be realized that there are subgroups of predicted poor responders who will benefit from an individual rather than ‘one fits all’ mild stimulation approach and thus we should provide the same standard of treatment for all our poor responder patients.

scholarly journals Studies on factors affecting superovulation and embryo transfer in Hungarian Merino ewes

2001 ◽  
Vol 49 (4) ◽  
pp. 431-441 ◽  
Author(s):  
S. Cseh ◽  
L. Solti
Keyword(s):  
Developmental Stage ◽  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Ovarian Stimulation ◽  
Corpora Lutea ◽  
Treatment Protocols ◽  
Factors Affecting ◽  
Factors Influencing ◽  
Significant Difference ◽  
One Year

The objectives of this study were (a) to assess the ovulatory response and embryo production of Hungarian Merino ewes after superovulation, (b) to investigate the factors influencing the efficiency of embryo transfer (ET) in Hungarian Merino ewes, (c) to compare the results of two ovarian stimulation protocols (PMSG and PMSG+FSH treatment) in Hungarian Merino ewes, and (d) to study how superovulation, laparoscopic insemination and surgical embryo retrieval (ER) affect the subsequent reproduction of Hungarian Merino donor females after an ET programme. There was no significant difference between the ovarian stimulation protocols in the ratio of donor ewes responding to superovulation nor in the average number of corpora lutea. However, the number of transferable embryos recovered per donor ewe was higher in the PMSG+FSH group. The proportion of transferable embryos, unfertilised oocytes and degenerated embryos did not differ between the treatment protocols. The total pregnancy rate was 53.4% (179/335). Neither the developmental stage of the embryo nor the number of transferred embryos affect the implantation of embryos. However, the increased number of transferred embryos positively influenced the pregnancy rate. No difference was found in the pregnancy rate between synchronised and nonsynchronised groups of recipients. Thirty-six out of 45 donor ewes (80%) became pregnant within one year after the ET programme, indicating that ovarian stimulation and surgical ER did not affect adversely their reproduction.

scholarly journals Morphokinetic Characteristics and Developmental Potential of In Vitro Cultured Embryos from Natural Cycles in Patients with Poor Ovarian Response

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
N. Hojnik ◽  
V. Vlaisavljević ◽  
B. Kovačič
Keyword(s):  
Implantation Rate ◽  
Ovarian Response ◽  
Time Lapse ◽  
Poor Responder ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Developmental Potential ◽  
The Impact ◽  
Natural Cycles

Background. Patients with poor ovarian response to ovarian hyperstimulation represent an interesting group for studying the impact of embryo cleavage irregularities on clinical outcome since all embryos, regardless of their quality, are usually transferred to the uterus. The aim of our study was to follow the morphokinetics of fertilized oocytes from natural cycles in poor responders. Methods. Zygotes from 53 cycles were cultured in vitro for 3 days. The morphokinetics of their development and transfer outcomes were retrospectively analyzed for the normally and irregularly cleaved embryos. Results. Of all embryos, 30.2% had single and 20.8% multiple cleavage irregularities with the following prevalence: developmental arrest 30.2%, direct cleavage to more than two cells 24.5%, chaotic cleavage 13.2%, and reverse cleavage 11.3%. These embryos had longer pronuclear phases, first cytokinesis, second embryo cell cycles, and less synchronized divisions. The transfer of normally developing embryos resulted in an implantation rate of 30.8% and a delivery rate of 23.1%, but irregularly cleaved embryos did not implant. Conclusions. The use of time-lapse microscopy in poor responder patients identified embryos with cleavage abnormalities that are related with no or extremely low implantation potential. Gained information about embryo quality is important for counselling patients about their expectations.

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

2018 ◽  
Vol 22 (3) ◽  
pp. 503-508
Author(s):  
G.V. Strelko
Keyword(s):  
Gestational Diabetes ◽  
Ovarian Stimulation ◽  
Preterm Labor ◽  
Perinatal Outcomes ◽  
Ovarian Response ◽  
Control Group ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Normal Response ◽  
Significant Difference

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.

Modified natural cycle IVF versus conventional stimulation in advanced-age Bologna poor responders

2019 ◽  
Vol 39 (4) ◽  
pp. 698-703 ◽  
Author(s):  
Panagiotis Drakopoulos ◽  
Alessia Romito ◽  
Joaquín Errázuriz ◽  
Samuel Santos-Ribeiro ◽  
Biljana Popovic-Todorovic ◽  
...  
Keyword(s):  
Advanced Age ◽  
Poor Responders ◽  
Natural Cycle ◽  
Natural Cycle Ivf

scholarly journals Q10 Co-enzyme Effect on Fetus Implantation in ART Cycles

2020 ◽  
Vol 8 (2) ◽  
pp. 17
Author(s):  
Aliyeh Ghasemzadeh ◽  
Samira Abdollahi Moghadam ◽  
Laya Farzadi ◽  
Mohammad Noori
Keyword(s):  
Pregnancy Rate ◽  
Coenzyme Q10 ◽  
Implantation Rate ◽  
Fertilization Rate ◽  
Small Sample ◽  
Control Group ◽  
Case Group ◽  
Significant Difference ◽  
Grade Ii

Background and Aim: Infertility is a common condition that affects many couples. Although current cutting-edge therapeutic methods have been found promising in this regard, their success still is not sufficiently high. Accordingly, researchers are working to develop new methods to augment the likelihood of successful results of Assisted Reproductive Technology (ART). Recently, coenzyme Q10 has been recognized an important and influential factor in the process of reproduction and some scarce studies have been along favorable results in this regard. This study aims to examine the effect of oral administration of coenzyme Q10 on embryo implantation in ART cycles. Methods and Materials: In this randomized, placebo-controlled clinical trial, a total of 128 infertile females who were candidates for ART were randomized in two groups receiving either a daily capsule of coenzyme Q10 by the commencement of gonadotropin through to pregnancy test result (case group, 64 patients), or placebo (control group, 64 patients). Finally, oocyte count, fertilization rate, embryo count, quality of embryos, transferred embryo count, implantation rate and pregnancy rate were compared between the two groups. Results: The mean age of the patients was 32.77±6.01 years (20-41) in the case group and 32.45±5.93 years (20-42) in the case group, with no significant difference between the two groups (p=0.77). In comparison between the case and control groups, in spite of better results in the case group, no significant difference was found in terms of oocyte count (10.47±7.16 and 9.38±7.52, respectively; p=0.40), fertilization rate (66.88±16.08 % and 66.73±21.50 %, respectively; p=0.96), embryo count (7.03±4.78 and 5.84±4.85, respectively; p=0.17), quality of embryos (71.9% grade I and 28.1% grade II in cases, 68.8% grade I and 31.3% grade II in controls; p=0.70) transferred embryo count (10.9% one, 56.3% two-three and 32.8% more than three in cases, 14% one, 56.3% two-three and 29.7% more than three in controls; p=0.84), implantation rate (8.39±12.73 % and 7.22±12.80 %, respectively; p=0.60), and pregnancy rate (34.4% and 26.6%, respectively; p=0.34). Conclusion: Although using coenzyme Q10, in comparison with placebo, was along with better results in terms of outcome variables of ART, the difference was statistically insignificant possibly because of a small sample size and short duration of the intervention.

scholarly journals Accumulation of oocytes and/or embryos by vitrification: a new strategy for managing poor responder patients undergoing pre implantation diagnosis

F1000Research ◽  
2014 ◽  
Vol 2 ◽  
pp. 240 ◽  
Author(s):  
Alexia Chatziparasidou ◽  
Martine Nijs ◽  
Martha Moisidou ◽  
Oraiopoulou Chara ◽  
Christina Ioakeimidou ◽  
...  
Keyword(s):  
Genetic Analysis ◽  
Ovarian Stimulation ◽  
Genetic Diagnosis ◽  
Poor Responder ◽  
Optimal Number ◽  
Poor Responders ◽  
Healthy Pregnancy ◽  
Group A ◽  
Low Responder ◽  
Group B

Background: Low (or poor) responder patients are women who require large doses of stimulation medications and produce less than an optimal number of oocytes during IVF cycles. Low responder patients produce few oocytes and embryos, which significantly reduces their chances for success in a preimplantation genetic diagnosis (PGD) cycle. Accumulation of vitrified oocytes or embryos before the actual PGD cycle is a possible strategy that might increase patient’s chances for a healthy pregnancy.Aim of the study: This retrospective study evaluates the efficacy of a PGD program in low responder patients after repeated ovarian stimulation cycles with cumulative vitrification of oocytes and embryos.Methods: Over a period of 30 months, 13 patients entering the PGD program were identified as poor responders after their first ovarian stimulation. These patients started a PGD cycle for one of the following indications: history of recurrent implantation failure (n=1), cystic fibrosis (n=1), X-linked microtubular myopathy (n=1), recurrent miscarriages (n=5), Duchene muscular dystrophy (n=1), chromosomal translocation (n=1) and high sperm aneuploidy (n=1).  After multiple ovarian hormonal stimulations patients had either all mature oocytes (Group A; 3 patients) or all of their day 2 embryos vitrified (group B; 10 patients). Mean total number of oocyte collections per patient was 2.3 (range: 2 - 5 cycles).Results: In the actual PGD cycle, all vitrified oocytes from group A patients were warmed and underwent intra cytoplasmic sperm injection (ICSI) followed by culture up to day 3. For group B patients all vitrified day 2 embryos were warmed and cultured overnight. On day 3 of culture, all embryos from Group A and B had blastomere biopsy followed by genetic analysis. In group A, 20 embryos were found suitable for biopsy and genetic analysis; at least one healthy embryo was available for transfer for each patient.  For group B, 72 embryos in total were available for biopsy and PGD.  All patients, except one, had at least one healthy day 5 embryo for transfer (mean number of 2.1 embryos per transfer). Nine patients had a clinical pregnancy; 7 patients delivered a healthy baby.Conclusion: Low responder patients entering a PGD program might increase their chances for a healthy pregnancy by repeat ovarian stimulation in combination with cumulative oocyte or embryo vitrification.

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