Live-birth rates in very poor prognosis patients, who are defined as poor responders under the Bologna criteria, with nonelective single embryo, two-embryo, and three or more embryos transferred

Abstract Study question Does the dose or type of gonadotropin affect the reproductive outcomes of poor responders undergoing MNC-IVF? Summary answer Neither the type nor the dose of gonadotropins affects the reproductive outcomes of poor responders undergoing MNC-IVF. What is known already Poor ovarian response (POR) to ovarian stimulation remains a major therapeutic challenge in routine IVF practice, because of the association with low live birth rates and high cancellation rates. Although high doses of gonadotropins are traditionally used to stimulate the ovaries in women with predicted POR, MNC-IVF has been proposed as a mild-approach alternative in this population. Typically, the MNC protocol includes GnRH-antagonists to avoid premature ovulation and gonadotropin add-back stimulation at the late follicular phase. However, evidence is sparse, and there is no consensus regarding a specific dose or type of gonadotropins in this mild stimulation protocol. Study design, size, duration This is a retrospective cohort study including patients attending a tertiary referral University Hospital from 1st January 2017 until 1st March 2020. Participants/materials, setting, methods All women who underwent MNC-IVF in our center were included. Gonadotropins [recombinant FSH (rFSH), urinary FSH (uFSH) or highly purified human menopausal gonadotrophin (hp-hMG)] were started when a follicle with a mean diameter of 12–14 mm was observed on ultrasound scan, followed by GnRH antagonists (0.25mg/day) from the next day onwards. Mature oocytes were inseminated using ICSI. Main results and the role of chance In total, 484 patients undergoing 1398 cycles were included. Mean (SD) age and serum AMH were 38.2 (3.7) years and 0.46 (0.78) ng/ml, respectively. The daily dose of gonadotropins was either <75 IU/d [11/1398 (0.8%)] or 75 to < 100 IU/d [1303/1398 (93.2%)] or ≥ 100 IU/d [84/1398 (6%)]. Patients were stimulated with: rFSH [251/1398 (18%)], uFSH [45/1398 (3.2%)] or hp-hMG [1102/1398 (78.8%)]. Biochemical and clinical pregnancy rates were 142/1398 (10.1%) and 119/1398 (8.5%). Live birth was achieved in 80/1398 (5.7%) of cycles. Live birth rates (LBR) were similar between the different type and doses of gonadotropins (p-value 0.3 and 0.51, respectively). The GEE multivariate regression analysis adjusting for relevant confounders (age, BMI, number of MII oocytes) showed that the type of treatment strategy (rFSH/uFSH/hp-hMG) and the dose of gonadotropins were not significantly associated with LBR (coefficient 0.01 and –0.02, p value 0.09 and 0.3, respectively). Limitations, reasons for caution The main limitation is the retrospective design of our study, with an inherent risk of bias. Wider implications of the findings: This is the first and largest study evaluating MNC-IVF protocol modalities. Our data demonstrate that any type of gonadotropin can be used and there is no benefit from daily doses beyond 75IU. Trial registration number N/A

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Live birth rates in Bologna poor responders treated with ovarian stimulation for IVF/ICSI

Reproductive BioMedicine Online ◽

10.1016/j.rbmo.2013.11.010 ◽

2014 ◽

Vol 28 (4) ◽

pp. 469-474 ◽

Cited By ~ 64

Author(s):

Nikolaos P. Polyzos ◽

Milie Nwoye ◽

Roberta Corona ◽

Christophe Blockeel ◽

Dominic Stoop ◽

...

Keyword(s):

Live Birth ◽

Ovarian Stimulation ◽

Poor Responders ◽

Birth Rates ◽

Live Birth Rates

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Double embryo transfer gives good pregnancy and live birth rates in poor responders with a modest increase in multiple birth rates: results from an observational study

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/j.1600-0412.2011.01139.x ◽

2011 ◽

Vol 90 (7) ◽

pp. 761-766 ◽

Cited By ~ 5

Author(s):

INGUNN JONSDOTTIR ◽

KERSTI LUNDIN ◽

CHRISTINA BERGH

Keyword(s):

Observational Study ◽

Embryo Transfer ◽

Live Birth ◽

Multiple Birth ◽

Poor Responders ◽

Birth Rates ◽

Modest Increase ◽

Live Birth Rates ◽

Double Embryo Transfer

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DHEA Supplementation Confers No Additional Benefit to that of Growth Hormone on Pregnancy and Live Birth Rates in IVF Patients Categorized as Poor Prognosis

Frontiers in Endocrinology ◽

10.3389/fendo.2018.00014 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 10

Author(s):

Kevin N. Keane ◽

Peter M. Hinchliffe ◽

Philip K. Rowlands ◽

Gayatri Borude ◽

Shanti Srinivasan ◽

...

Keyword(s):

Growth Hormone ◽

Live Birth ◽

Poor Prognosis ◽

Additional Benefit ◽

Birth Rates ◽

Live Birth Rates

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Applying growth hormone as an adjuvant to correct poor prognosis outcomes in IVF: Study 2 compares dehydroepiandrosterone

GSC Biological and Pharmaceutical Sciences ◽

10.30574/gscbps.2021.16.3.0277 ◽

2021 ◽

Vol 16 (3) ◽

pp. 164-190

Author(s):

John Lui Yovich ◽

Shanthi Srinivasan ◽

Mark Sillender ◽

Shipra Gaur ◽

Philip Rowlands ◽

...

Keyword(s):

Live Birth ◽

Ovarian Reserve ◽

Poor Prognosis ◽

Birth Rate ◽

Live Birth Rate ◽

Utilization Rate ◽

Recurrent Implantation Failure ◽

Birth Rates ◽

Live Births ◽

Live Birth Rates

This retrospective study examines the influence of recombinant growth hormone (rGH) and dehydroepiandrosterone (DHEA) adjuvants on oocyte numbers, embryo utilization and live births arising from 3637 autologous IVF±ICSI treatment cycles undertaken on 2376 women across ten years (2011-2020) within a pioneer Australian facility. Despite using an FSH-dosing algorithm enabling maximal doses up to 450 IU for women with reduced ovarian reserve, younger women had significantly higher mean numbers of oocytes recovered than older women ranging from 11.1 for women <35 years to 9.4 for women aged 35-39 years reducing to 6.5 for women aged 40-44 years and 4.1 for those aged ≥45 years (p<0.0001). Overall, the embryo utilization rate was 48.5% and live birth productivity rate was 35.4 % across all ages and neither rGH nor DHEA showed any benefit on these rates, in fact, those women with nil adjuvants showed the highest live birth rate per initiated cycle (44.94% overall: p<0.0001, and 55.2% for the youngest group: p<0.001). Embryo utilization was increased by rGH in those women aged 40-44 years who had low ovarian reserve (p<0.0001), but this benefit did not translate into any improvement in the live birth rate, in fact those women who did not use adjuvants had the highest overall birth rate (p<0.0001). Similarly, other factors known to cause a poor prognosis, including low IGF-1 profile, recurrent implantation failure, and low oocyte numbers at OPU, showed no improvement in embryo utilization nor in live births from the adjuvants. The relevance of embryo quality was examined on 1135 women whose residual embryos after a single fresh-embryo transfer failed to develop to a suitable grade for cryopreservation. From 1727 cycles such women often displayed an improved embryo utilization rate with both rGH, and with DHEA or combined rGH+DHEA. Even so, live birth rates were not improved by either of the adjuvants excepting young women <35 years using rGH without DHEA (p<0.05). Examining poor prognosis sub-groups, indicated both rGH and DHEA or combined rGH+DHEA consistently improved embryo utilization in those women with low ovarian reserve (p<0.0001), or those with low IGF-1 levels (p<0.0001) or with recurrent implantation failure (p<0.02). All the poor-prognosis sub-groups showed low live birth rates and, notwithstanding the improvements in embryo utilization, the live birth rates were not significantly improved by the adjuvants, albeit the rates were closer to the nil adjuvant groups (not significantly different).

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Live Birth Rates in Poor Responders’ Group after Previous Treatment with Autologous Platelet-Rich Plasma and Low Dose Ovarian Stimulation Compared with Poor Responders Used Only Low Dose Ovarian Stimulation Before in Vitro Fertilization

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.825 ◽

2019 ◽

Vol 7 (19) ◽

pp. 3184-3188 ◽

Cited By ~ 4

Author(s):

Snezhana Stojkovska ◽

Gligor Dimitrov ◽

Nikoleta Stamenkovska ◽

Makuli Hadzi-Lega ◽

Zoran Petanovski

Keyword(s):

Live Birth ◽

Ovarian Stimulation ◽

Low Dose ◽

Platelet Rich Plasma ◽

Previous Treatment ◽

Poor Responders ◽

Birth Rates ◽

Live Birth Rates ◽

Autologous Platelet Rich Plasma

BACKGROUND: This prospective pilot study determined the efficacy of previous transvaginal intraovarian injection with autologous platelet-rich plasma (PRP) in poor ovarian responders (PORs) fulfilling the Bologna criteria before in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) with low dose ovarian stimulation. Current knowledge of efficient treatment for PORs is limited and often contradictory; also, LBRs of IVF remains disappointingly low. AIM: We assessed the live birth rates (LBRs) in PORs after previous ovarian treatment with PRP. METHODS: Overall, 40 patients undergoing IVF/ICSI between June 2017 ending December 2018 were included. A transvaginal intraovarian injection of PRP was performed on 20 patients. Both compered groups were balanced for all basic characteristics, and multivariate analysis was performed to adjust for all known confounders. RESULTS: Between the groups, a statistical significance in clinical pregnancies and LBR was not found. Clinical pregnancy and live birth rates were 33.33 ± 44.99 and 40.00 ± 50.71 in the PRP group and 10.71 ± 28.95 and 14.29 ± 36.31 in control group retrospectively. However, there is a trend towards higher implantation rates and LBRs in patients with previous treatment with PRP. Anyhow, the number of patients used in the research is insufficient to make a concrete conclusion, and more studies are needed in the future to confirm these results entirely. CONCLUSION: Even though the treatment of POR responders remains as a therapeutical challenge, the usage of intraovarian injection of autologous PRP in PORs before the IVF performance brings a glimpse of new hope in increasing the success of IVF defined by clinical pregnancy and LBRs.

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Live birth rates in different subgroups of poor ovarian responders according to Bologna criteria and POSEIDON group classification

10.21203/rs.2.19911/v1 ◽

2020 ◽

Author(s):

Mehri Mashayekhy ◽

Arezoo Arabipoor ◽

Forouzan Barabi ◽

Zahra Zolfaghari

Keyword(s):

Live Birth ◽

Group Classification ◽

Birth Rates ◽

Cross Sectional ◽

Group Iii ◽

Live Births ◽

Bologna Criteria ◽

Live Birth Rates ◽

Poor Ovarian Responders

Abstract Background Recently, some studies evaluated the live births rates (LBRs) in two poor ovarian responders (POR) classification methods separately, but present study was designed to compare the LBRs among different groups of patients on the basis of Bologna criteria or POSIEDON group classifications and find the important predictive factors for LBR in patients with POR.Methods In this cross-sectional study, the database containing clinical and laboratory information on infertility treatment cycles were evaluated from December 2015 to December 2017 and all the patients with at least one POR after standard controlled ovarian stimulation (COH) during IVF/ICSI cycles were evaluated. The eligible patients were enrolled and divided into five and four groups according to the Bologna criteria and POSEIDON groups’ classifications, respectively.Results 812 patients with POR diagnosis were investigated which in overall 517 of them had embryo transfer in the last treatment cycle (63.6%) and total clinical pregnancy rate 19.3% (100 cases) and live birth rates 16.1% (86 cases) were found. When the patients were grouped on the Basis of the POSEIDON classification, the highest LBR was observed in the POSEIDON group III. On the other hand, according to the Bologna criteria, 41 patients were not included in any group, and in the analysis of cycle outcome, the LBR in the Bologna group II was more than other groups. The multivariable regression analysis revealed that the significant independent variables remained in the model as important predictive factor for live births in the study population were the number and quality of the transferred embryos transmission (good and excellent quality), and the POSSIDON classification group (POSSIDON group III).ConclusionsOn the basis of present results, the POSEIDON group classification could be more comprehensive and practical than Bologna criteria for diagnosing and categorizing POR patients. In addition, it was found the number and quality of transferred embryos were the most important prognostic factor for live birth in POR patients; therefore we suggest to consider COH protocols with a freezing embryos strategy, and the collection of more good quality embryos to improve the probability of a live birth.

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Live birth rates after modified natural cycle compared with high-dose FSH stimulation using GnRH antagonists in poor responders

Human Reproduction ◽

10.1093/humrep/dev198 ◽

2015 ◽

Vol 30 (10) ◽

pp. 2321-2330 ◽

Cited By ~ 29

Author(s):

Trifon G. Lainas ◽

Ioannis A. Sfontouris ◽

Christos A. Venetis ◽

George T. Lainas ◽

Ioannis Z. Zorzovilis ◽

...

Keyword(s):

Live Birth ◽

Poor Responders ◽

High Dose ◽

Natural Cycle ◽

Birth Rates ◽

Gnrh Antagonists ◽

Live Birth Rates

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Live birth rates in different subgroups of poor ovarian responders according to Bologna and POSEIDON group classification criteria

10.21203/rs.3.rs-22461/v1 ◽

2020 ◽

Author(s):

Mehri Mashayekhy ◽

Arezoo Arabipoor ◽

Forouzan Barabi ◽

Zahra Zolfaghari

Keyword(s):

Live Birth ◽

Predictive Factors ◽

Treatment Cycle ◽

Group Analysis ◽

Group Classification ◽

Birth Rates ◽

Live Births ◽

Bologna Criteria ◽

Live Birth Rates ◽

Group 3

Abstract Background: Live birth rates (LBRs) have been separately evaluated in two poor ovarian responder (POR) classification methods. We designed the present study to compare the LBRs according to Bologna criteria or Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) group classifications to determine the important predictive factors for LBR in patients with POR. Methods: In this cross-sectional study, we evaluated a database that contained clinical and laboratory information on infertility treatment cycles of all patients with at least one POR after standard controlled ovarian stimulation (COH) during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles from December 2015 to December 2017. The eligible data were collected and the subjects divided into five groups according to Bologna criteria and four groups according to POSEIDON group classification. Results: We assessed 812 patients diagnosed with POR; overall, 517 underwent embryo transfer (ET) during the last treatment cycle (63.6%). The results indicated a total clinical pregnancy rate of 19.3% (100 cases) and LBR of 16.1% (86 cases). According to Bologna criteria, 41 patients were not included in any group. Analysis of treatment cycle outcome showed that patients classified as Bologna group II had a higher LBR than the other groups. In terms of POSEIDON classification, all of the patients could be classified into groups. Patients in POSEIDON group 3 had the highest LBR. According to multivariable regression analysis, the significant independent variables that remained in the model as important predictive factors for live births were the number and quality (good and excellent) of the embryos transferred, and POSEIDON group 3 classification. Conclusion: The results indicated that the POSEIDON group classification could be more comprehensive and practical than Bologna criteria for diagnosing and categorizing POR patients. In addition, we noted that the number and quality of transferred embryos were the most important prognostic factors for live births in POR patients. Therefore, we suggest that clinicians consider COH protocols that have a freezing embryo strategy and the collection of more good quality embryos to improve the probability of a live birth.

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