Circulating basal anti-Müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization

Abstract Background In vitro fertilization (IVF) is a well-established method to treat various causes of infertility. Some previous retrospective studies suggested a lower ovarian response in Asian women compared to Caucasian women. However, the ovarian stimulation regimens were not standardized, potentially confounding the findings. The objective of this study is to compare the number of oocytes obtained after ovarian stimulation between Chinese and Caucasian women undergoing IVF using a standardized stimulation regimen. Methods This is a prospective cohort study conducted in two tertiary IVF units in Hong Kong, China and Sydney, Australia from October 2016 to August 2019. A total of 192 women aged 18–42 years with a body weight > 60 kg underwent IVF with a standard ovarian stimulation regimen of 150 micrograms corifollitropin alfa (Elonva®) followed by 200 IU follitropin beta (Puregon®) per day. The number of oocytes retrieved in Chinese women treated in the Hong Kong center was compared to that of Caucasian women treated in the Australian center. Results Serum AMH levels were similar between the two groups. Although women in the Chinese cohort were older and had a higher body mass index (BMI), longer duration of infertility and lower antral follicle count (AFC) than those in the Caucasian cohort in this study, no differences in the number of oocytes retrieved [11 (8–17) vs. 11 (6–17), p=0.29], total dosage and duration of stimulation and number of follicles aspirated were noted between the two ethnic cohorts. The peak estradiol level was greater in Chinese women than in Caucasian women. After controlling for age, BMI and AFC, ethnicity was a significant independent determinant of the number of oocytes obtained. Conclusions Chinese women had a higher number of oocytes after ovarian stimulation using a standardized stimulation regimen compared with Caucasian women undergoing IVF after controlling for age, BMI, AFC and AMH despite presenting later after a longer duration of infertility. Trial registration number: NCT02748278

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Use of androgens and aromatase inhibitors in poor responders undergoing in vitro fertilization

Journal of obstetrics and women s diseases ◽

10.17816/jowd68637-46 ◽

2020 ◽

Vol 68 (6) ◽

pp. 37-46

Author(s):

Alexandra I. Merkulova ◽

Lyailya Kh. Dzhemlikhanova ◽

Dariko A. Niauri ◽

Alexander M. Gzgzyan ◽

Igor Yu. Kogan ◽

...

Keyword(s):

In Vitro Fertilization ◽

Aromatase Inhibitors ◽

Ovarian Stimulation ◽

Poor Response ◽

Ovarian Response ◽

Controlled Ovarian Stimulation ◽

Controlled Clinical Trial ◽

Poor Responders ◽

Vitro Fertilization

Hypothesis/aims of study. Poor ovarian response is still considered one of the most challenging tasks in reproductive medicine. Poor responders have decreased circulating androgens during spontaneous cycles. Androgens are known to play an important role in follicular growth and development. Hence, the use of various androgens and androgen inhibitors in poor responders undergoing ovarian stimulation for IVF has been proposed to improve efficacy of treatment. This study was aimed to examine the efficacy of aromatase inhibitors and androgens in infertility treatment in patients with poor response. Study design, materials and methods. This prospective cohort-controlled clinical trial included 204 patients under 42 years of age with infertility and poor response to ovarian stimulation. In vitro fertilization treatment with an antagonist FSH/hMG protocol with letrozole (5 mg/day) was administered in the first group of patients (n = 26) during the first 5 days of stimulation. Patients of the second group (n = 38) were applied testosterone (25 mg/day) transdermally, starting from the 5th day of the menstrual cycle preceding controlled ovarian stimulation for in vitro fertilization. The third group of patients (n = 18) was administered dehydroepiandrosterone (100 mg/day) for 3 months prior to controlled ovarian stimulation for in vitro fertilization. Results. Improved response to FSH stimulation with letrozole co-treatment was evidenced, with parameters of stimulation efficacy and embryo development being better in the testosterone group. No significant improvement in ovarian response markers, ovarian response to gonadotrophin stimulation and in vitro fertilization outcomes were found in poor responders receiving pre-treatment dehydroepiandrosterone. Conclusion. Further studies are necessary to improve approaches of testosterone and aromatase inhibitors use in poor responders undergoing in vitro fertilization.

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Effect of midfollicular luteinizing hormone levels on ovarian response and pregnancy outcome in patients undergoing in vitro fertilization in a short-term protocol

Fertility and Sterility ◽

10.1016/j.fertnstert.2004.12.015 ◽

2005 ◽

Vol 83 (4) ◽

pp. 1043-1046 ◽

Cited By ~ 5

Author(s):

Su-ying Liu ◽

Jin-lan Han ◽

Xian-dong Peng ◽

Xi Dong ◽

Jun Xu ◽

...

Keyword(s):

In Vitro Fertilization ◽

Luteinizing Hormone ◽

Pregnancy Outcome ◽

Ovarian Response ◽

Short Term ◽

Vitro Fertilization ◽

Hormone Levels

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Type and dose of gonadotropins in poor ovarian responders: does it matter?

Therapeutic Advances in Reproductive Health ◽

10.1177/26334941211024203 ◽

2021 ◽

Vol 15 ◽

pp. 263349412110242

Author(s):

Liese Boudry ◽

Annalisa Racca ◽

Herman Tournaye ◽

Christophe Blockeel

Keyword(s):

In Vitro Fertilization ◽

Ovarian Stimulation ◽

Ovarian Response ◽

Oocyte Donation ◽

Reproductive Technology ◽

Poor Ovarian Response ◽

Vitro Fertilization ◽

Poor Ovarian Responders ◽

Infertile Patients

Infertile patients with a diminished ovarian reserve, also referred to as poor ovarian responders, constitute a substantial and increasing population of patients undergoing in vitro fertilization. The management of patients with poor ovarian response is still a controversial issue. Almost a century has passed since the introduction of the first gonadotropin. A broad collection of urinary and recombinant gonadotropins, including biosimilars, is commercially available now. Despite great advances in assisted reproductive technology, there remains uncertainty about the optimal treatment regimen for ovarian stimulation in poor ovarian responders. Although oocyte donation is the most successful and ultimate remedy for poor ovarian responders, most patients persist on using their own oocytes in several attempts, to achieve the desired pregnancy. The aim of this review is twofold: first, to provide an overview of the commercially available gonadotropins and summarize the available evidence supporting the use of one or another for ovarian stimulation in poor ovarian responders, and second, to address the controversies on the dosage of gonadotropins for this specific in vitro fertilization population.

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