P–520 Live birth rate with a euploid embryo is the same irrespective of the number of oocyte retrievals undertaken to produce a euploid embryo

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Theodorou ◽  
D Cardena. Armas ◽  
B P Jones ◽  
P Serhal ◽  
J Ben-Nagi
Keyword(s):  
Logistic Regression ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Multivariate Logistic Regression ◽  
Group A ◽  
Group B ◽  
Euploid Embryo

Abstract Study question Does a euploid embryo from one ovarian stimulation lead to the same live birth rate as a euploid embryo arising from multiple ovarian stimulations? Summary answer The live birth rate of a euploid embryo transferred is comparable irrespective of the number of ovarian stimulations required. What is known already Embryo transfer of a euploid embryo leads to a high live birth rate. Women with low ovarian reserve or poor responders may not have a euploid embryo from one cycle of ovarian stimulation and can be discouraged from undergoing preimplantation genetic testing for aneuploidy (PGT-A). Embryo batching from multiple cycles offers such patients a potential solution to increase their chance of achieving a euploid embryo. Study design, size, duration A retrospective analysis of 506 cycles of single euploid frozen embryo transfers (FET) from January 2015 to March 2020 was carried out. The indication for PGT-A was advanced maternal age, recurrent miscarriages or repetitive IVF failures. Only the first single euploid FETs per patient were included. Participants/materials, setting, methods Group A (N = 323) included women who had a normal ovarian reserve and only one cycle of ovarian stimulation before the FET, whilst Group B (N = 183) had low ovarian reserve or previous poor ovarian response requiring 2 or more cycles of ovarian stimulation. All embryos were biopsied at the blastocyst stage and subjected to a-CGH or NGS. Univariate statistical analysis with Chi-square or Wilcox Man U as required and multivariate logistic regression was performed with SPSS. Main results and the role of chance Group A and Group B were comparable in terms of BMI (average 22.3 vs 22.6), sperm origin, number of blastocysts biopsied (median N = 6, range 4–8), day 5 vs day 6 biopsy (day 5, 81.1% vs 75.4%, p = 0.130) and whether only one euploid embryo was available (42% vs 34%; p = 0.103). There was a significant difference in the number of eggs retrieved per cycle between the two groups (median 15 vs 9, p < 0.001), the total number of eggs retrieved (median 15 vs 20, p < 0.001) and whether a top-quality embryo was transferred (38% vs 25%, p = 0.026). Pregnancy rate, live birth rate and pregnancy loss was equivalent for both groups: 69.3% (224/323) vs 63.9% (178/183) (p = 0.212), 57.6% (186/323) vs 57.4% (105/183) (p = 0.096) and 17.0% (38/224) vs 10.3% (12/117) (p = 0.964), respectively. Multivariate logistic regression was performed to ascertain the effect of the treatment variables on the live birth rate. The number of oocyte collections was not a significant predictive factor (OR 1.19, 95% CI 0.72 - 1.96, p = 0.491), whilst an embryo biopsy performed on day 5 vs day 6, increased significantly the live birth rate (OR 2.58, 95% CI 1.61 - 4.13, p < 0.001). Limitations, reasons for caution The main limitation of this study is that it is retrospective, single centre and therefore vulnerable to confounding factors and bias. Wider implications of the findings: These results can be used to counsel and reassure women with poor response embarking on embryo batching and PGT-A that should a euploid embryo become available, their chance of success is unaffected by the number of cycles they undertake albeit the physical, emotional and financial burden of multiple ovarian stimulations Trial registration number Not applicable

The Deferred Embryo Transfer Strategy Seems Not to be a Good Option After Repeated IVF/ICSI Cycle Failures

2018 ◽  
Vol 26 (9) ◽  
pp. 1210-1217 ◽  
Author(s):  
Mathilde Bourdon ◽  
Pietro Santulli ◽  
Yulian Chen ◽  
Catherine Patrat ◽  
Khaled Pocate-Cheriet ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Previous History ◽  
Multivariate Logistic Regression Analysis ◽  
Live Birth Rate ◽  
Multivariate Logistic Regression ◽  
Icsi Cycle ◽  
Significant Difference

Objective: The aim of this study was to assess whether a deferred frozen–thawed embryo transfer (Def-ET) offers any benefits compared to a fresh ET strategy in women who have had 2 or more consecutive in vitro fertilization (IVF)/intracytoplasmic injection (ICSI) cycle failures. Design: An observational cohort study in a tertiary referral care center including 416 cycles from women with a previous history of 2 or more consecutive IVF/ICSI failures cycles. Both Def-ET and fresh ET strategies were compared using univariate and multivariate logistic regression models. The main outcome measured was the cumulative live birth rate (CLBR). Results: A total of 416 cycles were included in the analysis: 197 in the fresh ET group and 219 in the Def-ET group. The CLBR was not significantly different between the fresh and Def-ET groups (58/197 [29.4%] and 57/219 [26.0%], respectively, P = .437). In addition, after the first ET, there was no significant difference in the live birth rate between the fresh ET and Def-ET groups (50/197 [25.4%] vs 44/219 [20.1%], respectively). Multivariate logistic regression analysis indicated that compared to the fresh strategy, the Def-ET strategy was not associated with a higher probability of live birth. Conclusions: In cases with 2 or more consecutive prior IVF/ICSI cycle failures, a Def-ET strategy did not result in better ART outcomes than a fresh ET strategy.

scholarly journals Comparison of the C Umulative Live Birth Rates After One ART Cycle Including All Subsequent Frozen–thaw Cycles in Women Undergoing IVF Using Progestin Primed Ovarian Stimulation Versus Long GnRH Agonist Protocol

2021 ◽  
Author(s):  
Hong Chen ◽  
Zhi qin Chen ◽  
Ernest Hung Yu Ng ◽  
zili sun ◽  
Zheng wang ◽  
...  
Keyword(s):  
Live Birth ◽  
Gnrh Agonist ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Stimulation Protocol ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Cumulative Live Birth

Abstract Background: The efficacy and reproductive outcomes of progestin primed ovarian stimulation protocol (PPOS) were previously compared to rarely used ovarian stimulation protocol and also the live birth rate were reported by per embryo transfer rather than cumulative live birth rates (CLBRs). Does the use of PPOS improve the cumulative live birth rates (CLBRs) and shorten time to live birth when compared to long GnRH agonist protocol in women with normal ovarian reserve?Methods: A retrospective cohort study was designed to include women aged<40 with normal ovarian reserve (regular menstrual cycles, FSH <10 IU/L, antral follicle count >5) undergoing IVF from January 2017 to December 2019. The primary outcome was cumulative live birth rates (CLBRs) within 18 months from the day of ovarian stimulation.Results: A total of 995 patients were analyzed. They used either PPOS (n=509) or long GnRH agonist (n=486) protocol at the discretion of the attending physicians. Both groups had almost comparable demographic and cycle stimulation characteristics except for duration of infertility which was shorter in the PPOS group. In the GnRH agonist group 372 cases (77%) completed fresh embryo transfer, resulting into 218 clinical pregnancies and 179 live birth. The clinical pregnancy rate, ongoing pregnancy, and live birth per transfer were 58.6%, 54.0%, 53.0% respectively. In the PPOS, no fresh transfer was carried out. During the study period, the total number of initiated FET cycles with thawed embryos was 665 in the PPOS group and 259 in the long agonist group. Of all FET cycles, a total of 206/662 (31.1%) cycles resulted in a live birth in the PPOS group versus 110/257 (42.8%) in the long agonist group (OR: 0.727; 95% CI: 0.607–0.871; p<0.001) .The implantation rate of total FET cycles was also lower in the PPOS group compared with that in the agonist group 293/1004 (29.2%) and 157/455 (34.5%) (OR: 0.846; 95% CI: 0.721–0.992; p= 0.041). Cumulative live birth rates after one complete IVF cycle including fresh and subsequent frozen embryo cycles within 18 months follow up were significantly lower in the PPOS group compared that in the long agonist group 206/509 (40.5%) and 307/486 (63.2%), respectively (OR: 0.641; 95% CI: 0.565-0.726). The average time from ovarian stimulation to pregnancy and live birth was significantly shorter in the long agonist group compared to the PPOS group (p<0.01) In Kaplan-Meier analysis, the cumulative incidence of ongoing pregnancy leading to live birth was significantly higher in the long agonist compared in the PPOS group(Log rank test, p<0.001). Cox regression analysis revealed stimulation protocol adopted was strongly associated with the cumulative live birth rate after adjusting other confounding factors (OR =1.917 (1.152-3.190), p=0.012) .Conclusion: Progestin primed ovarian stimulation was associated with a lower cumulative live birth rates and a longer time to pregnancy / live birth than the long agonist protocol in women with a normal ovarian reserve.

Laparoscopic Ablation of Endometriosis in Infertile Patients: A Retrospective Study

2011 ◽  
Vol 3 (1) ◽  
pp. 53-57
Author(s):  
Fortunato Genovese ◽  
Maria Cristina Teodoro ◽  
Gabriella Rubbino ◽  
Marco Antonio Palumbo ◽  
Giuseppe Zarbo
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Early Stage ◽  
Live Birth Rate ◽  
Fertility Rate ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
Group A ◽  
Group B

Purpose Even at the early stage endometriosis, may be associated with infertility, whose treatment, which is not always straightforward, is often controversial. This study intends to determine the effectiveness of laparoscopic ablation of lesions at an early stage. Methods The charts of 250 women suffering from infertility, admitted from July 1998 to December 2008 to the obstetric and gynecologic departments of Vittorio Emanuele and Santo Bambino hospitals in Catania were reviewed. Among these women, 97 patients (38.8%) affected by stage 1 and 2 endometriosis were found and divided into 2 groups of 53 (A) and 44 (B) patients. According to the approach of the surgeon, group A patients underwent laparoscopic ablation of endometriotic lesions with or without adesiolysis, while group B patients only had diagnostic laparoscopy. Cumulative pregnancy rate, cumulative live birth rate, monthly fertility rate and outcome of pregnancies (miscarriages and live birth), developed within the first year soon after laparoscopy, were determined in each group. Results This study shows that, according to the literature, laparoscopic systematic destruction of minimal and mild stage endometriotic lesions, improves the cumulative pregnancy rate (49.1% in group A versus 22.7% in group B) and cumulative live birth rate (39.6% in group A versus 18.2% in group B) in selected patients. However, this type of intervention, by itself, does not normalize the monthly fertility rate that remains low in both groups (4.1% in group A and 1.9% in group B). Conclusions This study suggests that laparoscopic treatment of minimal-mild endometriotic lesions is a valid therapeutic option because it improves the fertility rate, even if it does not completely resolve the reduced fertility.

scholarly journals The key factors affecting cumulative live birth rate after single oocyte retrieved in women during IVF/ICSI-ET: a retrospective analysis of 1380 PCOS patients

2021 ◽  
Author(s):  
You Li ◽  
Leizhen Xia ◽  
Jun Tan ◽  
Qiongfang Wu ◽  
Ziyu Zhang
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Factors Affecting ◽  
Live Births ◽  
Cumulative Live Birth ◽  
Starting Dose ◽  
Group A ◽  
Group B

Abstract Background: The factors affecting the cumulative live birth rate (CLBR) of PCOS patients who received in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) are unknown.Methods: Here we carried out a retrospective analysis of 1380 PCOS patients who received IVF/ICSI-ET for the first time from January 2014 to December 2016. According to the cumulative live births of PCOS patients after single oocyte collection, they were divided into cumulative live births group (group A) and non-cumulative live births group (group B).Results: The conservative cumulative live birth rate was 63.48%. There were 876 cumulative live births (group A) and 504 non-cumulative live births (group B) according to whether the patients had live births or not. Competition analysis showed that duration of infertility, primary/secondary type of infertility, stimulation protocols, starting dose of gonadotrophins and oocyte retrieved numbers were significantly correlated with CLBR. The Cox proportional risk regression model of PCOS patients showed that stimulation protocols had a significant impact on CLBR. Patients in the GnRH-antagonist protocol group and the mild stimulation protocol had lower CLBR than those in the Prolonged GnRH-agonist protocol, which was statistically significant. PCOS patients with the starting dose of gonadotrophins greater than 112.5u had lower CLBR than those with less than 100u, which was statistically significant. Women with 11-15 oocytes and 16-20 oocytes had higher CLBR than women with 1-9 oocytes, which was statistically significant.Conclusions: According to our statistical results, patients with PCOS represent a challenge for reproductive medicine.

scholarly journals The exact synchronization timing between the cleavage embryo stage and duration of progesterone therapy-improved pregnancy rates in frozen embryo transfer cycles: A cross-sectional study

2021 ◽  
Author(s):  
Marjan Omidi ◽  
Iman Halvaei ◽  
Fatemeh Akyash ◽  
Mohammad Ali Khalili ◽  
Azam Agha-Rahimi ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Cross Sectional Study ◽  
Frozen Embryo Transfer ◽  
Cross Sectional ◽  
Group A ◽  
Embryo Stage ◽  
Group B

Background: Synchronization between the embryonic stage and the uterine endometrial lining is important in the outcomes of the vitrified-warmed embryo transfer (ET) cycles. Objective: The aim was to investigate the effect of the exact synchronization between the cleavage stage of embryos and the duration of progesterone administration on the improvement of clinical outcomes in frozen embryo transfer (FET) cycles. Materials and Methods: 312 FET cycles were categorized into two groups: (A) day- 3 ET after three days of progesterone administration (n = 177) and (B) day-2 or -4 ET after three days of progesterone administration (n = 135). Group B was further divided into two subgroups: B1: day-2 ET cycles, that the stage of embryos were less than the administrated progesterone and B2: day-4 ET cycles, that the stage of embryos were more than the administrated progesterone. The clinical outcome measures were compared between the groups. Results: The pregnancy outcomes between groups A and B showed a significant differences in the chemical (40.1% vs 27.4%; p = 0.010) and clinical pregnancies (32.8% vs 22.2%; p = 0.040), respectively. The rate of miscarriage tended to be higher and live birth rate tended to be lower in group B than in group A. Also, significantly higher rates were noted in chemical pregnancy, clinical pregnancy, and live birth in group A when compared with subgroup B2. Conclusion: Higher rates of pregnancy and live birth were achieved in day-3 ET after three days of progesterone administration in FET cycles. Key words: Endometrium, Embryo transfer, Pregnancy, Live birth, Progesterone.

P–291 Searching for a suitable serum progesterone range at triggering day to achieve optimal cumulative live birth rate in high responders – Which range is better?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M J Chen ◽  
C Ya-Fang ◽  
G Hwa-Fen ◽  
Y Yu-Chiao ◽  
K Hsioa-Fan ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Blastocyst Formation ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
Group A ◽  
Group B ◽  
High Responders

Abstract Study question Is there a suitable range of serum progestereone level at triggering day to optimize the cumulative live birth rate (LBR) in high responders? Summary answer Fom the point of view of cLBR, the optimal P4 range for triggering is between 1.5 to 2.5 ng/ml generally and in the high responders. What is known already It is well established that premature progesterone rise (PPR) affect adversely the pregnancy outcome in fresh embryo transfer cycle. It is inferred that PPR alters synchrony between endometrium and the embryos. However, detailed study of the effect of PPR on efficiency of oocyte retrieval , embryo quality and the subsequent cumulative pregnancy outcome is still lacking. Hence we sort to analyze the effect of PPR on the final cumulative LBR in our program especially focused on high responders. Study design, size, duration ART Database in our center was retrospectively reviewed. Total 1523 cycles between 20160101 and 20191231 were recruited under the condition of GnRH antagonist cycle with duration of ovulation induction for more than 5 days and available serum P4 level data on triggering day for data analysis for the relationship between serum P4 value and final cumulative LBRs. Participants/materials, setting, methods Cycles with serum P4 level &lt; 1.5 ng/ml were defined as without PPR (Group A: n = 1383). Cycles with serum P4 level &gt;1.5 were defined as with PPR: P4 between 1.5 and 2.5 as Group B (n = 113), P4 &gt; 2.5 as Group C (n = 27). Those high responding cycles (n = 404) were analyzed similarly and separately as Group A’ (n = 304), B’ (n = 81) and C’(n = 19). The statistics were carried out by SPSS-PC ver. 22.0 with p &lt; 0.05 as statistical significance. Main results and the role of chance Group A had significantly lower number of oocytes (9.8 + 8.0) retrieved as compared to Group B (19.3 + 11.2) and Group C (18.2 + 9.9). However there were no differences in fertilization rate, good embryo rates and BC formation rates between groups. The cumulative LBR (cLBR) were significantly higher in Group B (65.1%) as compared to Group A (40.9%, p &lt; 0.001) and Group C (37.0%, p = 0.008). For the high responding cycles, Group B’ also had marginally significant higher cLBR (75.3%) as compared to group A’(63.8% ; p=0.051) and Group C’ (52.6%; p = 0.050). Comparisons between Group A’ and C revealed significantly less oocytes retrieved but significantly higher blastocyst formation rates in Group A’ and the resultant cLBR were comparable between these two groups. Comparisons between Groups B’ and C’ revealed comparable oocytes retrieved but significant lower blastocyst formation rates and cLBRs in Group C’. The baseline of the first part analysis revealed higher age and lower AMH in Group A, but comparable age and AMH between groups B and C.The lower cLBR in group A could be due to selection bias.The second part (high responders) showed comparable baselines between three groups. However, the case numbers are too few in group C’ which might also result in uncertainty. Limitations, reasons for caution Although the data revealed interesting, significantly different results between groups, this is only a retrospective analysis from our ART patient series. Selection bias could not be precluded. Analysis restricted to high responders could have a more balanced population for comparisons. However, more cases are needed to affirm the findings. Wider implications of the findings: We still do not know the tolerable ceiling of serum P4 at the triggering day in high responders if future FET already planned. Pushing P4 value too high not only could not increase mature oocyte yields and possibly may decrease the number of available good blastocysts for optimizing final cLBRs. Trial registration number Not applicable

scholarly journals Strengthen Luteal Phase Support for the Patients With Low Serum Progesterone on the Day of Embryo Transfer in Artificial Endometrial Preparation Cycles: a Large-sample Retrospective Trial

2020 ◽  
Author(s):  
Hongyuan Gao ◽  
Jing Ye ◽  
Hongjuan Ye ◽  
Qingqing Hong ◽  
Lihua Sun ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Luteal Phase ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Serum Progesterone ◽  
Group A ◽  
Group B ◽  
Low Serum

Abstract Background: The low serum progesterone (P) on the day of frozen embryo transfer (FET) is associated with diminished pregnancy rates in artificial endometrium preparation cycles using vaginal micronized P, but it is no consensus whether the strengthened luteal phase support (LPS) for the patients with low P on the FET day in artificial cycles is beneficial. A single centric, large-sample retrospective trial was aimed to investigate the contribution of strengthened LPS to the pregnancy outcomes for the groups of low P levels on the FET day in artificial endometrium preparation cycles.Methods: Women who had undergone first artificial cycle for endometrium preparation after freeze-all in our clinic during 2016 and 2018 were classified into two groups depending on the serum P levels on the FET day, routine LPS was administered for group B (P ≥10.0ng/ml on the FET day, n=1261) and strengthened LPS (routine LPS+ im P 40mg daily) for group A (P <10.0 ng/ml on the FET day, n=1295), the primary endpoint was the live birth rate and secondary endpoints were clinical pregnancy, miscarriage and neonatal outcomes.Results: The results showed the clinical pregnancy rate in group A was lower than group B (48.4% vs 53.2%, aRR 0.81, 95% CI 0.68, 0.96), the miscarriage rate was similar between the two groups (16.0% vs 14.7%, aRR 1.09, 95%CI 0.77, 1.54). The live birth rate was slightly lower than group B (39.5% vs 43.3%, aRR 0.84, 95%CI 0.70, 1.0). The birthweights and other neonatal outcomes were found no difference between the two groups (P>0.05).Conclusions: The strengthened LPS for the section of patients of low P levels on the FET day might help to have a reasonable pregnancy outcome, although the live birth rate was slightly lower than the groups with normal serum P levels on the FET day and usage of routine LPS. Trial registration: no available.

scholarly journals Dyslipidemia Is Negatively Associated With the Cumulative Live-Birth Rate in Patients Without PCOS Following IVF/ICSI

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhenteng Liu ◽  
Jianxiang Cong ◽  
Xuemei Liu ◽  
Huishan Zhao ◽  
Shoucui Lai ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Live Birth ◽  
Birth Rate ◽  
Multivariate Logistic Regression Analysis ◽  
Live Birth Rate ◽  
Control Group ◽  
Multivariate Logistic Regression ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth

Objective: To evaluate the effect of dyslipidemia on the cumulative live-birth rate (cLBR) in patients without polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection–embryo transfer (IVF/ICSI–ET) cycles.Methods: A total of 1,132 patients from the Yantai Yuhuangding Hospital Affiliated to Qingdao University from January 2016 to December 2017 were retrospectively included. The subjects were distributed into two groups based on their lipid profiles, namely, dyslipidemia group (n = 195) and control group (n = 937). The clinical and laboratory parameters of the two groups were analyzed, and a multivariate logistic regression analysis of the cLBR was conducted. In addition, subgroup analysis was carried out to avoid deviation according to the body mass index (BMI).Results: Patients with dyslipidemia had significantly greater BMI and longer duration of infertility, as well as lower antral follicle count and basal follicle-stimulating hormone level compared with patients without dyslipidemia. Stratified analysis showed that dyslipidemia was associated with a significantly higher total gonadotrophin dosage required for ovarian stimulation as well as lower number of oocytes retrieved, independent of obesity. The live-birth rate in fresh cycle and cLBR were higher in the control group, although the difference between the groups was not significant (54.9% vs. 47.3%, p = 0.116; 67.6% vs. 62.1%, p = 0.138). However, multivariate logistic regression analysis adjusting for potential confounders showed that dyslipidemia was negatively associated with cLBR (OR, 0.702, 95% CI, 0.533–0.881, p = 0.044).Conclusion: Our findings demonstrate for the first time that dyslipidemia has a deleterious impact on cLBR, independent of obesity, in non-PCOS population considered to have good prognosis. Assessment of serum lipid profiles as well as the provision of nutritional counseling is essential for increasing successful outcomes in assisted reproductive techniques.

scholarly journals Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Tal Lazer ◽  
Shir Dar ◽  
Ekaterina Shlush ◽  
Basheer S. Al Kudmani ◽  
Kevin Quach ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Poor Responders ◽  
High Dose ◽  
Poor Ovarian Reserve

We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR). Inclusion criteria included patients with an anti-Müllerian hormone (AMH) ≤8 pmol/L and/or antral follicle count (AFC) ≤5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5 mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14 mm or larger. The HS group received gonadotropins (≥300 IU/day) throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (P=0.007). Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (P=0.034). In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage) and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders.

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