Comparison of Dydrogesterone and Medroxyprogesterone in the Progestin-Primed Ovarian Stimulation Protocol for Patients With Poor Ovarian Response

ObjectiveTo compare the clinical outcomes of dydrogesterone (DYG) and medroxyprogesterone (MPA) in the progestin-primed ovarian stimulation (PPOS) protocol for patients with poor ovarian response (POR).Patients and MethodsThis was a retrospective cohort study. Women with POR who underwent IVF/ICSI at the Reproductive Center of Third Affiliated Hospital of Zhengzhou University between January 2020 and January 2021 were included. The primary outcome measure of our study was the number of oocytes retrieved. The secondary outcome measures in the present study were the number of 2PN, number of available embryos, oocyte retrieval rate, fertilization rate, viable embryo rate per oocyte retrieved, cancellation rate and pregnancy outcomes of the first embryo transfer cycle, including the biochemical pregnancy, clinical pregnancy and miscarriage rates.ResultsIn total, 118 women underwent hMG +DYG protocols, and 692 women who underwent hMG +MPA met the Bologna criteria for POR. After baseline characteristics were balanced using the PSM model, 118 hMG +DYG protocols were matched to 118 hMG +MPA protocols, and the baseline characteristics were comparable between the two groups. The numbers of oocytes retrieved, 2PN, and available embryos and the oocyte retrieval rate, fertilization rate, viable embryo rate per oocyte retrieved and cancellation rate of the hMG+DYG and hMG+MPA protocols were comparable. Altogether, 66 women in the hMG+DYG group and 87 women in the hMG+MPA group underwent first embryo transfers. In the hMG+DYG group, 81.8% (54/66) of the patients underwent cleavage embryo transfers; similarly, 79.3% (69/87) of patients in the hMG+MPA group had cleavage embryo transfers (P=0.70).The biochemical pregnancy rate of the hMG+DYG group was 42.4%, and this was comparable to the rate in the hMG+DYG group, at 34.5% (P=0.32). The clinical pregnancy rates were similar between the two groups (36.4% vs. 31.0%, P=0.49), and there was no significant difference in the rate of miscarriage between the two groups (12.5% vs. 29.6%, P=0.14).ConclusionFor women with POR, the clinical outcome of the hMG + DYG group was similar to that of the hMG + MPA group, indicating that both combinations can be useful options for PPOS protocols.

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Oocyte retrieval rate through repeated identical controlled ovarian stimulation cycles in donors.

Fertility and Sterility ◽

10.1016/s0015-0282(01)02382-2 ◽

2001 ◽

Vol 76 (3) ◽

pp. S129-S130

Author(s):

C. Caligara ◽

J. Navarro ◽

F. Camargo ◽

C. Simón ◽

A. Pellicer ◽

...

Keyword(s):

Ovarian Stimulation ◽

Oocyte Retrieval ◽

Controlled Ovarian Stimulation ◽

Retrieval Rate ◽

Oocyte Retrieval Rate

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miR-15a-5p levels correlate with poor ovarian response in human follicular fluid

Reproduction ◽

10.1530/rep-17-0157 ◽

2017 ◽

Vol 154 (4) ◽

pp. 483-496 ◽

Cited By ~ 5

Author(s):

Kaiyue Zhang ◽

Wanxia Zhong ◽

Wei-Ping Li ◽

Zi-Jiang Chen ◽

Cong Zhang

Keyword(s):

Follicular Fluid ◽

Quantitative Polymerase Chain Reaction ◽

Young Patients ◽

Oocyte Retrieval ◽

Ovarian Response ◽

Poor Ovarian Response ◽

Human Follicular Fluid ◽

Transfer Procedures ◽

Response Group

Poor ovarian response is a significant problem encountered during in vitro fertilization and embryo transfer procedures. Many infertile women may suffer from poor ovarian response and its incidence tends to be increasing in young patients nowadays. It is a major cause of maternal infertility because it is associated with low pregnancy and live birth rates. However, the cause of poor ovarian response is not clear. In this study, we extracted microRNAs from human follicular fluid and performed miRNA sequencing to investigate a potential posttranscriptional mechanism underlying poor ovarian response. The results showed that many miRNAs were obviously different between the poor ovarian response and non-poor ovarian response groups. We then performed quantitative polymerase chain reaction, Western blot analysis and used an in vitro culture system to verify the sequencing results and to study the mechanism. Notably, we found that miRNA-15a-5p was significantly elevated in the young poor ovarian response group. Furthermore, we demonstrated that high levels of miR-15a-5p in the young poor ovarian response group repressed granulosa cell proliferation by regulating the PI3K-AKT-mTOR signaling pathway and promoted apoptosis through BCL2 and BAD. This could explain the reduced oocyte retrieval number seen in poor ovarian response patients.

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Oocyte retrieval rate through repeated controlled ovarian hyperstimulation cycles in donors

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(00)81786-5 ◽

2000 ◽

Vol 70 ◽

pp. D41-D41

Author(s):

C. Califara ◽

G. Vargas ◽

S. Cuneo ◽

M. Rodrǵuez ◽

C. Simon ◽

...

Keyword(s):

Oocyte Retrieval ◽

Controlled Ovarian Hyperstimulation ◽

Ovarian Hyperstimulation ◽

Retrieval Rate ◽

Oocyte Retrieval Rate

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Is the time interval between HCG administration and oocyte retrieval associated with oocyte retrieval rate?

Reproductive BioMedicine Online ◽

10.1016/j.rbmo.2015.08.005 ◽

2015 ◽

Vol 31 (5) ◽

pp. 625-632 ◽

Cited By ~ 4

Author(s):

Julia K. Bosdou ◽

Efstratios M. Kolibianakis ◽

Christos A. Venetis ◽

Leonidas Zepiridis ◽

Katerina Chatzimeletiou ◽

...

Keyword(s):

Oocyte Retrieval ◽

Time Interval ◽

Retrieval Rate ◽

Oocyte Retrieval Rate

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Analyzing the risk factors for a diminished oocyte retrieval rate under controlled ovarian stimulation

Reproductive Medicine and Biology ◽

10.1002/rmb2.12004 ◽

2016 ◽

Vol 16 (1) ◽

pp. 40-44 ◽

Cited By ~ 4

Author(s):

Mayumi Nakamura ◽

Yoshiki Yamashita ◽

Atsushi Hayashi ◽

Natsuho Saito ◽

Masae Yu ◽

...

Keyword(s):

Risk Factors ◽

Ovarian Stimulation ◽

Oocyte Retrieval ◽

Controlled Ovarian Stimulation ◽

Retrieval Rate ◽

Oocyte Retrieval Rate

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P–676 Mild stimulation followed by embryo accumulation via vitrification appears to be beneficial for managing poor ovarian response: A retrospective cohort study including 610 patients

Human Reproduction ◽

10.1093/humrep/deab130.675 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

A Pantou ◽

P Giannelou ◽

S Grigoriadis ◽

E Maziotis ◽

P Tzonis ◽

...

Keyword(s):

Live Birth ◽

Management Strategy ◽

Oocyte Retrieval ◽

Ovarian Response ◽

Clinical Pregnancy ◽

Human Reproduction ◽

P Value ◽

Poor Ovarian Response ◽

Cleavage Stage ◽

Mild Stimulation

Abstract Study question Could embryo accumulation employing mild stimulation cycles prove beneficial for managing patients presenting with poor ovarian response (POR)? Summary answer Embryo accumulation may be an efficient POR management strategy, enabling a higher number and quality cohort of embryos, ultimately improving success results. What is known already It is widely accepted that POR constitutes a challenging condition. The limited oocyte yield associated with POR detrimentally impacts in vitro fertilization (IVF) success rates. Moreover, the documented heterogeneity among POR patients compromises our efforts to successfully address POR, despite the advances noted regarding stimulation protocols employed today. Considering the aforementioned, embryo accumulation following consecutive stimulation cycles has emerged as an alternative management strategy towards increasing the number of available embryos prior to embryo transfer (ET), mimicking normoresponding conditions. However, only few studies have been so far conducted and the need for further data is underlined. Study design, size, duration A single-center retrospective study was conducted in the Centre of Human Reproduction, Genesis-Athens Clinic from January 2015-December 2019. Only patients presenting with POR according to Bologna criteria were included. In total, 610 POR patients were considered eligible and were divided in three groups namely, mild stimulation-fresh ET (150 IUs of gonadotropins) (MILDF), mild stimulation employing embryo accumulation (MILDA), and natural cycle employing embryo accumulation (NATA). Respective comparisons on embryology and pregnancy data are provided. Participants/materials, setting, methods Resulting embryos from the MILDF, MILDA, and NATA groups were cultured up to the cleavage stage and categorized into three groups according to quality, namely top (grade 1), good (grade 2–3) and poor (grade 4–5) (Veeck, 1999). Top and good quality embryos were considered eligible for ET/vitrification. The banking scenario entailed accumulation of at least three embryos, including at least one top quality embryo. Embryo transfers included up to two cleavage stage embryos. Main results and the role of chance Comparing MILDF and MILDA groups, a higher number of available oocytes and embryos was observed in MILDA (2.36±1.15 vs 6.58±1.11; 1.72±1.02 vs 3.51±0.61, P-value<0.001). However, a mean number of 3.90±1.56 oocyte retrievals were required to conclude MILDA compared to MILDF which was concluded following a single oocyte retrieval (P-value<0.001). Cancellation-rate was significantly lower in the MILDA compared to MILDF group (0% vs 18.93%, P-value <0.001). A higher proportion of top quality embryos were transferred in the MILDA group (66.58% vs 43.67%, P-value<0.001). The MILDA group presented with higher positive-HCG (27.89% vs 23.30%, P-value=0.302), clinical-pregnancy (22.11% vs 17.96%, P-value=0.316) and live-birth rates (16.84% vs 14.08%, P-value=0.487). However, these differences were not significant. Comparing MILDA and NATA groups, the MILDA presented with a lower number of required oocyte retrievals and a higher number of oocytes per oocyte retrieval compared with NATA (3.90±1.56 vs 7.15±1.80; 1.95±0.74 vs 0.89±0.20, P-value<0.001). Moreover, the MILDA presented with a higher mean number of resulting embryos (5.20±0.78 vs 4.82±0.88, P-value<0.001). No difference was observed regarding the proportion of the resulting top quality embryos. The MILDA group presented with slightly higher clinical-pregnancy (22.11% vs 20.09%, P-value=0.628) and live-birth (16.84% vs 14.02%, P-value=0.490) rates, however these differences were not significant. Limitations, reasons for caution The retrospective nature of the study constitutes a major limitation. Considering that numerous confounders are inevitable when retrospective data is analyzed, authors employed strict eligibility criteria in an effort to reduce bias. Statistical analysis revealed a well-controlled population, considering that general patients’ characteristics did not differ between the three groups. Wider implications of the findings: Embryo accumulation may constitute an efficient management strategy for POR, as more embryos of better quality are available for ET compared to fresh-IVF-ET. Mild stimulation should be preferred for embryo accumulation instead of natural cycles, as less oocyte retrievals are required. Future studies should be conducted to verify these conclusions. Trial registration number Not applicable

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TO EVALUATE IVF OUTCOME BETWEEN FLARE-UP VERSUS ANTAGONIST AMONG POOR RESPONDERS’ PROGNOSIS PATIENTS AND RELATED FACTORS AT NATIONAL CENTER FOR ASSISTED REPRODUCTIVE TECHNOLOGY

Tạp chí Y học Cộng đồng ◽

10.52163/jcm.v62i5.159 ◽

2021 ◽

Vol 62 (5) ◽

Author(s):

Nguyen Anh Tho ◽

Ngo Toan Anh ◽

Nguyen Xuan Hoi ◽

Nguyen Viet Tien

Keyword(s):

Poor Response ◽

Ovarian Response ◽

Reproductive Technology ◽

Poor Responders ◽

Poor Ovarian Response ◽

Related Factors ◽

Biochemical Pregnancy ◽

Random Control ◽

Antagonist Protocol ◽

Significant Factors

Objectives: To assess the outcome of Flare-up versus Antagonist protocol and to determine factors related to poor responders.Methodology: this is a random control trial among 834 patients who were predicted to ovarian poor response from 2014 to 2018.Results: The rate of biochemical pregnancy was 4.5% with Flare-up versus 8,1% with Antagonist (p<0.05). The rate of fertilization, implantation and clinical pregnancy were not significant differentbetween the 2 protocols. Age and number of AFC were significant factors to predict poor ovarian response. However, with Flare-up, there were 2 more factors could be used for the purpose whichwas basal FSH and E2 day 7.Conclusion: The outcome of treatment between Flare-up and Antagonist among predicted poor ovarian response was comparable. Age and AFC were valuable factors in prediction of poor ovarianresponse.

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