LOW RESPONSE TO CONTROLLED OVARIAN STIMULATION

2012 ◽  
pp. 5-14
Author(s):  
Ngoc Thanh Cao ◽  
Minh Tam Le ◽  
Vu Quoc Huy Nguyen
Keyword(s):  
Ovarian Stimulation ◽  
Assisted Reproductive Technologies ◽  
Ovarian Response ◽  
Reproductive Technologies ◽  
Oocyte Donation ◽  
Controlled Ovarian Stimulation ◽  
Poor Responders ◽  
Limited Data ◽  
Static Tests ◽  
Definition Of

In routine assisted reproductive technologies (ART), controlled ovarian stimulation is recommended to overcome the selection of one dominant follicle and to allow the growth of a cohort of follicles. This management aims to increase the number of oocytes and therefore the number of embryos leads to increasing the chance of transferring the high quality embryos. However, there is still about 10% of ART cycles face to low response with controlled ovarian stimulation which is one of the major challenges to clinical endocrinologists. Poor responders have a higher incidence of cycle cancellation, lower fertilization, and lower implantation rates. So far, there is no universally accepted definition of poor responders, with many different criteria in static tests and dynamic tests as well as different cutoff levels used to predict the ovarian response. That is the reason why the review studies show limited data of highly agreed diagnosis, management and prediction of the condition. After trying some different stimulation protocols, oocyte donation can be a choice and more research in basic medicine should be carried out to understand the mechanism underlying this condition

scholarly journals Predictive value of ovarian hormone-producing function assessment in poor responders undergoing assisted reproductive technologies

2020 ◽  
Vol 68 (6) ◽  
pp. 7-18
Author(s):  
Alexandra I. Merkulova ◽  
Lyailya Kh. Dzhemlikhanova ◽  
Dariko A. Niauri ◽  
Alexander M. Gzgzyan ◽  
Igor Yu. Kogan ◽  
...  
Keyword(s):  
Follicular Fluid ◽  
Ovarian Stimulation ◽  
Ovarian Function ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Fertility Treatment ◽  
Total Testosterone ◽  
Poor Responders ◽  
Aromatase Activity ◽  
Serum Estradiol

Hypothesis/aims of study. The management of poor responders to ovarian stimulation for in vitro fertilization (IVF) has always been a challenge. It is difficult for both doctors and patients to make decision to proceed to oocyte donation or abandon fertility treatment. More predictors of successful IVF treatment in poor responders are needed. The aim of this study was to assess hormonal ovarian function in poor responders undergoing ovarian stimulation and to identify predictors of the chance of clinical pregnancy after IVF cycle. Study design, materials and methods. The study included 45 infertile patients undergoing ovarian stimulation with poor ovarian response according to the Bologna criteria. All patients underwent standard IVF or IVF/ICSI protocol using gonadotropin releasing hormone antagonists. Letrozole (5 mg/day) was administered during the first 5 days of stimulation in standard antagonist FSH/hMG protocol to 13 of the patients included in the study, with standard antagonist FSH/hMG protocol being only administered to other 32 patients. Serum and follicular fluid were collected at the time of follicle aspiration, and the concentrations of total testosterone, estradiol and androstenedione were determined. Results. Follicular fluid concentrations of testosterone and androstenedione were higher and serum estradiol level was lower in the letrozole group. The serum concentrations of testosterone and androstenedione were comparable in both groups, while the serum estradiol/testosterone ratio was lower in the letrozole group. The threshold level of estradiol/testosterone ratio 1000 on the day of oocyte retrieval above which pregnancy and implantation rates were increased was 1532.68 (odds ratio 7.0 (95% CI 1.3935.35), р = 0.02). Conclusion. Evaluating of the serum estradiol / testosterone ratio has been shown to determine aromatase activity of ovarian preovulatory follicles and to predict IVF outcome in poor responders undergoing assisted reproductive technology.

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

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.

scholarly journals Aromatase inhibitors in “poor” ovarian responders undergoing in vitro fertilization

2017 ◽  
Vol 66 (3) ◽  
pp. 169-175
Author(s):  
Alexandra I. Merkulova
Keyword(s):  
Aromatase Inhibitors ◽  
Ovarian Stimulation ◽  
Treatment Protocol ◽  
Ovarian Response ◽  
Controlled Ovarian Stimulation ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Vitro Fertilization ◽  
The Ideal

Since the IVF treatment expands worldwide, it has become apparent that a proportion of women responds suboptimally to controlled ovarian stimulation with exogenous gonadotrophins. There is still no consensus on the ideal controlled ovarian stimulation protocol for patients with “poor” ovarian response. Many strategies have been studied. However, no compelling advantage for one treatment protocol over another has been identified. The addition of aromatase inhibitors in “poor” responders stimulation protocols is described in this article.

SOCIAL AND ETHICAL ASPECTS OF IN VITRO FERTILIZATION

1999 ◽  
Vol 15 (1) ◽  
pp. 22-35 ◽  
Author(s):  
Elizabeth Heitman
Keyword(s):  
In Vitro Fertilization ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Oocyte Donation ◽  
Social Needs ◽  
Vitro Fertilization ◽  
The Social ◽  
Definition Of

In vitro fertilization (IVF) stands out as one of the contemporary period's most extraordinary technologies, and its social and ethical consequences among the most far reaching. Despite its uncertain effectiveness and medical consequences, IVF has contributed significantly to the medicalization of infertility and the increasingly imperative character of reproductive technology. New developments in IVF, particularly oocyte donation, have created new definitions of treatable infertility and new social needs for IVF; when the technology does not result in pregnancy or healthy babies, these developments have created profound new disappointments. IVF and the commodification of the extracorporeal embryo have also confused the social meaning and legal definition of parenthood. Ultimately the relationship between prospective parents, infertility specialists, and the embryos that they create is a highly ambiguous one. This ambiguity is likely to be a long-term characteristic of efforts to develop, use, and assess assisted reproductive technologies.

scholarly journals MODERN APPROACHES TO THE TREATMENT OF INFERTILITY IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME IN ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAMS

2020 ◽  
pp. 108-115
Author(s):  
M. S. Khmil ◽  
B. M. Ventskivskyi ◽  
S. V. Khmil
Keyword(s):  
Vitamin D3 ◽  
Gnrh Agonist ◽  
Ovarian Stimulation ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Acid Group ◽  
Infertility Treatment ◽  
Controlled Ovarian Stimulation ◽  
Total Percentage ◽  
Group 1

The aim of the study – to improve infertility treatment by optimizing pregravid therapy and selecting the optimal stimulation protocol and ovulation trigger in patients with PCOS. Materials and Methods. 157 infertile patients with PCOS were examined. Depending on the method of treatment, patients were divided into three clinical groups. Group 1 consisted of 63 women who received FT 500-Plus and vitamin D3 Aquadetrim for 2–3 months before stimulation, group 2 – 48 women who received folic acid, group 3 – 46 women who did not receive pregravid preparation. Stimulation was conducted with corifolitropin-alpha Elonva according to a short protocol, GnRH antagonist Orgalutran and follicle-stimulating hormone Puregon, as a trigger GnRH agonist Diphereline was used (in groups 2 and 3 – 0.2 mg/ml once, and in group 1 the protocol was modified by us: 0.2 mg/ml + an additional 0.1 mg/ml after 12 hours). The effectiveness of the proposed infertility treatment regimen was assessed by the following indicators: the frequency of complications, in particular OHSS, the total percentage of efficiency of the obtained oocytes, the degree of maturity of the oocytes obtained and the yield of blastocysts. Results and Discussion. When evaluating the results of superovulation induction, it was found that the duration of stimulation in group 1 was probably lower compared to groups 2 and 3. On the day of the ovulation trigger, a significantly lower concentration of estradiol and progesterone was found in group 1, compared with the data of other groups. In study group 1, where the introduction of the ovulation trigger was modified in own way, significantly fewer immature (GV and MI) oocytes were found, while the average number of mature eggs significantly exceeded the data of groups 2 and 3. The number of blastocysts in women with infertility on the background of PCOS group 1 was also significantly higher than the results obtained in other groups. Conclusions. Controlled ovarian stimulation according to a short protocol using a vitamin complex with inositol and vitamin D3 in pregravid preparation and gonadotropin-releasing hormone antagonists and GnRH agonist trigger –Diphereline at a dose of 0.2 mg/ml + 0.1 mg/ml after 12 hours is more effective in the program of assisted reproductive technologies in PCOS, as it increases the number of mature cells (by 12.20 %) and blastocysts (by 16.26 %). It is also safer because its use significantly reduces the incidence of ovarian hyperstimulation syndrome (1.6 %) in women with infertility with PCOS compared to other controlled ovarian stimulation (COS) regimens.

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