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

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.

scholarly journals Effects Of Hormonal Supplements In Women With Poor Ovarian Response Undergoing Assisted Reproductive Technology

2019 ◽  
pp. 1 ◽  
Author(s):  
Silan Melis Bozan ◽  
Gurkan Bozdag
Keyword(s):  
Growth Hormone ◽  
Assisted Reproductive Technology ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Ovarian Response ◽  
Reproductive Technology ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Technology Cycles

<p>Poor ovarian response remains one of the major challenges of assisted reproductive technology. Over the years, various interventions have been proposed to improve reproductive outcomes in poor responders, yet few have been shown to be beneficial. Recent studies indicate that hormonal pretreatments might increase clinical pregnancy rate, live birth rate and the number of oocytes retrieved in women with poor ovarian response undergoing assisted reproductive technology. Areas covered: Following extensive research of the up to date literature, this review aims to cover current considerations and controversies regarding the use of hormonal supplements such as dehydroepiandrosterone, transdermal testosterone and growth hormone. Expert opinion: There is limited data for the validity of using growth hormone and androgens or androgen modulating agents during assisted reproductive technology cycles in women suffering from poor ovarian response. However, there is a need to support the available data with further randomized controlled trials seeking for live birth rate as the primary outcome.</p>

scholarly journals The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 687
Author(s):  
Polina Giannelou ◽  
Mara Simopoulou ◽  
Sokratis Grigoriadis ◽  
Evangelos Makrakis ◽  
Adamantia Kontogeorgi ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Platelet Rich Plasma ◽  
Ovarian Response ◽  
Poor Responders ◽  
Common Denominator ◽  
Success Rates ◽  
Poor Ovarian Response ◽  
Management Options ◽  
Mitochondrial Replacement Therapy ◽  
Heated Debate

Despite recent striking advances in assisted reproductive technology (ART), poor ovarian response (POR) diagnosis and treatment is still considered challenging. Poor responders constitute a heterogeneous cohort with the common denominator of under-responding to controlled ovarian stimulation. Inevitably, respective success rates are significantly compromised. As POR pathophysiology entails the elusive factor of compromised ovarian function, both diagnosis and management fuel an ongoing heated debate depicted in the literature. From the criteria employed for diagnosis to the plethora of strategies and adjuvant therapies proposed, the conundrum of POR still puzzles the practitioner. What is more, novel treatment approaches from stem cell therapy and platelet-rich plasma intra-ovarian infusion to mitochondrial replacement therapy have emerged, albeit not claiming clinical routine status yet. The complex and time sensitive nature of this subgroup of infertile patients indicates the demand for a consensus on a horizontally accepted definition, diagnosis and subsequent effective treating strategy. This critical review analyzes the standing criteria employed in order to diagnose and aptly categorize POR patients, while it proceeds to critically evaluate current and novel strategies regarding their management. Discrepancies in diagnosis and respective implications are discussed, while the existing diversity in management options highlights the need for individualized management.

Antral Follicle Diameter Variance Within Each Ovary May Be A Predictor For Poor Response In Cases With Normal Ovarian Reserve

2018 ◽  
Vol 126 (08) ◽  
pp. 521-527
Author(s):  
Ilhan Sanverdi ◽  
Enis Ozkaya ◽  
Suna Kucur ◽  
Dilsat Bilen ◽  
Meryem Eken ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Poor Response ◽  
Ovarian Response ◽  
Antral Follicle ◽  
Multivariate Regression Analysis ◽  
Antral Follicle Count ◽  
Estradiol Level ◽  
Poor Ovarian Response ◽  
Follicle Diameter ◽  
The Right

Abstract Objectives To determine the predictive value of antral follicle diameter variance within each ovary for ovarian response in cases with normal ovarian reserve tests. Methods This is a prospective observational study. One hundred and thirty nine infertile women who underwent ART in IVF-ICSI unit of Zeynep Kamil women and children’s Health Training and research hospital between January 2017 to June 2017 were recruited. Blood samples were collected on day 2/day 3 for assessment of serum FSH and estradiol. Trans-vaginal sonography was done for antral follicle count. During antral follicle count, in order to determine antral follicle diameter variance, diameters of the largest and smallest follicles were recorded. Variance was calculated by subtracting the smallest diameter from the largest one. Following ovarian stimulation with antagonist protocol, poor response was determined in cases with total oocyte number≤3. Ovarian reserve tests and antral follicle diameter variance were utilized to predict cases with poor response in women with normal ovarian reserve. Results Antral follicle diameter variance both in right (AUC=0.737, P<0.001) and left (AUC=0.651, P<0.05) ovaries significantly predicted poor ovarian response. Variance>3.5 mm was found to have 75% sensitivity to predict poor response. Basal serum FSH with estradiol levels and AFC failed to predict poor response (P>0.05). Other significant predictors for poor response were day 5 estradiol level and estradiol level at trigger day (P<0.05). In multivariate regression analysis, both AFC and antral follicle diameter variance in the right ovary were found to be significantly associated with clinical pregnancy, on the other hand peak estradiol concentration and antral follicle diameter variance in the right ovary were significantly associated with poor response. Conclusion Antral follicle diameter variance may be utilized to predict poor ovarian response in cases with normal ovarian reserve.

scholarly journals Anti-Mullerian hormone (AMH) as predictor of ovarian reserve

2017 ◽  
Vol 6 (9) ◽  
pp. 4006 ◽  
Author(s):  
Chaitanya Ashok Shembekar ◽  
Jayshree Jayant Upadhye ◽  
Manisha Chaitanya Shembekar ◽  
Shravani H. Welekar
Keyword(s):  
Ovarian Response ◽  
Poor Responders ◽  
Success Rates ◽  
Antral Follicles ◽  
Relationship Of ◽  
The Relationship ◽  
High Chance ◽  
Antagonist Protocol ◽  
High Range

Background: Anti-Müllerian hormone (AMH) is produced by the granulosa cells of preantral and small antral follicles and its levels can be assessed in serum. Since the number of ovarian follicles declines with increasing age, AMH levels might be used as a marker for ovarian ageing. Therefore, we studied the relationship between AMH levels and ovarian response during ovarian stimulation for In vitro fertilization.Methods: A total of 100 patients who have undergone their ICSI treatment cycle using a GnRH antagonist protocol were retrospectively included. Co-relation between AMH and antral follicular count (AFC) was assessed.Results: In present study, 36% patients had normal AMH, 18% patients were in low normal range, 5% patients had low values and 2% patients had very low values. 41% of patients had values in high range suggestive of PCOS. Amongst this, 21% had values between 4 to 8 ng/ml where we got good AFC count and good result in terms of pregnancy. 80% were good responders while 20% were poor responders. When we evaluated the relationship of retrieved oocyte counts with the parameters included, we found that only basal AMH levels and the number of antral follicles were statistically correlated.Conclusions: High AMH levels correlated with low cancellation rates, retrieval of more eggs, higher live birth rates and a high chance for freezing of embryos. Low AMH levels (alone) do not predict low success rates in women under 35 years of age.

scholarly journals LH Pretreatment as a Novel Strategy for Poor Responders

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Anna Pia Ferraretti ◽  
Luca Gianaroli ◽  
Tatiana Motrenko ◽  
Elisabetta Feliciani ◽  
Carla Tabanelli ◽  
...  
Keyword(s):  
Young Patients ◽  
Poor Response ◽  
Ovarian Response ◽  
Historical Control ◽  
Controlled Study ◽  
Poor Responders ◽  
Stimulation Protocol ◽  
Novel Strategy ◽  
Group B

Introduction. Poor response to ovarian stimulation is still a major problem in IVF. The study presents a new stimulation protocol evaluated in a suppopulation of very difficult young poor ovarian responders.Material and Methods. The study consists in two sections. The first includes data from a randomized controlled study involving forty-three young patients with a poor ovarian response in at least two previous cycles (intended as cycle cancellation or with ≤3 collected oocytes). Patients were randomized in two groups: group A (control) received FSH (400 IU/day), while group B received the new stimulation protocol consisting in a sequential association of 150 IU r-LH for 4 days followed by 400 IU r-FSH/after downregulation with daily GnRh agonist. The second includes data from the overall results in 65 patients treated with the new protocol compared to their previous performance with conventional cycles (historical control).Results. Both in the RCT and in the historical control study, LH pretreatment was able to decrease the cancellation rate, to improve thein vitroperformance, and to significantly increase the live birth rates.Conclusions. LH pretreatment improved oocyte quantity and quality in young repeated poor responders selected in accordance with the Bologna criteria.

scholarly journals Morphokinetic Characteristics and Developmental Potential of In Vitro Cultured Embryos from Natural Cycles in Patients with Poor Ovarian Response

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
N. Hojnik ◽  
V. Vlaisavljević ◽  
B. Kovačič
Keyword(s):  
Implantation Rate ◽  
Ovarian Response ◽  
Time Lapse ◽  
Poor Responder ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Developmental Potential ◽  
The Impact ◽  
Natural Cycles

Background. Patients with poor ovarian response to ovarian hyperstimulation represent an interesting group for studying the impact of embryo cleavage irregularities on clinical outcome since all embryos, regardless of their quality, are usually transferred to the uterus. The aim of our study was to follow the morphokinetics of fertilized oocytes from natural cycles in poor responders. Methods. Zygotes from 53 cycles were cultured in vitro for 3 days. The morphokinetics of their development and transfer outcomes were retrospectively analyzed for the normally and irregularly cleaved embryos. Results. Of all embryos, 30.2% had single and 20.8% multiple cleavage irregularities with the following prevalence: developmental arrest 30.2%, direct cleavage to more than two cells 24.5%, chaotic cleavage 13.2%, and reverse cleavage 11.3%. These embryos had longer pronuclear phases, first cytokinesis, second embryo cell cycles, and less synchronized divisions. The transfer of normally developing embryos resulted in an implantation rate of 30.8% and a delivery rate of 23.1%, but irregularly cleaved embryos did not implant. Conclusions. The use of time-lapse microscopy in poor responder patients identified embryos with cleavage abnormalities that are related with no or extremely low implantation potential. Gained information about embryo quality is important for counselling patients about their expectations.

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