Serum CA-125 and inhibin B levels in the prediction of ovarian response to gonadotropin stimulation in in vitro fertilization cycles

There is much controversy about the relationship between serum CA-125 levels during in vitro fertilization (IVF) cycles and ovarian function. To evaluate the prognostic value of serum CA-125 and inhibin B measurements in predicting ovarian response to gonadotropin stimulation, we compared the CA-125 and inhibin B levels of poor and normal responders on the first day of ovarian stimulation, on the day of ovulation induction (OI) and at oocyte pick-up. Sixteen patients with poor ovarian response (???3 oocytes, serum estradiol (E₂) ??900?pg/ml at OI) in IVF/intracytoplasmic sperm injection cycles were matched with normal responders (???6 oocytes, E₂ ??1800?pg/ml) by age, spontaneous cycle day-3 follicle-stimulating hormone level and cause of infertility. Inhibin B concentrations were significantly lower at all three time points in poor responders, but CA-125 levels were not. No statistically significant correlation was found between CA-125 levels and any of the clinical or laboratory parameters examined. Thus, CA-125 measurements during stimulation are not useful in predicting or identifying poor ovarian response to gonadotropin stimulation in IVF cycles. The lack of difference in CA-125 concentrations between poor and normal responders and lack of correlation with E₂ or inhibin B levels suggest that ovarian steroidogenesis and other granulosa cell functions do not influence the production of CA-125. Inhibin B, however, seems to predict ovarian response as early as at the start of stimulation.     

Treatment-Associated Serum FSH Levels in Very Poor Responders to Ovarian Stimulation

Purpose : To compare treatment-associated follicle-stimulating hormone (FSH) response in patients undergoing controlled ovarian hyperstimulation with either microdose flare (MDF) leuprolide acetate or clomiphene citrate and human menopausal gonadotropin (CC/hMG). Methods : Thirteen patients who were deemed poor responders underwent stimulation with one of two poor responder stimulation protocols (MDF group: n = 8; CC/hMG group: n = 5). Serum FSH, estrone (E₁), estrone sulfate (E₁S), and estradiol (E₂) levels were measured at baseline, day 5 of medication, and on day of hCG administration. Ovarian and uterine responses were evaluated by ultrasound. Results : Treatment-associated FSH levels were consistently higher in the group that took CC/hMG. However, serum E₁, E₁S, and E₂ values were similar in both groups as were the number of oocytes retrieved and the endometrial echo complex. There were no differences between the two groups with regards to the quality of the oocytes obtained, fertilization rate, or the quality of the embryos. Conclusion : Clomiphene citrate, when administered in conjunction with exogenous hMG, is a more potent stimulator of FSH production than MDF leuprolide acetate among poor responders to ovarian stimulation. However, the number of oocytes is not increased.     

The different impact of stimulation duration on oocyte maturation and pregnancy outcome in fresh cycles with GnRH antagonist protocol in poor responders and normal responders

ObjectiveTo study the impact of stimulation duration on intracytoplasmic sperm injection (ICSI) - embryo transfer (ET) outcome in poor and normal responders during controlled ovarian stimulation using gonadotropin-releasing hormone (GnRH) antagonist protocol.Materials and methodsThis is a retrospective cohort study. There were 1481 women undergoing ICSI-ET cycles. Women with ovum pick-up number ≤3 were defined as poor responders (n = 235), and those with a number ≥4 were normal responders (n = 1246).ResultsThe mean stimulation duration was shorter in poor responders with pregnancy group as compared with normal responders with pregnancy group (7.8 ± 2.2 vs. 9.2 ± 1.6 days, p < 0.01). Poor responders with a shortest stimulation duration (≤6 days) appeared a higher live birth rate (≤6 days: 33.3%, 7–8 days: 20.0%, 9–10 days: 15.9%, and ≥11 days: 11.1%, p = 0.18). Normal responders with a shortest stimulation duration (≤6 days) appeared a lowest live birth rate (≤6 days: 28.6%, 7–8 days: 35.8%, 9–10 days: 33.6%, and ≥11 days: 29.3%, p = 0.61). Oocyte maturation rate was significantly lower at stimulation durations ≤6 days group (≤6 days: 67%, 7–8 days: 80%, 9–10 days: 85%, and ≥11 days: 87%, p = 0.02) in normal responders.ConclusionIn ICSI-ET cycles, stimulation duration appears to have different impact on oocyte maturation, clinical pregnancy rates and live birth rates in both poor and normal responders.     

Serum CA-125 and inhibin B levels in the prediction of ovarian response to gonadotropin stimulation in in vitro fertilization cycles.

There is much controversy about the relationship between serum CA-125 levels during in vitro fertilization (IVF) cycles and ovarian function. To evaluate the prognostic value of serum CA-125 and inhibin B measurements in predicting ovarian response to gonadotropin stimulation, we compared the CA-125 and inhibin B levels of poor and normal responders on the first day of ovarian stimulation, on the day of ovulation induction (OI) and at oocyte pick-up. Sixteen patients with poor ovarian response (3 oocytes, serum estradiol (E2) 900 pg/ml at OI) in IVF/intracytoplasmic sperm injection cycles were matched with normal responders (6 oocytes, E2 1800 pg/ml) by age, spontaneous cycle day-3 follicle-stimulating hormone level and cause of infertility. Inhibin B concentrations were significantly lower at all three time points in poor responders, but CA-125 levels were not. No statistically significant correlation was found between CA-125 levels and any of the clinical or laboratory parameters examined. Thus, CA-125 measurements during stimulation are not useful in predicting or identifying poor ovarian response to gonadotropin stimulation in IVF cycles. The lack of difference in CA-125 concentrations between poor and normal responders and lack of correlation with E2 or inhibin B levels suggest that ovarian steroidogenesis and other granulosa cell functions do not influence the production of CA-125. Inhibin B, however, seems to predict ovarian response as early as at the start of stimulation.     

Gonadotropin levels at the start of ovarian stimulation predict normal fertilization after hCG re-trigger in GnRH antagonist cycles

PurposeTo assess the appropriateness of human chorionic gonadotropin (hCG) re‐trigger in poor responders to gonadotropin‐releasing hormone agonist (GnRHa) trigger in controlled ovarian stimulation (COS) cycles.MethodsThe 2251 cycles in 2251 patients triggered with GnRHa for oocyte stimulation, with or without requiring hCG re‐trigger between 2013 and 2018, were retrospectively analyzed to compare gonadotropin levels at the start of COS and the rate of normal fertilization between the re‐trigger and non–re‐trigger group. Furthermore, patients in the re‐trigger group were stratified by the rate of normal fertilization (good: ≥60% or poor: <60%) to compare patient demographics, hormone profiles, and clinical outcome between the subgroups.ResultsIn the re‐trigger group, FSH and LH levels at the start of COS were significantly lower in the good fertilization group than in the poor fertilization group (P < .01). Receiver operating characteristic curves identified cutoff values of the FSH and LH levels of 1.30 and 0.35 mIU/mL, respectively, for predicting ≥60% normal fertilization.ConclusionGonadotropin levels at the start of COS are predictors of response to GnRHa trigger and hCG re‐trigger necessity, and may serve as indicators to help clinicians appropriately choose hCG re‐trigger rather than abandoning the cycles or continuing the first oocyte aspiration attempt.     

Modified natural cycle IVF versus conventional stimulation in advanced-age Bologna poor responders

Research questionDo ongoing pregnancy rates (OPR) differ between modified natural cycle IVF (MNC-IVF) and conventional high-dose ovarian stimulation (HDOS) in advanced-age Bologna poor responders?DesignThis was a retrospective cohort study including patients with poor ovarian response (POR) attending a tertiary referral university hospital from 1 January 2011 to 1 March 2017. All women who fulfilled the Bologna criteria for POR and aged ≥40 years who underwent their first intracytoplasmic sperm injection (ICSI) cycle in the study centre were included.ResultsIn total, 476 advanced-age Bologna poor responder patients were included in the study: 189 in the MNC-IVF group and 287 in the HDOS group. OPR per patient were significantly lower in the MNC-IVF group (5/189, 2.6%) compared with the HDOS group (29/287, 10.1%) (P = 0.002). However, after adjustment for relevant confounders (number of oocytes and presence of at least one top-quality embryo), the multivariate logistic regression analysis showed that the type of treatment strategy (HDOS versus MNC-IVF) was not significantly associated with OPR (odds ratio 2.56, 95% confidence interval 0.9–7.6).ConclusionsIn advanced-age Bologna poor responders, MNC-IVF, which is a more patient-friendly approach, could be a reasonable alternative in this difficult-to-treat group of women.     

Quantification of ovarian stromal Doppler signals in poor responders undergoing in vitro fertilization with three-dimensional power Doppler ultrasonography

OBJECTIVE: This was a prospective comparative clinical study to test the hypothesis that the decreased ovarian sensitivity to gonadotropins observed in women embarking on an in vitro fertilization (IVF) treatment may be due to changes in ovarian stromal blood flow. STUDY DESIGN: Three-dimensional (3D) power Doppler ultrasonographic indexes were used to quantify ovarian stromal blood flow and vascularization in poor responders. Forty patients undergoing an IVF cycle were collected and divided into two groups, a poor responder group (n=17) (estradiol <600 pg/mL or < or =3 oocytes retrieved) and normal responder group (n=23), based on their response to a standard down-regulation protocol for controlled ovarian stimulation. During ovarian stimulation, on the day of administration of human chorionic gonadotropin (HCG), patients underwent hormonal (serum E2), ultrasonographic (follicular number and diameter), and 3D power Doppler (ovarian stromal blood flow) evaluation. RESULTS: Compared with poor responders, the serum estradiol levels on the day of administration of HCG, the number of follicles more than 14 mm, the number of oocytes retrieved, the number of embryos transferred, and the pregnancy rate were significantly higher in normal responders. The Vascularization Index, Flow Index, and Vascularization Flow Index were significantly lower (P<.05) in the poor responder (0.13+/-0.11, 30.89+/-10.35, and 0.05+/-0.04, respectively) compared with the women with a normal response (1.20+/-1.10, 43.88+/-7.77, and 0.61+/-0.57, respectively). CONCLUSION: The 3D power Doppler indexes of ovarian stromal blood flow in poor responders was significantly lower than normoresponders. This may help to explain the poor response during HCG administration in controlled ovarian stimulation.     

Early follicular anti-mullerian hormone as a predictor of ovarian response during ICSI cycles

ObjectiveTo evaluate the use of AMH in predicting the ovarian response in ICSI cycles compared to other markers of ovarian function.DesignProspective study.SettingIVF/ICSI Unit; Enjab Hospital for infertility, Gulf Medical College and Research Centre (UAE) and Biochemistry department, Faculty of Pharmacy for Girls, Al-Azhar University (Egypt).Subject(s)A total of 220 infertile women attending an ART program (ICSI) for the first time during the period from June 2007 to October 2009 who met the inclusion criteria were our subjects . On day-3 of the menstrual cycle, serum levels of AMH, FSH, LH, E2, and inhibin B were measured for each woman. Early antral follicles were evaluated by vaginal ultrasound. Thereafter, the patients were classified according to oocyte count into two groups; Good responders (those with ?4 oocytes) and poor responders (those with <4 oocytes).Intervention(s)None.Main outcome measure(s)Comparison of day-3 serum AMH levels in both groups. Antral follicle count, basal FSH, LH, E2 and inhibin B were also compared.ResultsThe serum level of AMH, AFC and FSH levels were significantly different in both groups. Parameters such as serum LH, E2 and inhibin B levels were not significantly different between the two groups. Ovarian response was significantly correlated with basal AMH levels, FSH levels and AFC. However, AMH levels were highly correlated with the number of retrieved oocytes (P<0.001) than did AFC (P<0.01) or FSH (P<0.05) on day-3 of the cycle. Day-3 AMH was more sensitive and specific with higher predictivity for ovarian response than either day-3 AFC or day-3 FSH.ConclusionSerum AMH levels may reflect ovarian response better than the usual hormone markers.     

Mini-dose long gonadotropin-releasing hormone (GnRH) agonist versus agonist flare stimulation protocol for in vitro fertilization poor responders

ObjectivesTo compare 2 stimulation protocols, mini-dose long gonadotropin releasing hormone (GnRH) agonist versus agonist flare for in vitro fertilization poor responders.DesignProspective comparative nonrandomized clinical trial.SettingDr. Samir Abasss IVF center, Jeddah, Kingdom of Saudi Arabia from april 2012 to December 2012 on 50 women undergoing IVF/ICSI fulfilling the criteria of poor responders.Material and methodsPatients were allocated into 2 groups, group 1 (n = 25) received mini-dose long agonist and group 2 (n = 25) received agonist flare protocol.Main outcomeNumber of oocytes retrieved (primary outcome), duration of stimulation (days), peak E2 level on the day of hCG injection, number of fertilized oocytes, number of transferred embryos and pregnancy rate/cycle.ResultsBoth groups were comparable regarding age, body mass index and duration of infertility (years). The difference in basal FSH and duration of stimulation (days) does not reach statistical significance (p value 0.833 and 0.373 respectively). There was a high statistical difference between both groups regarding peak E2 on day of hCG injection, number of oocytes retrieved, number of fertilized oocytes, number of transferred embryos; which is higher in the mini-dose agonist group (p value 0.00).Pregnancy rate/cycle was higher in the mini-dose agonist group (9/25 vs. 6/25) however this difference does not reach statistical significance (p value 0.355) which may be attributed to small sample size or advanced maternal age.ConclusionMini-dose long GnRHa stimulation protocol appears to be more beneficial for poor responders than GnRHa agonist flare.     

Serum anti-Müllerian hormone and basal serum FSH as predictors of poor ovarian response in assisted conception cycles

ObjectiveThe aim of the study was to correlate serum AMH and serum FSH levels with ovarian response to stimulation in IVF–ICSI cycles.Design and settingsThis was a prospective observational study conducted in a private assisted conception unit.Subjects and methodsOne hundred and two patients were selected on their first IVF cycle. Basal serum FSH and serum AMH were measured one month before the stimulation cycle. A fixed dose GnRH antagonist protocol was used in all cycles transferring a maximum of three day-3 cleavage stage embryos. We defined poor ovarian response as retrieval of fewer than four mature oocytes in cycles requiring ? 3000 IU of gonadotropins for stimulation or cycle cancellation due to poor response. The correlation between different parameters was expressed as a Spearman’s correlation coefficient. The clinical value of AMH and FSH as predictors of poor ovarian response as well as predictors of pregnancy was evaluated by constructing relevant receiver operator characteristics curves (ROC curves).ResultsOf these 102 cycles, 28 fitted our definition of poor response while the remaining 74 cycles all produced an adequate response to stimulation. There was a statistically significant difference between the adequate responders group and poor responders group regarding their mean age (31.5 versus 39.6, p < 0.001), the mean value of AMH (2.84 ng/ml versus 0.9 ng/ml, p < 0.0001) as well as the mean value of basal FSH (7.6 IU/ml versus 9.7 IU/ml, p < 0.0001). Serum AMH level had a positive correlation while serum FSH had a negative correlation with the number of oocytes collected while only serum AMH had a significant positive correlation with the occurrence of pregnancy. ROC curve analysis of our results showed that serum AMH with an optimal cut-off value of 1.2 ng/ml is a reliable predictor of poor ovarian response with an area under the ROC curve of 90.4%. Serum basal FSH with an optimal cut-off value of 8.9 IU/ml was of lower value than AMH as a predictor of poor ovarian response with an area under the ROC curve of 81.9%. However, neither serum AMH nor basal serum FSH was found to able to reliably predict the occurrence of pregnancy with an area under the ROC curve of 59.4% and 58.6% respectively.ConclusionOur results show that serum AMH level is more reliable than basal serum FSH as a predictor of poor ovarian response to stimulation with a cut-off value of 1.2 ng/ml shown to predict poor ovarian response with a sensitivity of 91.7%.     

Comparisons of follicular levels of sex steroids, gonadotropins and insulin like growth factor-1 (IGF-1) and epidermal growth factor (EGF) in poor responder and normoresponder patients undergoing ovarian stimulation with GnRH antagonist

OBJECTIVE: To determine the serum and intrafollicular concentrations of sex steroids, epidermal growth factor (EGF) and insulin like growth factor-1 (IGF-1) in women demonstrating poor response to ovarian stimulation with gonadotropins and GnRH antagonists, and to compare the results with age-matched women displaying normal ovarian response. STUDY DESIGN: This is a prospective cross-sectional study conducted in a private IVF center. Forty-eight age-matched women producing 5 or fewer oocytes (poor responders) or 10 or more oocytes (normoresponders) at the end of controlled ovarian stimulation for assisted conception participated in the experiment. Gonadotropins and GnRH antagonists were used for ovarian stimulation, while ICSI was employed for assisted fertilization. Serum and follicular concentrations of FSH, LH and sex steroids (estradiol, progesterone and testosterone), and follicular concentrations of EGF and IGF-1 were assayed in both groups. RESULTS: Serum and follicular levels of E(2) and progesterone were significantly lower in the poor responder group compared to the normoresponder group. Follicular level of testosterone was also lower in poor responders, but not to a level of statistical significance. The serum FSH level was higher in the poor responder group, but follicular levels of gonadotropins did not differ between the two groups. The follicular level of IGF-1 was significantly lower in poor responders. In contrast, the EGF concentration did not differ between the two groups. CONCLUSIONS: Decreased levels of sex steroids in poor responder patients undergoing COH with GnRH antagonist, suggests that reduced IGF-1 expression acts as a modulator of impaired ovarian steroidogenesis.     

Serum Progesterone Before and After Human Chorionic Gonadotropin Injection Depends on the Estradiol Response to Ovarian Hyperstimulation During In Vitro Fertilization–Embryo Transfer Cycles

Purpose: Our purpose was to assess if periovulatory serum progesterone is reflective of ovarian responsiveness in controlled ovarian hyperstimulation (COH). Methods: One-hundred forty-two in vitro fertilization–embryo transfer cycles in women using GnRH-a suppression and human menopausal gonadotropin (hMG) stimulation were evaluated. Responses were studied according to ovarian response to hMG and age. Outcome measures included peak serum estradiol, serum progesterone and estrogen/progesterone ratios on the day of hCG injection, number of harvested oocytes, fertilization rates, and delivered pregnancy rates. Results: A periovulatory rise in serum progesterone (>0.9 ng/ml) occurred only among younger women (<40 years old) with a good response (P<0.05). Though the number of oocytes was greater in good responders, fertilization and pregnancy rates were similar among all women regardless of age and ovarian response. Conclusions: Periovulatory levels of serum progesterone vary according to ovarian response to COH. Elevations in progesterone do not appear to be a manifestation of poor responders. Reduced periovulatory progesterone may reflect inadequate steroidogenesis.     

Serum tumor necrosis factor-α, interleukin-6, monocyte chemotactic protein-1 and paraoxonase-1 profiles in women with endometriosis,pcos, or unexplained infertility

ObjectiveTo investigate the serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), and Paraoxonase-1 (PON-1) during fertility treatment of women with endometriosis (Endo), PCOS or unexplained infertility (Unexpl).MethodsThirty-six patients with Endo, PCOS or Unexpl undergoing controlled ovarian stimulation for IVF or IUI were consented and their serum, on day-3 (baseline) and at the end of FSH treatment (peak), was collected and investigated for levels of TNF-α, IL-6, MCP-1, and PON-1. Correlations, ANOVA and Student''s t-test were used for statistical analysis.ResultsPeak serum levels of IL-6, MCP-1 and PON-1 were positively correlated to E₂ peak levels. TNF-α levels were inversely correlated to estradiol levels and they were lower in patients who ultimately became pregnant when compared to non-pregnant (P < 0.05). Mean TNF-α levels were significantly higher in Unexpl group (P < 0.05). The mean levels of IL-6, and MCP-1 were significantly (p < 0.05) higher in women with PCOS compared with Endo and Unexpl. No differences were found between the three clinical groups in patient’s age, BMI, Day-3 FSH, PON-1 and pregnancy outcome.ConclusionCirculating cytokine levels were influenced by ovarian stimulation, as demonstrated by increased levels of IL-6, MCP-1 and PON-1, and decreased level of TNF-α at the end of controlled ovarian stimulation. While evidence of relationship between circulating cytokines with mild endometriosis was not found, PCOS was associated with elevated serum IL-6 and MCP-1 but lower TNF-α concentration. Unexplained infertility was associated with elevated TNF-α level. No relationship between serum PON-1 concentration and PCOS, mild endometriosis or unexplained infertility was noted.     

Effect of recombinant LH supplementation on cumulative live birth rate compared with FSH alone in poor ovarian responders: a large,real-world study

Research questionThe benefit of LH supplementation (LHS) over sole use of FSH during controlled ovarian stimulation (COS) remains controversial. Meta-analyses have provided some evidence that the benefit of LHS is limited to women with poor ovarian response (POR). This study aimed to assess the effectiveness of LHS on cumulative live birth rate (CLBR) in POR using a large controlled study in a real-world context.DesignThis retrospective multicentre controlled study used data from registries at 12 French ART centres. All instances of POR undergoing ovarian stimulation and treated with follitrophin-alfa (FSH-α) with or without lutrophin-α were selected following an intention-to-treat principle. POR was defined according to the ESHRE Bologna criteria, and classified into three categories (Mild, Moderate and Severe) according to the Poor Responder Outcome Prediction (PROsPeR) score. The primary end-point was the CLBR associated with fresh and frozen embryos originating from the same ovarian stimulation.ResultsA total of 9787 instances of ovarian stimulation (5218 LHS, 4569 FSH-α only) were analysed, 33.0%, 52.4% and 14.6% being allocated to the Mild, Moderate and Severe PROsPeR categories, respectively. Using a mixed logistic model and adjusting for matched subclasses and baseline POR severity, it was found that the benefit of LHS compared with use of FSH alone differed between baseline severity categories (interaction test, P = 0.007): a significant benefit of LHS for CLBR was found for patients in the Moderate (14.3% versus 11.3%, odds ratio [OR] = 1.37, 95% confidence interval [CI] 1.07–1.75, risk ratio [RR] = 1.29, P = 0.013) and Severe (9.8% versus 4.4%, OR = 2.40, 95% CI– 1.48–3.89, RR = 1.89, P < 0.001) categories, but not for the Mild category (18.8% versus 19.6%, OR = 0.95, 95% CI 0.78–1.15, RR = 0.95, P = 0.60).ConclusionLHS has a significant effect on increasing CLBR in moderately and severely poor ovarian responders.     

GnRH-II mRNA expression in tumor tissue and peripheral blood mononuclear cells (PBMCs) in patients with malignant and benign ovarian tumors

Objective

To investigate the expression of the second form of GnRH (GnRH-II) in tumor tissue and peripheral blood mononuclear cells (PBMCs) in malignant and benign ovarian tumors in humans.

Study design

Sixty-six women were studied: 24 with epithelial ovarian carcinomas, 22 with benign ovarian tumors and 20 in the control group undergoing surgery. Malignant, benign and normal ovarian tissue and PBMCs were obtained for measurement of GnRH-II mRNA levels using quantitative real-time RT-PCR.

Result(s)

The expression of GnRH-II was found to be 1.5 times higher in malignant ovarian tumors compared with benign ovarian tumors and the control group in post-menopausal patients (P < 0.01). In the post-menopausal patient group with malignant ovarian tumors, there were significant positive correlations between serum FSH level and ovarian tissue GnRH-II mRNA expression (r = 0.68; P = 0.03), and serum LH level and ovarian tissue GnRH-II mRNA expression (r = 0.71; P = 0.02). Controls, benign and malignant groups were similar in terms of GnRH-II expression in PBMCs in the pre- and post-menopausal periods. There was no significant correlation between ovarian tissue GnRH-II mRNA expression vs. PBMC GnRH-II mRNA expression in patient and control groups.

Conclusion(s)

We have shown increased GnRH-II expression in human ovarian cancer tissue in post-menopausal women in vivo. Expression of GnRH-II in PBMCs did not reflect the local GnRH-II expression levels in ovarian tissue. These preliminary data suggest that local GnRH-II may participate in the regulation of ovarian tumor growth in post-menopausal women.     

Pregnancy After Modified Natural Cycle IVF: Case Report of a Young Patient With Elevated FSH Levels and Male Factor Infertility

BackgroundAlthough the first pregnancy obtained by IVF was in a natural cycle, this method was soon abandoned in favour of gonadotropin-stimulated protocols to improve pregnancy rates. In women who are poor responders to ovarian stimulation, the use of a natural cycle may provide a good alternative for achieving a pregnancy, although there is limited information on the success of modified natural cycle in vitro fertilization (MNC-IVF) in young patients with poor ovarian reserve.CaseA 35-year-old woman with significantly elevated FSH levels (consistently > 30 IU/L) but regular menses, and with severe male factor infertility, conceived using MNC-IVF with intracytoplasmic sperm injection (ICSI).ConclusionThis case demonstrates that younger patients (aged 35 or under) with elevated basal serum FSH levels and regular menses can be offered MNC-IVF as an option prior to considering oocyte donation when a secondary cause of infertility necessitates IVF or ICSI.     

Estrogen or anti-estrogen for Bologna poor responders?

Abstract

The current study aims to compare cycle outcomes of two ovarian stimulation protocols in poor responders according to the Bologna criteria; luteal estrogen priming (LE) or letrozole (LZ) co-treatment in antagonist protocol. Following retrospective chart review of a single center, 162 cycles were found eligible for the comparison of two ovarian stimulation protocols. After interpreting data, significantly higher serum estradiol levels, longer duration of cycle, higher number of fertilized oocytes and good quality embryos were detected in patients who received LE. Despite any statistical significance, higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) per embryo transfer (ET) were detected with LE protocol compared with LZ (12.3% versus 18.2% and 9.6% versus 12.7%, respectively). Younger patients (<40 years) revealed higher CPR and OPR per started cycle compared with older patients (≥40 years) where only OPR was statistically significant. Multivariable analysis demonstrated that basal antral follicle count, peak serum estradiol levels and number of fertilized oocytes were independent variables significantly associated with clinical pregnancies (p < 0.05). In the current analysis, LE or LZ protocols revealed comparable but quite low pregnancy rates in poor responders according to the Bologna criteria. Younger patients were more likely to achieve pregnancy compared to older patients with both protocols.     

In Vitro Fertilization with Low-Dose Clomiphene Citrate Stimulation in Women Who Respond Poorly to Superovulation

Purpose: Our experience with IVF using low-dose clomiphene citrate for stimulation in non- and poor responders was reviewed and the treatment outcomes with the previous controlled ovarian stimulation cycles in which hMG and GnRH agonist were used were compared. Methods: The treatment outcome in 11 non- and 20 poor responders having 30 and 53 clomiphene citrate IVF treatment cycles, respectively, were compared with the treatment outcome in the previous long-protocol buserelin/hMG cycles. Results: The clinical pregnancy rates per oocyte collection achieved in the first clomiphene citrate cycle in non (9.1%)- and poor (10%) responders were comparable to those achieved by poor responders (11.9%) who had buserelin/hMG using the long protocol. Although the numbers were small, a similar pregnancy rate could still be achieved in poor responders up to the third attempt using clomiphene citrate. Conclusions: IVF using long-protocol buserelin/hMG is more successful than using clomiphene citrate stimulation. However, this advantage may not be significant in those women with a previous poor response to buserelin/hMG. It is suggested that for such poor responders, three attempts of IVF in a clomiphene citrate cycle may offer a viable therapeutic alternative before reverting to more stressful, expensive, and time-consuming treatment.