IVF outcome in poor responders failing to produce viable embryos in the preceding cycle

Rescue intrauterine insemination in women failing to retrieve oocytes at ovum pick-up: report of a case series

PURPOSE

Failure to collect oocytes at the time of oocyte pick-up is an unfavorable outcome of in vitro fertilization (IVF) cycles. In these cases, prompt intrauterine insemination (IUI) could be an option (rescue IUI), but this possibility has been poorly studied.

METHODS

Rescue IUI is routinely offered in our unit in women failing to retrieve oocytes, provided that they have at least one patent tube, normal male semen analysis, and the total number of developed follicles is ≤ 3. We therefore reviewed all oocyte retrievals performed from 2006 to 2022 in our unit to identify these cases. As a comparator, we referred to preplanned IUI performed during the same study period. The 95% confidence interval (95% CI) of proportions was calculated using a binomial distribution model.

RESULTS

Rescue IUI was performed in 96 out of 3531 oocyte retrievals (2.7%; 95% CI 2.2-3.3%). Six live births were obtained, corresponding to 6.2% (95% CI 2.3-13.1). All pregnancies were singletons.

CONCLUSIONS

Rescue IUI in women failing to retrieve oocytes is a possible option that may be considered in selected cases. The efficacy is low, but the procedure is simple, and without significant risks. Generalizability to a conventional IVF protocol setting is however limited.

Utilization of the Bologna criteria: a promise unfulfilled? A review of published and unpublished/ongoing trials

OBJECTIVE

To study the use of the Bologna criteria (BC) for the definition of poor ovarian responders (POR) in clinical practice and research.

DESIGN

Systematic review of published and unpublished/ongoing trials between January 2012 and August 2017 on POR.

SETTING

Not applicable.

PATIENT(S)

Not applicable.

INTERVENTION(S)

The databases were searched using the relevant medical subject headings including all subheadings. The search was limited to humans and English language. The references of the included studies were cross-searched for possibly missed articles. Only clinical trials providing an evidence level ≥ III were included. Case reports, review, letters, and hypothetical articles were excluded.

MAIN OUTCOME MEASURE(S)

Extracted studies were divided into two groups: studies in which the BC were used or not.

RESULT(S)

One hundred nine published clinical studies analyzing a total of 30,540 women and 112 unpublished/ongoing trials were identified. The BC were used to define POR in 56 (51%) of the published and 44 (39%) of the unpublished trials. The use of the BC gradually increased from 29% to 53% from 2012 to 2017. Asian researchers were more likely to use the BC compared with European and North American researchers (65%, 49%, and 23%, respectively). Neither the design of the study nor the impact factor of the publishing journal was correlated with the use of the BC.

CONCLUSION(S)

There is still reluctance to use the BC for the definition of POR, which makes it difficult to combine data from small studies and reach a meaningful conclusion.

Comparison of The Effectiveness of Clomiphene Citrate versus Letrozole in Mild IVF in Poor Prognosis Subfertile Women with Failed IVF Cycles

BACKGROUND

Our objective was to evaluate the effectiveness of clomiphene citrate (CC) vs. letrozole (L) plus human menopausal gonadotropin (hMG) in gonadotropin releasing hormone (GnRH) antagonist protocol in poor prognosis women with previous failed ovarian stimulation undergoing intracytoplasmic sperm injection (ICSI).

MATERIALS AND METHODS

This retrospective cohort study included cycles with CC and L plus hMG/GnRH antagonist protocols of 32 poor responders who had failed to have ideal follicles to be retrieved during oocyte pick-up (OPU) or embryo transfer (ET) at least for 2 previous in vitro fertilization (IVF) cycles with microdose flare protocol or GnRH antagonist protocol from January 2006 to December 2009. Main outcome measures were implantation, clinical pregnancy and live birth rates per cycle. Duration of stimulation, mean gonadotropin dose used, endometrial thickness, number of mature follicles, serum estradiol (E2) and progesterone (P) levels on the day of human chorionic gonadotropin (hCG) administration, number of retrieved oocytes and fertilization rates were also evaluated.

RESULTS

A total number of 42 cycles of 32 severe poor responders were evaluated. Total gonadotropin consumption was significantly lower (1491 ± 873 vs. 2808 ± 1581 IU, P=0.005) and mean E2 level on the day of hCG injection were significantly higher in CC group than L group (443.3 ± 255.2 vs. 255.4 ± 285.2 pg/mL, P=0.03). ET, overall pregnancy and live birth rates per cycle were significantly higher in CC than L protocol (27.2 vs. 15%, 13.6 vs. 0% and 4.5 vs. 0%, respectively, P<0.05).

CONCLUSION

Severe poor responders who had previously failed to respond to microdose or GnRH antagonist protocols may benefit from CC plus hMG/GnRH antagonist protocol despite high cancellation rate.

Can serum estradiol levels on the fourth day of IVF/ICSI cycle predict outcome in poor responder women?

We aimed to investigate the value of fourth day serum estradiol levels in predicting cycle outcome in poor responders. The medical records of 426 patients with low oocyte yield following controlled ovarian hyperstimulation (COH) treatment for a procedure in our institution's center for ART between 2008 and 2013 were evaluated. Eighty-eight patients exhibiting poor ovarian response (POR) were included in the study. The clinical outcomes of IVF/ICSI were compared based on the basal hormone profile, clinical, and laboratory parameters. Cycle day 4 E2 levels below 110 pg/ml had an odds ratio of 6.05 (95% CI 2.33-15.7; p < 0.001) for embryo transfer. The early follicular response to ovarian stimulation can be anticipated with the cycle day 4 estradiol levels during COH. When a low day 4 serum estradiol level is encountered, abandoning the current COH and proceeding with agents that increase ovarian response to ovarian stimulation before the next treatment cycle can be a realistic approach.