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Kahyaoglu I, Tutkun Kilinc EC, Gulerman C, Yilmaz N, Ceran MU, Bardakci Y, Engin Ustun Y. Early or late response in poor responders: does it make a difference in cycle outcome? HUM FERTIL 2023; 26:1485-1490. [PMID: 37325892 DOI: 10.1080/14647273.2023.2197627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/08/2022] [Indexed: 06/17/2023]
Abstract
Ovarian response to stimulation mainly determines the length of stimulation. However, there is no clarity in the literature regarding the optimal duration required to achieve oocyte maturity in patients with the poor ovarian response (POR) defined by Bologna criteria. Therefore, a total of 267 cycles that fulfilled the inclusion criteria were selected retrospectively. Group A constitute of patients with a stimulation period < 9 d (n = 70); and group B included patients with a stimulation period ≥ 9 d (n = 133). The results showed that antral follicle count (5.72 ± 1.82 vs. 5.10 ± 1.78, p = 0.023), serum oestradiol level on hCG day (1286.88 ± 778.18 pg/mL vs. 820.14 ± 479.04 pg/mL, p = 0.001), and total gonadotropin dose used (2949.53 ± 727.92 IU vs 2020.94 ± 415.17 IU, p = 0.0001) were higher in group B when compared to group A. Although the number of total (5.47 ± 3.32 vs 3.86 ± 2.15, p = 0.0001) and mature oocytes retrieved (4.34 ± 2.88 vs 2.84 ± 1.67, p = 0.0001) were higher in group B, no significant difference was observed in the pregnancy rates between groups (25.6 vs 15.7%, p > 0.05). In conclusion, no deleterious effect of a shorter duration of stimulation on cycle outcome was seen in patients with POR.
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Affiliation(s)
- Inci Kahyaoglu
- Department of Reproductive Endocrinology, Etlik Zubeyde Hanim Women's Health Hospital, University of Health Sciences, Ankara, Turkey
| | - Elif Ceren Tutkun Kilinc
- Department of Gynecology and Obstetrics, Gaziantep Abdulkadir Yuksel Government Hospital, Gaziantep, Turkey
| | - Cavidan Gulerman
- Department of Reproductive Endocrinology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Nafiye Yilmaz
- Department of Reproductive Endocrinology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Ufuk Ceran
- Department of Gynecology and Obstetrics, Baskent University School of Medicine, Konya Medical and Research Center, Selcuklu, Konya, Turkey
| | - Yesim Bardakci
- Department of Embryology, Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Ustun
- Department of Reproductive Endocrinology, Etlik Zubeyde Hanim Women's Health Hospital, University of Health Sciences, Ankara, Turkey
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Bai L, Pan H, Zhao Y, Chen Q, Xiang Y, Yang X, Zhu Y. The Exploration of Poor Ovarian Response-Related Risk Factors: A Potential Role of Growth Differentiation Factor 8 in Predicting Ovarian Response in IVF-ET Patient. Front Endocrinol (Lausanne) 2021; 12:708089. [PMID: 34630324 PMCID: PMC8499678 DOI: 10.3389/fendo.2021.708089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Controlled ovarian hyperstimulation (COH) is the most common therapeutic protocol to obtain a considerable number of oocytes in IVF-ET cycles. To date, the risk factors affecting COH outcomes remain elusive. Growth differentiation factor 8 (GDF-8), a member of transforming growth factor β (TGF-β) superfamily, has been long discerned as a crucial growth factor in folliculogenesis, and the aberrant expression of GDF-8 is closely correlated with the reproductive diseases. However, less is known about the level of GDF-8 in IVF-ET patients with different ovarian response. In the present study, the potential risk factors correlated with ovarian response were explored using logistic regression analysis methods. Meanwhile, the expression changes of GDF-8 and its responsible cellular receptors in various ovarian response patients were determined. Our results showed that several factors were intensely related to poor ovarian response (POR), including aging, obesity, endometriosis, surgery history, and IVF treatment, while irregular menstrual cycles and PCOS contribute to hyperovarian response (HOR). Furthermore, POR patients exhibited a decrease in numbers of MII oocytes and available embryos, thereby manifesting a lower clinical pregnancy rate. The levels of GDF-8, ALK5, and ACVR2B in POR patients were higher compared with those in control groups, whereas the expression level of ACVR2A decreased in poor ovarian response patients. In addition, clinical correlation analysis results showed that the concentration of GDF-8 was negatively correlated with LH and estradiol concentration and antral follicle count. Collectively, our observations provide a novel insight of ovarian response-associated risk factors, highlighting the potential role of GDF-8 levels in ovarian response during COH process.
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Affiliation(s)
- Long Bai
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Women’s Reproductive Health Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huihui Pan
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinjun Zhao
- Institute of Genetics and Department of Genetics, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qingqing Chen
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Xiang
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohang Yang
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Women’s Reproductive Health Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Institute of Genetics and Department of Genetics, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yimin Zhu, ; Xiaohang Yang,
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Women’s Reproductive Health Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Yimin Zhu, ; Xiaohang Yang,
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Jamaludin R, Ahmad MF, Park DK, Zain MM, Yoon TK, Lee WS, Koong MK, Lee KA. The stimulation protocol in poor responder IVF; a minimal or high-dose stimulation? - A meta-analysis. Horm Mol Biol Clin Investig 2019; 41:/j/hmbci.ahead-of-print/hmbci-2019-0018/hmbci-2019-0018.xml. [PMID: 31782947 DOI: 10.1515/hmbci-2019-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/20/2019] [Indexed: 11/15/2022]
Abstract
Background To determine whether a minimal stimulation (MS) or high-dose stimulation (HDS) protocol is a better option for patients classified as poor ovarian responders (POR) in terms of reproductive and pregnancy outcomes. Materials and methods A database search for evaluation of the study outcome by using meta-analysis method was carried out. The primary outcome was the clinical pregnancy (CP) rate for each of two groups, namely, the MS and HDS groups. The secondary outcomes were the gonadotropin dose used, duration of stimulation, cancellation rate, number of oocytes retrieved, number of fertilized oocytes, number of embryos transferred and live birth rates. Results Across five databases, 4670 potential studies for further screening were selected. But ultimately only six studies, three RCTs and three retrospective or case control studies were selected that meet the Bologna criteria for POR. In all there were 624 cycles. Our meta-analysis indicated that the CP rates, cycle cancellation rates, durations of stimulation, numbers of oocytes fertilized and numbers of embryos transferred were not statistically significant. Clearly, the number of oocytes retrieved in the MS group was significantly lower than in the HDS group, while the HDS group consumed significantly higher doses of gonadotropins than the MS group. The live birth rates were significantly higher in the MS group than in the HDS group. Conclusion MS should be the first-line protocol for managing POR because the live birth rate is significantly higher, even with fewer oocytes retrieved.
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Affiliation(s)
- Ridzuan Jamaludin
- Department of Obstetrics and Gynecology, Reproductive Unit, Sultanah Bahiyah Hospital, Km 6, Jln Langgar, 05460 Alor Setar, Kedah Darul Aman, Malaysia, Phone: +6019-4161310.,Department of Obstetrics and Gynecology, CHA University, Fertility Center, CHA General Hospital, Seoul, Korea
| | - Mohd Faizal Ahmad
- Department of Obstetrics and Gynecology, UKM Medical Centre, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Dae-Keun Park
- Department of Business Intelligence, CHA University, Seoul, Korea
| | - Murizah Mohd Zain
- Department of Obstetrics and Gynecology, Reproductive Unit, Sultanah Bahiyah Hospital, Alor Setar, Kedah Darul Aman, Malaysia
| | - Tae-Ki Yoon
- Department of Obstetrics and Gynecology, CHA University, Fertility Center, CHA General Hospital, Seoul, Korea
| | - Woo-Sik Lee
- Department of Obstetrics and Gynecology, CHA University, Fertility Center, CHA General Hospital, Seoul, Korea
| | - Mi Kyoung Koong
- Department of Obstetrics and Gynecology, CHA University, Fertility Center, CHA General Hospital, Seoul, Korea
| | - Kyung-Ah Lee
- Department of Biomedical Science, College of Life Sciences, CHA University, Fertility Center, CHA General Hospital, Seoul, Korea
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Youssef MAF, van Wely M, Mochtar M, Fouda UM, Eldaly A, El Abidin EZ, Elhalwagy A, Mageed Abdallah AA, Zaki SS, Abdel Ghafar MS, Mohesen MN, van der Veen F. Low dosing of gonadotropins in in vitro fertilization cycles for women with poor ovarian reserve: systematic review and meta-analysis. Fertil Steril 2018; 109:289-301. [PMID: 29317127 DOI: 10.1016/j.fertnstert.2017.10.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens in terms of ongoing pregnancy per fresh IVF attempt in women with poor ovarian reserve undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment. DESIGN A systematic review and meta-analysis of randomized controlled studies that evaluate the effectiveness of low dosing of gonadotropins alone or combined with oral compounds compared with high doses of gonadotropins in women with poor ovarian reserve undergoing IVF/ICSI treatment. SETTING Not applicable. PATIENT(S) Subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment. INTERVENTION(S) We searched the PubMed, EMBASE, Web of Science, the Cochrane Library, and the Clinical Trials Registry using medical subject headings and free text terms up to June 2016, without language or year restrictions. We included randomized controlled studies (RCTs) enrolling subfertile women with poor ovarian reserve undergoing IVF/ICSI treatment and comparing low doses of gonadotropins and gonadotropins combined with oral compounds versus high doses of gonadotropins. We assessed the risk of bias using the criteria recommended by the Cochrane Collaboration. We pooled the results by meta-analysis using the fixed and random effects model. MAIN OUTCOMES MEASURE(S) The primary outcome was ongoing pregnancy rate (PR) per woman randomized. RESULT(S) We retrieved 787 records. Fourteen RCTs (N = 2,104 women) were included in the analysis. Five studies (N = 717 women) compared low doses of gonadotropins versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (2 RCTs: risk rate 0.98, 95% confidence interval 0.62-1.57, I2 = 0). Nine studies (N = 1,387 women) compared ovarian stimulation using gonadotropins combined with the oral compounds letrozole (n = 6) or clomiphene citrate (CC) (n = 3) versus high doses of gonadotropins. There was no evidence of a difference in ongoing PR (3 RCTs: risk rate 0.90, 95% confidence interval 0.63-1.27, I2 = 0). CONCLUSION(S) We found no evidence of a difference in pregnancy outcomes between low doses of gonadotropins and gonadotropins combined with oral compounds compared with high doses of gonadotropins in ovarian stimulation regimens. Whether low doses of gonadotropins or gonadotropins combined with oral compounds is to be preferred is unknown, as they have never been compared head to head. A health economic analysis to test the hypothesis that an ovarian stimulation with low dosing is more cost-effective than high doses of gonadotropins is needed. PROSPERO REGISTRATION NUMBER CRD42016041301.
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Affiliation(s)
- Mohamed Abdel-Fattah Youssef
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Madelon van Wely
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Monique Mochtar
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Usama Mohamed Fouda
- Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ashraf Eldaly
- Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Zein El Abidin
- Department of Obstetrics & Gynecology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Elhalwagy
- Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Sherif Sameh Zaki
- Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Nagi Mohesen
- Department of Obstetrics & Gynecology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Fulco van der Veen
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Busnelli A, Papaleo E, Del Prato D, La Vecchia I, Iachini E, Paffoni A, Candiani M, Somigliana E. A retrospective evaluation of prognosis and cost-effectiveness of IVF in poor responders according to the Bologna criteria. Hum Reprod 2014; 30:315-22. [DOI: 10.1093/humrep/deu319] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Koshy AK, Gudi A, Shah A, Bhide P, Timms P, Homburg R. Pregnancy prognosis in women with anti-Müllerian hormone below the tenth percentile. Gynecol Endocrinol 2013; 29:662-5. [PMID: 23772777 DOI: 10.3109/09513590.2013.797395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although serum anti-Müllerian hormone (AMH) is considered a good predictor of ovarian response during in vitro fertilisation (IVF), pregnancies have been reported with low values, questioning its usefulness as a predictor of treatment outcome. A retrospective study was therefore carried out to assess the IVF treatment outcomes in women with AMH below the tenth percentile of the study population. In all, 134 women with AMH ≤ 3 pmol/L underwent 180 IVF cycles. The mean age at the time of treatment was 37 ± 5 years. Fifty-three (29.4%) cycles were abandoned because of poor response to gonadotrophins, 12 (6.7%) due to absence of eggs at oocyte retrieval and 18 (10%) due to fertilisation failure. Seven (3.8%) had a biochemical pregnancy, 4 (2.2%) had a missed miscarriage and 8 (4.4%) had a live birth. When stratified by age, women older than 42 years had less number of follicles (p < 0.05) and those older than 39 years had less oocytes (p < 0.01) compared to those 35 years and younger. Live births declined with increasing age, when age was assessed as a continuous variable (p = 0.023). Women with low AMH levels have a high probability of treatment cancellation, failure to proceed to embryo transfer and a low chance of achieving a viable pregnancy.
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Affiliation(s)
- Aby Kottal Koshy
- Homerton Fertility Centre, Homerton University Hospital, London, UK.
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7
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IVF outcome in poor responders failing to produce viable embryos in the preceding cycle. Reprod Biomed Online 2013; 26:569-76. [DOI: 10.1016/j.rbmo.2013.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 02/22/2013] [Accepted: 02/26/2013] [Indexed: 11/17/2022]
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Maman E, Geva LL, Yerushalmi G, Baum M, Dor J, Hourvitz A. ICSI increases ongoing pregnancy rates in patients with poor response cycle: multivariate analysis of 2819 cycles. Reprod Biomed Online 2012; 25:635-41. [DOI: 10.1016/j.rbmo.2012.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 07/26/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
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