Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Μάρα Σιμοπούλου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μιχαήλ Κουτσιλιέρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αναστάσιος Φιλίππου, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Παναγούλα Αγγελογιάννη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Κλειώ Μαυραγάνη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Νικόλαος Νικολέττος, Καθηγητής, Ιατρική Σχολή, ΔΠΘ
Βύρωνας Ασημακόπουλος, Καθηγητής, Ιατρική Σχολή, ΔΠΘ
Original Title:
Εξετάζοντας το φαινόμενο των πτωχών απαντητριών στην εξωσωματική γονιμοποίηση
Translated title:
Investigating the phenomenon of poor responders in IVF
Summary:
Despite the recent noted outstanding advances in the world of assisted reproductive technology (ART), poor ovarian response (POR) diagnosis and treatment is still considered challenging. The so called “poor responders” constitute a highly heterogeneous group of infertile patients with the common denominator of under-responding to controlled ovarian stimulation. In the context of in vitro fertilization (IVF) treatment, patients presenting with poor ovarian response (POR) are characterized by diminished ovarian reserve, inevitably, respective success rates are significantly compromised. Considering POR patients’ performance during IVF treatment, this is associated with a compromised number and quality of retrieved oocytes, a limited number of available embryos as well as with lower pregnancy rates and higher cycle cancellation rates. POR patients’ management still remains a conundrum and more studies are needed in order to draw safe conclusions. From the criteria employed for diagnosis to the plethora of strategies and adjuvant therapies proposed, the conundrum of POR still puzzles the practitioner. This study aims to investigate the efficiency of four different strategies proposed in the literature in an effort to add data to the current exploration of the most efficient management protocol of this subgroup of IVF patients.
In this retrospective study, four different strategies are compared for managing poor ovarian response (POR) namely, conventional stimulation (300 IU) fresh-IVF-ET (CONVF), mild stimulation (150 IU) fresh-IVF-ET (MILDF), mild stimulation-embryo banking (MILDB) and embryo banking in natural cycles (NATB). In total, 796 POR patients were considered eligible to participate in the study. Statistical analysis revealed a lower duration of stimulation and a lower required number of gonadotropins in MILDF compared with CONF (9.34±1.17 vs 10.37±1.14; 1402±176 vs 3110±343, P-value <0.001). Comparing MILDF and MILDB, a higher number of available oocytes and embryos was observed in MILDB (2.36±1.15 vs 6.58±1.11; 1.72±1.02 vs 3.51±0.61, P-value <0.001). Moreover, the MILDB presented with a lower number of required oocyte retrievals and a higher number of oocytes per oocyte retrieval compared with NATB (3.90±1.56 vs 7.15±1.80; 1.95±0.74 vs 0.89±0.20, P-value <0.001). Data indicate that MILDF is equally efficient and is associated with lower duration of stimulation and a lower required number of gonadotropins compared with CONVF.
As a result, the newly proposed strategy employed embryo accumulation may be more efficient compared with one treatment IVF cycle concluding to one embryo-transfer (ET). This new approach of embryo accumulation via mild stimulation cycles (MILDB) may constitute a more efficient approach compared with the strategy of natural cycles compared with embryo banking NATB. To conclude, embryo accumulation following mild stimulation appear to form the optimal strategy for POR management. Nonetheless, future randomized controlled trials are needed to verify these conclusions.
Main subject category:
Health Sciences
Keywords:
Assisted reproduction, Poor ovarian response, Ovarian stimulation protocols, Natural cycle, Mild stimulation
Number of references:
248
