Norbert Gleicher1, David Barad. 1. Center for Human Reproduction, New York, New York 10021, USA. ngleicher@thechr.com <ngleicher@thechr.com>
Abstract
OBJECTIVE: To determine whether pregnancy outcome can be positively affected if the ovarian stimulation in women with diminished ovarian reserve (DOR) is changed. DESIGN: Case control study. SETTING: Medical school-affiliated private infertility center. PATIENT(S): Sixty-two women, aged 26-35 years, with the diagnosis of DOR (study group) and 62 age-matched controls with apparently normal ovarian function (control group). INTERVENTION(S): Study group patients received a modified (ovarian age-based) stimulation with microdose GnRH agonist (GnRH-a) and 450-600 IU of gonadotropin daily. Women in the control group received a standard "chronological age-based" stimulation with long luteal phase GnRH-a and up to 300 IU of gonadotropins (two patients in this group received an antagonist in place of an agonist). MAIN OUTCOME MEASURE(S): The IVF cycle outcome parameters, including pregnancy rates (PR). RESULT(S): Women with DOR and controls did not differ significantly in patient profiles or underlying infertility conditions and received identical embryo numbers at transfer. The DOR patients demonstrated a strong trend toward lower gravidity. Peak E(2) levels were similar between groups but controls produced significantly more oocytes, a strong trend toward more embryos and significantly more cycles of cryopreservation. Both groups achieved a 47% rate of first positive pregnancy test (hCG), with controls demonstrating a 39% and DOR patients a 32% ongoing PR. CONCLUSION(S): Women with DOR, if treated with an ovarian age-based rather than chronological age-based ovarian stimulation protocols, will demonstrate surprisingly good PR with IVF in comparison to women with normal ovarian function.
OBJECTIVE: To determine whether pregnancy outcome can be positively affected if the ovarian stimulation in women with diminished ovarian reserve (DOR) is changed. DESIGN: Case control study. SETTING: Medical school-affiliated private infertility center. PATIENT(S): Sixty-two women, aged 26-35 years, with the diagnosis of DOR (study group) and 62 age-matched controls with apparently normal ovarian function (control group). INTERVENTION(S): Study group patients received a modified (ovarian age-based) stimulation with microdose GnRH agonist (GnRH-a) and 450-600 IU of gonadotropin daily. Women in the control group received a standard "chronological age-based" stimulation with long luteal phase GnRH-a and up to 300 IU of gonadotropins (two patients in this group received an antagonist in place of an agonist). MAIN OUTCOME MEASURE(S): The IVF cycle outcome parameters, including pregnancy rates (PR). RESULT(S): Women with DOR and controls did not differ significantly in patient profiles or underlying infertility conditions and received identical embryo numbers at transfer. The DOR patients demonstrated a strong trend toward lower gravidity. Peak E(2) levels were similar between groups but controls produced significantly more oocytes, a strong trend toward more embryos and significantly more cycles of cryopreservation. Both groups achieved a 47% rate of first positive pregnancy test (hCG), with controls demonstrating a 39% and DOR patients a 32% ongoing PR. CONCLUSION(S): Women with DOR, if treated with an ovarian age-based rather than chronological age-based ovarian stimulation protocols, will demonstrate surprisingly good PR with IVF in comparison to women with normal ovarian function.
Authors: Bruno Ramalho de Carvalho; Ana Carolina Japur de Sá Rosa e Silva; Júlio César Rosa e Silva; Rosana Maria dos Reis; Rui Alberto Ferriani; Marcos Felipe Silva de Sá Journal: J Assist Reprod Genet Date: 2008-08-05 Impact factor: 3.412