International Journal of
Reproductive Biomedicine
Tue, Dec 31, 2024
[Archive]
Volume 18, Issue 6 (June 2020)
IJRM 2020, 18(6): 465-470 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Eftekhar M, Mohammadi B, Khani P, Mortazavi Lahijani M. Dual stimulation in unexpected poor responder POSEIDON classification group 1, sub–group 2a: A cross-sectional study. IJRM 2020; 18 (6) :465-470
URL: http://ijrm.ir/article-1-1661-en.html
URL: http://ijrm.ir/article-1-1661-en.html
1- Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
2- Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. ,banafsheh.mo1360@gmail.com
3- Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
4- Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Department of Obstetrics and Gynecology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
2- Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. ,
3- Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
4- Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Department of Obstetrics and Gynecology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
Abstract: (3101 Views)
Background: Poor ovarian response management is a complex and controversial issue in the field of reproductive medicine.
Objective: The aim of this study was to apply double stimulation in the same cycle in unexpected poor responders in POSEIDON classification group 1, sub group 2a and compare assisted reproductive technology outcomes between luteal phase and follicular phase ovarian stimulation.
Materials and Methods: In this cross-sectional study, 10 women with age < 35 yr, antral follicle count > 5, and anti-müllerian hormone > 1.2 ng/mL were enrolled. All participants received conventional antagonist protocol in the follicular phase and only the cycles with retrieved oocytes < 4 in this phase included. The luteal phase ovarian stimulation was initiated from the day of first oocytes retrieval by 300 IU of human menopausal gonadotropin / day. When dominant follicles amounted to 14 mm in mean diameter, 0.25 mg/day of gonadotropin-releasing hormone antagonist was initiated and 10,000 IU human chorionic gonadotropin was injected when at least two follicles with a mean diameter of 17 mm were observed. Oocyte retrieval was carried out 34-36 hr following human chorionic gonadotropin injection. Finally, a comparison was made between the two phase in terms of the number of retrieved oocytes as well as the number of obtained embryos and fertilization rates.
Results: Numbers of retrieved oocytes (p= 0.004), mature oocytes (p= 0.016), and embryos (p= 0.013) was significantly higher in luteal phase in compared with follicular phase. Quality of embryos was similar in two phases.
Conclusion: Double stimulation protocol can increase number of retrieved oocytes in unexpected PORs.
Objective: The aim of this study was to apply double stimulation in the same cycle in unexpected poor responders in POSEIDON classification group 1, sub group 2a and compare assisted reproductive technology outcomes between luteal phase and follicular phase ovarian stimulation.
Materials and Methods: In this cross-sectional study, 10 women with age < 35 yr, antral follicle count > 5, and anti-müllerian hormone > 1.2 ng/mL were enrolled. All participants received conventional antagonist protocol in the follicular phase and only the cycles with retrieved oocytes < 4 in this phase included. The luteal phase ovarian stimulation was initiated from the day of first oocytes retrieval by 300 IU of human menopausal gonadotropin / day. When dominant follicles amounted to 14 mm in mean diameter, 0.25 mg/day of gonadotropin-releasing hormone antagonist was initiated and 10,000 IU human chorionic gonadotropin was injected when at least two follicles with a mean diameter of 17 mm were observed. Oocyte retrieval was carried out 34-36 hr following human chorionic gonadotropin injection. Finally, a comparison was made between the two phase in terms of the number of retrieved oocytes as well as the number of obtained embryos and fertilization rates.
Results: Numbers of retrieved oocytes (p= 0.004), mature oocytes (p= 0.016), and embryos (p= 0.013) was significantly higher in luteal phase in compared with follicular phase. Quality of embryos was similar in two phases.
Conclusion: Double stimulation protocol can increase number of retrieved oocytes in unexpected PORs.
Keywords: Dual stimulation, Poor responder, POSEIDON classification, Luteal-phase, Follicular phase, Ovarian stimulation
Type of Study: Original Article |
Subject:
Fertility & Infertility
References
1. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L, et al. Eshre consensus on the definition of 'poor response'to ovarian stimulation for in vitro fertilization: the bologna criteria. Hum Reprod 2011; 26: 1616-1624. [DOI:10.1093/humrep/der092] [PMID]
2. Tolunay EH. Treatment modalities in poor responder patients undergoing assisted reproductive techniques. Obstet Gynecol Int J 2018; 9: 458-463. [DOI:10.15406/ogij.2018.09.00386]
3. Zhuang J, Li H, Li X, Tian D, Yang D, Zhu M. The incidence of unexpected poor ovarian response in chinese young women. Medicine 2019; 98: e14379. [DOI:10.1097/MD.0000000000014379] [PMID] [PMCID]
4. Haahr T, Esteves SC, Humaidan P. Individualized controlled ovarian stimulation in expected poor-responders: an update. Reprod Biol Endocrinol 2018; 16: 20-29. [DOI:10.1186/s12958-018-0342-1] [PMID] [PMCID]
5. Humaidan P, Alviggi C, Fischer R, Esteves SC. The novel poseidon stratification of 'low prognosis patients in assisted reproductive technology'and its proposed marker of successful outcome. F1000Res 2016; 5: 2911. [DOI:10.12688/f1000research.10382.1] [PMID] [PMCID]
6. Eftekhar M, Mirhashemi ES, Tabibnejad N. Outcome of assisted reproductive technology in different subgroups of poor ovarian responders fulfilling the poseidon criteria. Middle East Fertility Society Journal 2018; 23: 399-403. [DOI:10.1016/j.mefs.2018.06.002]
7. Haahr T, Dosouto C, Alviggi C, Esteves SC, Humaidan P. Management strategies for poseidon groups 3 and 4. Front Endocrinol 2019; 10: doi.org/10.3389/fendo.2019.00614. [DOI:10.3389/fendo.2019.00614] [PMID] [PMCID]
8. Conforti A, Esteves SC, Cimadomo D, Vaiarelli A, Di Rella F, Ubaldi FM, et al. Management of women with an unexpected low ovarian response to gonadotropin. Front Endocrinol 2019; 10: 387. [DOI:10.3389/fendo.2019.00387] [PMID] [PMCID]
9. Kuang Y, Chen Q, Hong Q, Lyu Q, Ai A, Fu Y, et al. Double stimulations during the follicular and luteal phases of poor responders in ivf/icsi programmes (Shanghai protocol). Reprod Biomed Online 2014; 29: 684-691. [DOI:10.1016/j.rbmo.2014.08.009] [PMID]
10. Lin LT, Vitale SG, Chen SN, Wen ZH, Tsai HW, Chern Cu, et al. Luteal phase ovarian stimulation may improve oocyte retrieval and oocyte quality in poor ovarian responders undergoing in vitro fertilization: preliminary results from a single-center prospective pilot study. Adv Ther 2018; 35: 847-856. [DOI:10.1007/s12325-018-0713-1] [PMID]
11. Zhang W, Wang M, Wang S, Bao H, Qu Q, Zhang N, et al. Luteal phase ovarian stimulation for poor ovarian responders. JBRA Assist Reprod 2018; 22: 193-198. [DOI:10.5935/1518-0557.20180045] [PMID] [PMCID]
12. Ubaldi FM, Capalbo A, Vaiarelli A, Cimadomo D, Colamaria S, Alviggi C, et al. Follicular versus iuteal phase ovarian stimulation during the same menstrual cycle (duostim) in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation. Fertil Steril 2016; 105: 1488-1495. e1. [DOI:10.1016/j.fertnstert.2016.03.002] [PMID]
13. de Almeida Cardoso MC, Evangelista A, Sartório C, Vaz G, Werneck CLV, Guimarães FM, et al. Can ovarian double-stimulation in the same menstrual cycle improve ivf outcomes? JBRA Assist Reprod 2017; 21: 217-221. [DOI:10.5935/1518-0557.20170042] [PMID] [PMCID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
