Consecutive ovarian stimulation is beneficial in patients with a poor response to high-dose follicle-stimulating hormone. (2nd November 2021)

• Record Type: Journal Article
• Authors: Pailis, Monica; Sapir, Onit; Lande, Yechezkel; Ben-Haroush, Avi; Altman, Eran; Wertheimer, Avital; Shochat, Tzippy; Shufaro, Yoel
• Is Part Of: Gynecological endocrinology. Volume 37:Number 11(2021)
• Page Start: 995
• Page End: 999
• Publication Date: 2021-11-02
• Subjects: Poor ovarian response -- consecutive ovarian stimulation -- IVF -- fresh ET; Endocrine gynecology -- Periodicals; Generative organs, Female -- Diseases -- Periodicals; 618.1
• DOI: 10.1080/09513590.2021.1908991
• Languages: English
• ISSNs: 0951-3590

Abstract

Abstract: Objective: To investigate if an immediate additional IVF-ET cycle bear an advantage to patients with poor ovarian response in comparison to a cycle performed at some delay. Methods: A cohort study including 632 patients who underwent a fresh IVF-ET cycle with high-dose (≥300 IU/d) FSH stimulation that yielded ≤4 oocytes and did not achieve a clinical pregnancy. All underwent a second stimulation and oocyte pick-up (OPU), either consecutively or separately within 180 days (nonconsecutive OPU). The oocyte yield, number of embryos available for transfer, pregnancy live birth rates of the second OPU were compared between patients who had consecutive and nonconsecutive cycles. Results: Consecutive OPU was associated with more mature follicles in the second cycle compared to nonconsecutive OPU ( p = .03) in addition to higher peak estradiol level ( p < .0001), and more aspirated oocytes ( p = .03) and available embryos ( p = .023). There was no between-group difference in ongoing pregnancy and live birth rates. In a multivariate analysis of variance controlling for potential confounders, the difference in the number of aspirated oocytes and available embryos was associated significantly only with consecutive performance of the second cycle. Conclusion: Immediate sequential stimulation (without an intervening menstrual cycle) in poor responders is advantageous over delayed stimulation in terms of number of aspirated oocytes and available embryos. The administration of high-dose FSH in the first cycle may benefit follicular recruitment also in the subsequent cycle. Although the effect is modest, given that each additional oocyte aspirated contributes to the outcome, it might be of significance especially in younger patients.