DOI: https://doi.org/10.18370/2309-4117.2019.50.47-50

Outcomes in poor responders treated with in vitro fertilization/intracytoplasmic sperm injection according to bologna criteria

V. N. Lokshin, R. K. Valiev, A. N. Rybina, K. T. Nigmetova, Sh. K. Karibayeva

Abstract


Purpose of the study was to evaluate the effectiveness of various approaches of artificial reproductive technologies (ART) in advanced maternal age patients with poor ovarian response (POR).

Materials and methods. This is retrospective cohort study of 455 patients with POR who have undergone an IVF and embryo transfer program at from June 2016 to June 2018. Researchers evaluated pregnancy rate (PR) per embryo transferand live birth rate (LBR) per embryo transferas in vitro fertilization (IVF) outcomes. The patients fulfilled Bologna criteria were divided into 5 groups: long protocol, ant-gonadotropin-releasing hormone protocol, freeze embryos transfer without preimplantation genetic diagnostic (PGS), freeze embryos transfer with PGS, natural cycle.

Results. There was no statistically significant difference in the age, Anti-Müllerian hormone level and duration of infertility between the groups. Despite different protocols of ovarian stimulation, there was no statistically significant difference in pregnancy rate in fresh cycles. At the same time, cancellation of transfer was significantly higher observed in natural cycles (p <0.001). PR and LBR were statistically significant higher in freeze embryo transfer group 29% and 12.1% vs 13.3% and 5,5% respectively (p<0.001 and p = 0.040). During the transfer of the embryo unexamined by PGS and after PGS the pregnancy rate did not differ (29.4% vs 28.2%, p <0.05), but LBR was statistically significant higher after euploid embryo transfer (8.2% without PGS vs 20.5% after PGS, p = 0.028).

Conclusion. The most effective approach in patients with a poor ovarian response was cycle segmentation, cryopreservation of embryos, PGS and transfer of an euploid embryo. This category

of patients requires a personalized approach to the treatment of infertility. The choice of protocol in ART program must be carried out with the full voluntary and informed consent of the patient, depending on their desires and capabilities, including financial.


Keywords


infertility; poor ovarian response; in vitro fertilization

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References


Lokshin, V., Valiev, R., Rybina, A., Zaichenko, K. “’Poor responders’ – modern ideas, principles of management in art programs. review.” Bulletin of National Academy of Sciences of the Republic of Kazakhstan 2.378 (2019): 177–88. DOI: 10.32014/2019.2518-1467.54

Orazov, M.R., Radzinsky, V.Y. Khamoshina, M.B., et al. “Gonadotropin-releasing hormone agonists and antagonists: influence on neuroangiogenesis and apoptosis in eutopic endometrium in a therapy for recurrering endometriosis genitalis externa-associated pelvic pain in patients.” Bulletin of National Academy of Sciences of Republic of Kazakhstan 6.376 (2018): 19–33. ISSN 1991-3494. DOI: 10.32014/2018.2518-1467

Streuli, I., de Ziegler, D., Gayet, V., et al. “In women with endometriosis anti-Müllerian hormone levels are decreased only in those with previous endometrioma surgery.” Human Reproduction 27.11 (2012): 3294–303.

Raffi, F., Metwally, M., Amer, S. “The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis.” The Journal of Clinical Endocrinology & Metabolism 97.9 (2012): 3146–54.

Rienzi, L., Cobo, A., Paffoni, A., et al. “Consistent and predictable delivery rates after oocyte vitrification: an observational longitudinal cohort multicentric study.” Human Reproduction 27.6 (2012): 1606–12.

Streuli, I., de Ziegler, D., Gayet, V., et al. “In women with endometriosis anti-Müllerian hormone levels are decreased only in those with previous endometrioma surgery,” Human Reproduction, vol. 27, no. 11, pp. 3294–3303, 2012.

de Vos, M., Devroey, P., Fauser, B.C.J.M. “Primary ovarian insufficiency.” The Lancet 376.9744 (2010): 911–21.

Soto, N., Iñiguez, G., López, P., et al. “Anti-Müllerian hormone and inhibin B levels as markers of premature ovarian aging and transition to menopause in type 1 diabetes mellitus.” Human Reproduction 24.11 (2009): 2838–44.

Chang, H.-H., Chen, M.-J., Lu, M.-Y., et al. “Iron overload is associated with low anti-müllerian hormone in women with transfusion-dependent β-thalassaemia.” British Journal of Obstetrics and Gynaecology 118.7 (2011): 825–31.

Tropeano, G., Di Stasi, C., Amoroso, S., et al. “Long-term effects of uterine fibroid embolization on ovarian reserve: a prospective cohort study.” Fertility and Sterility 94.6 (2010): 2296–300.

Liu, K., Case, A.; Reproductive Endocrinology and Infertility Committee, Family Physicians Advisory Committee, Maternal- Fetal Medicine Committee, Executive and Council of the Society of Obstetricians. “Advanced reproductive age and fertility.” JOGC 33.11 (2011): 1165–75.

Sunkara, S.K., Rittenberg, V., Raine-Fenning, N., et al. “Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles.” Human Reproduction 26.7 (2011): 1768–74. DOI: 10.1093/humrep/der106

Ferraretti, A.P., et al. “ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria.” Hum Reprod 26.7 (2011): 1616–24.

Polyzos, N.P., Nwoye, M., Corona, R., et al. “Live birth rates in Bologna poor responders treated with ovarian stimulation for IVF/ICSI.” Reproductive BioMedicine Online 28.4 (2014): 469–74.

Polyzos, N.P., Devos, M., Humaidan, P., et al. “Corifollitropinalfa followed by rFSH in a GnRH antagonist protocol for poor ovarian responder patients: an observational pilot study.” Fertility and Sterility 99.2 (2013): 422–6.

Polyzos, N.P., Devroey, P. “A systematic review of randomized trials for the treatment of poor ovarian responders: is there any light at the end of the tunnel?” Fertility and Sterility 96.5 (2011): 1058.e7–1061.e7.

Al-Azemi, M., Killick, S.R., Duffy, S., et al. “Multi-marker assessment of ovarian reserve predicts oocyte yield after ovulation induction.” Human Reproduction 26.2 (2011): 414–22.

Frydman, R. “Poor responders: still a problem.” Fertil Steril 96.5 (2011): 1057. DOI: 10.1016/j.fertnstert.2011.09.051.2011

Kolibianakis, E.M., Venetis, C.A., Diedrich, K., et al. “Addition of growth hormone to gonadotrophins in ovarian stimulation of poor responders treated by in-vitro fertilization: a systematic review and meta-analysis.” Human Reproduction Update 15.6 (2009): 613–22.

Pandian, Z., McTavish, A.R., Aucott, L., et al. “Interventions for 'poor responders' to controlled ovarian hyper stimulation (COH) in in vitro fertilization (IVF).” Cochrane Database Syst Rev 1 (2010): CD004379. DOI: 10.1002/14651858.CD004379.pub3

Reynolds, K.A., Omurtag, K.R., Jimenez, P.T., et al. “Cycle cancellation and pregnancy after luteal estradiol priming in women defined as poor responders: a systematic review and meta-analysis.” Human Reproduction 28.11 (2013): 2981–9.

Polyzos, N.P., Blockeel, C., Verpoest, W., et al. “Live birth rates following natural cycle IVF in women with poor ovarian response according to the Bologna criteria.” Human Reproduction 27.12 (2012): 3481–6.

Ubaldi, F., Anniballo, R., Romano, S., et al. “Cumulative ongoing pregnancy rate achieved with oocyte vitrification and cleavage stage transfer without embryo selection in a standard infertility program.” Human Reproduction 25.5 (2010): 1199–1205.

Vaiarelli, A., Cimadomo, D., Trabucco, E., et al. “Double Stimulation in the Same Ovarian Cycle (DuoStim) to Maximize the Number of Oocytes Retrieved From Poor Prognosis Patients: A Multicenter Experience and SWOT Analysis.” Front Endocrinol (Lausanne) 9 (2018): 317. DOI: 10.3389/fendo.2018.00317

Zegers-Hochschild, F., Adamson, G.D., Dyer, S., et al. “The International Glossary on Infertility and Fertility Care, 2017.” Fertil Steril 108.3 (2017): 393–406. DOI: 10.1016/j. fertnstert.2017.06.005


GOST Style Citations


1.         Lokshin, V., Valiev, R., Rybina, A., Zaichenko, K. “’Poor responders’ – modern ideas, principles of management in art programs. review.” Bulletin of National Academy of Sciences of the Republic of Kazakhstan 2.378 (2019): 177–88. DOI: 10.32014/2019.2518-1467.54

2.         Orazov, M.R., Radzinsky, V.Y. Khamoshina, M.B., et al. “Gonadotropin-releasing hormone agonists and antagonists: influence on neuroangiogenesis and apoptosis in eutopic endometrium in a therapy for recurrering endometriosis genitalis externa-associated pelvic pain in patients.” Bulletin of National Academy of Sciences of Republic of Kazakhstan 6.376 (2018): 19–33. ISSN 1991-3494. DOI: 10.32014/2018.2518-1467

3.         Streuli, I., de Ziegler, D., Gayet, V., et al. “In women with endometriosis anti-Müllerian hormone levels are decreased only in those with previous endometrioma surgery.” Human Reproduction 27.11 (2012): 3294–303.

4.         Raffi, F., Metwally, M., Amer, S. “The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis.” The Journal of Clinical Endocrinology & Metabolism 97.9 (2012): 3146–54.

5.         Rienzi, L., Cobo, A., Paffoni, A., et al. “Consistent and predictable delivery rates after oocyte vitrification: an observational longitudinal cohort multicentric study.” Human Reproduction 27.6 (2012): 1606–12.

6.         Streuli, I., de Ziegler, D., Gayet, V., et al. “In women with endometriosis anti-Müllerian hormone levels are decreased only in those with previous endometrioma surgery,” Human Reproduction, vol. 27, no. 11, pp. 3294–3303, 2012.

7.         de Vos, M., Devroey, P., Fauser, B.C.J.M. “Primary ovarian insufficiency.” The Lancet 376.9744 (2010): 911–21.

8.         Soto, N., Iñiguez, G., López, P., et al. “Anti-Müllerian hormone and inhibin B levels as markers

of premature ovarian aging and transition to menopause in type 1 diabetes mellitus.” Human Reproduction 24.11 (2009): 2838–44.

9.         Chang, H.-H., Chen, M.-J., Lu, M.-Y., et al. “Iron overload is associated with low anti-müllerian hormone in women with transfusion-dependent β-thalassaemia.” British Journal of Obstetrics and Gynaecology 118.7 (2011): 825–31.

10.       Tropeano, G., Di Stasi, C., Amoroso, S., et al. “Long-term effects of uterine fibroid embolization on ovarian reserve: a prospective cohort study.” Fertility and Sterility 94.6 (2010): 2296–300.

11.       Liu, K., Case, A.; Reproductive Endocrinology and Infertility Committee, Family Physicians Advisory Committee, Maternal- Fetal Medicine Committee, Executive and Council of the Society of Obstetricians. “Advanced reproductive age and fertility.”  JOGC 33.11 (2011): 1165–75.

12.       Sunkara, S.K., Rittenberg, V., Raine-Fenning, N., et al.

“Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles.” Human Reproduction 26.7 (2011): 1768–74. DOI: 10.1093/humrep/der106

13.       Ferraretti, A.P., et al. “ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria.” Hum Reprod 26.7 (2011): 1616–24.

14.       Polyzos, N.P., Nwoye, M., Corona, R., et al. “Live birth rates in Bologna poor responders treated with ovarian stimulation for IVF/ICSI.” Reproductive BioMedicine Online 28.4 (2014): 469–74.

15.       Polyzos, N.P., Devos, M., Humaidan, P., et al. “Corifollitropinalfa followed by rFSH in a GnRH antagonist protocol for poor ovarian responder patients: an observational pilot study.” Fertility and Sterility 99.2 (2013): 422–6.

16.       Polyzos, N.P., Devroey, P. “A systematic review of randomized trials for the treatment of poor ovarian responders: is there any light at the end of the tunnel?” Fertility and Sterility 96.5 (2011): 1058.e7–1061.e7.

17.       Al-Azemi, M., Killick, S.R., Duffy, S., et al. “Multi-marker assessment of ovarian reserve predicts oocyte yield after ovulation induction.” Human Reproduction 26.2 (2011): 414–22.

18.       Frydman, R. “Poor responders: still a problem.” Fertil Steril 96.5 (2011): 1057. DOI: 10.1016/j.fertnstert.2011.09.051.2011

19.       Kolibianakis, E.M., Venetis, C.A., Diedrich, K., et al. “Addition of growth hormone to gonadotrophins in ovarian stimulation of poor responders treated by in-vitro fertilization: a systematic review and meta-analysis.” Human Reproduction Update 15.6 (2009): 613–22.

20.       Liu, K., Case, A.; Reproductive Endocrinology and Infertility Committee, Family Physicians Advisory Committee, Maternal- Fetal Medicine Committee, Executive and Council of the Society of Obstetricians. “Advanced reproductive age and fertility.”  JOGC 33.11 (2011): 1165–75.

21.       Pandian, Z., McTavish, A.R., Aucott, L., et al. “Interventions for 'poor responders' to controlled ovarian hyper stimulation (COH) in in vitro fertilization (IVF).” Cochrane Database Syst Rev 1 (2010): CD004379. DOI: 10.1002/14651858.CD004379.pub3

22.       Reynolds, K.A., Omurtag, K.R., Jimenez, P.T., et al. “Cycle cancellation and pregnancy after luteal estradiol priming in women defined as poor responders: a systematic review and meta-analysis.” Human Reproduction 28.11 (2013): 2981–9.

23.       Polyzos, N.P., Blockeel, C., Verpoest, W., et al. “Live birth rates following natural cycle IVF in women with poor ovarian response according to the Bologna criteria.” Human Reproduction 27.12 (2012): 3481–6.

24.       Ubaldi, F., Anniballo, R., Romano, S., et al. “Cumulative ongoing pregnancy rate achieved with oocyte vitrification and cleavage stage transfer without embryo selection in a standard infertility program.” Human Reproduction 25.5 (2010): 1199–1205.

25.       Vaiarelli, A., Cimadomo, D., Trabucco, E., et al. “Double Stimulation in the Same Ovarian Cycle (DuoStim) to Maximize the Number of Oocytes Retrieved From Poor Prognosis Patients: A Multicenter Experience and SWOT Analysis.” Front Endocrinol (Lausanne) 9 (2018): 317. DOI: 10.3389/fendo.2018.00317

26.       Zegers-Hochschild, F., Adamson, G.D., Dyer, S., et al. “The International Glossary on Infertility and Fertility Care, 2017.” Fertil Steril 108.3 (2017): 393–406. DOI: 10.1016/j. fertnstert.2017.06.005





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