TITLE:
The Challenge of Improving IVF Results in Normogonadotrophic (Unexpected) Young Poor Ovarian Responders: The Predictive Value of a Flexible Treatment Protocol Based on the “Biophysical Profile of the Uterus”
AUTHORS:
Menelaos J. Tzafetas, Theoharis Tantanasis, Vassiliki Zournatzi, Konstantinos Lathouras, Aristotle Loufopoulos
KEYWORDS:
Normo-Gonadotrophic Unexpected Young Poor Ovarian Responders, Biophysical Profile of the Uterus, Ovarian Stimulation, in Vitro Fertilization
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.5 No.11,
September
25,
2015
ABSTRACT: Objective: To study whether the unexpected poor ovarian responders
optimization of uterine receptivity with a flexible controlled ovarian hyper stimulation
protocol based on the Biophysical Profile of the Uterus, has an impact on their
reproductive performance. Design: Observational Prospective study. Setting(s):
i) General hospital-IVF and Infertility Centre; ii) University hospital.
Patient(s): 44 normogonadotrophic young women (26 -
38 yrs) with previous “unexpected” poor ovarian response underwent IVF/ICSI
treatment on a protocol based on the Biophysical Profile of their uterus (Group
A). The same patients were used as controls in a preceded IVF cycle on the
conventional stimulation protocol. Intervention(s): None. Main outcome
measure(s): Pregnancy, miscarriage and home take baby rates, amount and
duration of gonadotropins required, number and
quality of embryos resulted, Biophysical Profile of the Uterus score.
Result(s). Treatment in Group A in comparison to Group B resulted in
significantly larger number of eggs retrieved per patient,
and improved fertilization rates and higher number of embryos/ET (p = 0.011, 0.010
and 0.034 respectively). Group A also
demonstrated a trend for higher rates of clinical pregnancy (29.5% v.s.
15.9%), viable stage pregnancies ≥ 24 weeks (33.3% v.s. 20%) and home take
babies (26.6% v.s. 16%). The amount of gonadotropins used per patient (IU) was
similar in the two groups (p = 0.264). Cancellation, implantation and
miscarriage rates as well as embryos quality, although superior in the
treatment Group A, showed no significant difference. The number of pregnancies
achieved in Group A, were directly related with the score in the Biophysical
Profile of the Uterus 12 point scale. Conclusion(s): Unexpected Poor Ovarian
Responders on the flexible IVF/ICSI protocol (Group A), adjusting the
management according to the Biophysical Profile of their uterus (duration of
stimulation, day of HCG and day of embryo transfer), had a significantly better
performance in comparison to the Group B managed on the conventional protocol in
this difficult to manage and so far, rather understudied population.