In vitro fertilization for patients with poor response and occult ovarian failure: A randomized trial

G. Ragni, L. De Lauretis Yankowski, S. Piloni, W. Vegetti, E. Guermandi, M. Colombo, P. G. Crosignani

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Abstract

Background: Women with poor response to a previous in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycle or with occult ovarian failure (infertility, regular menses, and hypergonadotropic hypogonadism) usually exhibit poor response and poor reproductive prognosis to subsequent superovulation treatments. The aim of this randomized study was to compare the outcome of IVF and ICSI in spontaneous and daily gonadotropin-releasing hormone (GnRH) agonist long protocol plus pure follicle-stimulating hormone (FSH) stimulated cycles in this population. Methods: Fourteen regularly cycling patients with previous poor response to an IVF or ICSI cycle (six patients) or with occult ovarian failure (eight patients) were randomly assigned to IVF or ICSI, either during spontaneous cycles (group 1) or stimulated cycles (group 2). Ovarian stimulation in these latter patients was achieved using a GnRH agonist (Decapeptyl, Ipsen, France), which was administered daily and highly purified FSH (Metrodin HP, Serono, Switzerland). GnRH agonist was started in the midluteal phase according to a long protocol. After pituitary desensitization, gonadotropins were started between 7 to 14 days after the menstrual cycle that followed GnRH agonist administration. Human chorionic gonadotropin (hCG) was administered in both groups when at least one follicle reached a diameter greater than 17 mm. Oocyte retrieval was performed 34 hours after hCG administration. Oocytes were inseminated (six patients in group 1 and six patients in group 2) or microinjected (one patient in group 1 and one patient in group 2) 4 hours after pickup. Viable embryos were transferred 48 hours after oocyte retrieval. Pregnancy was assessed by ultrasound examination, and only viable pregnancies were considered (ultrasound visualization of gestational sac with cardiac embryo activity). Poor responding and occult ovarian failure patients were equally distributed between the two treatment groups, and the groups were homogeneous in age and levels of basal serum FSH. Results: Two pregnancies were obtained in each group. Except for the number of retrieved oocytes, no statistically significant differences in treatment outcome between the two groups were recorded. Conclusions: In a selected population of patients with poor pregnancy prognosis, IVF during spontaneous cycles offers a chance of conceiving similar to that of GnRH-agonist-stimulated cycles and gonadotropin-stimulated cycles.

Original languageEnglish
Pages (from-to)98-102
Number of pages5
JournalReproductive Technologies
Volume10
Issue number2
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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    Ragni, G., De Lauretis Yankowski, L., Piloni, S., Vegetti, W., Guermandi, E., Colombo, M., & Crosignani, P. G. (2000). In vitro fertilization for patients with poor response and occult ovarian failure: A randomized trial. Reproductive Technologies, 10(2), 98-102.