Is the modified natural in vitro fertilization cycle justified in patients with "genuine" poor response to controlled ovarian hyperstimulation?

Alon Kedem, Abraham Tsur, Jigal Haas, Gil M Yerushalmi, Ariel Hourvitz, Ronit Machtinger, Raoul Orvieto
Fertility and Sterility 2014, 101 (6): 1624-8

OBJECTIVE: To examine whether patients with poor ovarian response (POR) during conventional IVF/intracytoplasmic sperm injection (ICSI) treatment cycle may benefit from a modified natural cycle (MNC)-IVF.

DESIGN: Cohort historic study.

SETTING: Tertiary, university-affiliated medical center.

PATIENT(S): One hundred eleven patients with POR, defined according to the Bologna criteria, who underwent a subsequent MNC-IVF within 3 months of the previous failed conventional IVF/ICSI cycle. The elimination of bias in this selection, for the purposes of this study, was achieved by including only a subgroup of "genuine" poor responder patients, those who yielded up to three oocytes after controlled ovarian hyperstimulation (COH) with a minimal gonadotropin daily dose of 300 IU.

INTERVENTION(S): Modified natural cycle IVF protocol with GnRH antagonist (GnRH-a) supplementation. Gonadotropin-releasing hormone antagonist treatment was started when a follicle of 13 mm was present. Two to three ampules of hMG were coadministered daily during the GnRH-a treatment.

MAIN OUTCOME MEASURE(S): Live birth rate, pregnancy rate (PR), number of oocytes retrieved, and number of embryos transferred.

RESULT(S): Live birth rate in "genuine" poor ovarian responders was <1%. Furthermore, in the subgroup of patients with POR who underwent a previous conventional IVF/ICSI cycle with a yield of only one oocyte, no pregnancies were achieved during the MNC-IVF cycle.

CONCLUSION(S): Modified natural cycle-IVF is of no benefit for genuine poor ovarian responders and the option of egg donation should be seriously considered for this population.

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