Synchronization of Ovarian Stimulation with Follicle Wave Emergence in Patients undergoing in vitro fertilization with a Prior Suboptimal Response A Randomized Controlled Trial

Synchronizing ovarian stimulation with follicle wave emergence in patients with a prior suboptimal response resulted in an increase in the number of follicles that developed and serum E2 concentrations; however, corresponding improvements in oocyte, embryo, and pregnancy outcomes were not observed.

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Authors

Angela Baerwald, Ph.D., Paula Anderson, R.N., B.Sc.N., Albert Yuzpe, M.D., Allison Case, M.D., Margo Fluker, M.D.

Vol 98, Issue 4, Pages 881-887.e2

Abstract

Objective:

To test the hypothesis that synchronizing initiation of ovarian stimulation with follicle wave emergence would optimize IVF/intracytoplasmic sperm injection (ICSI) outcomes in patients with a prior suboptimal response.

Design:

Prospective, randomized, controlled trial.

Setting:

Academic and private reproductive endocrinology and infertility centers.

Patients:

Eighty women ≤43 years of age with a history of a suboptimal response.

Interventions:

Initiation of recombinant FSH/GnRH antagonist/recombinant LH/hCG on day 1 (n = 39) or day 4 (n = 41).

Main Outcome Measures:

Numbers of clinical and biochemical pregnancies, follicles >10 and >15 mm, oocytes collected, fertilized oocytes, cleavage-stage embryos, and blastocysts; serum estradiol concentrations. Outcomes were compared between treatment groups.

Results:

The numbers of follicles that developed to >10 and >15 mm and serum estradiol were greater when rFSH was initiated on day 1 (5.4, 4.3, 5827.2 pmol/L) versus day 4 (3.6, 2.5, 4230.1 pmol/L) (p<0.05). The numbers of collected, MII, and fertilized oocytes; cleavage-stage embryos; and blastocysts were not different between groups (p>0.05). When we evaluated only those cycles that proceeded to OPU, a lower implantation rate (16.1%, 56.0%; p=0.02), biochemical pregnancy rate (16.1%, 48.0%; p=0.01), and clinical pregnancy rate (12.9% versus 36.0%; p=0.03) were detected in the day 1 versus 4 group.

Conclusion:

Synchronizing initiation of ovarian stimulation with follicle wave emergence in patients with a prior suboptimal response resulted in an increase in the number of dominant follicles and serum estradiol concentrations; however, improvements in oocyte, embryo or pregnancy outcomes did not occur.

Clinical Trials Registration Number:

NCT00439829

Read the full text at: http://www.fertstert.org/article/S0015-0282(12)00704-2/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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