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.
Angela Baerwald, Ph.D., Paula Anderson, R.N., B.Sc.N., Albert Yuzpe, M.D., Allison Case, M.D., Margo Fluker, M.D.
Volume 98, Issue 4, Pages 881-887.e2, October 2012
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.
Prospective, randomized, controlled trial.
Academic and private reproductive endocrinology and infertility centers.
Eighty women ≤43 years of age with a history of a suboptimal response.
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.
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.
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: