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

Capsule:
Modified natural cycles is of no benefit for “genuine” poor ovarian responders and the option of egg donation should be seriously considered for this population.

Authors:
Alon Kedem, M.D., Abraham Tsur, M.D., Jigal Haas, M.D., Gil Yerushalmi, M.D. Ph.D., Ariel Hourvitz, M.D., M.H.A., Ronit Machtinger, M.D., Raoul Orvieto, M.D., M.MSc.

Volume 101, Issue 6, Pages 1624–1628

Abstract:

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.

  • Juan Garcia-Velasco, MD

    Another observation study that confirms that “we cannot create oocytes that do not exist”. Genuine poor responders need to proof themselves that COS has limited success in their case, and as shown, modified natural cycle does not improve their chances.

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