Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Embryo Banking with Mild Ovarian Stimulation for IVF: An Alternative Strategy for Poor Prognosis Patients

Authors
Ivan Sini 1
Arie A Polim 2
Nining Handayani 1
Adinda Pratiwi 1
Rosalina Thuffi 3
Nuraeni Yusup 3
Arief Boediono 4
1 Morula IVF Jakarta Clinic, Jakarta, Indonesia; IRSI Research and Training Center, Jakarta, Indonesia
2 Morula IVF Jakarta Clinic, Jakarta, Indonesia; IRSI Research and Training Center, Jakarta, Indonesia; Department of Obstetrics and Gynecology, School of Medicine and Health Sciences, Atmajaya Catholic University of Indonesia, Jaka
3 Morula IVF Jakarta Clinic, Jakarta, Indonesia
4 Morula IVF Jakarta Clinic, Jakarta, Indonesia; IRSI Research and Training Center, Jakarta, Indonesia; Department of Anatomy, Physiology and Pharmacology, IPB University, Bogor, Indonesia
Abstract
Background: Management of Poor Ovarian Reserve (POR) in in vitro fertilization remains a difficult challenge. The purpose of this retrospective cohort study was to compare the effectiveness of embryo banking strategy over a cohort of several mild stimulation cycles (Embryo Banking Strategy for Poor Prognosis/Embargo) to conventional full-dose antagonist protocol for IVF. Methods: Subjects identified as having poor ovarian response (POR) based on the Bologna criteria were recruited. In total, there were 113 subjects included in the analysis. Fifty-three subjects underwent embryo banking procedure (Embargo) protocol, and sixty subjects underwent the conventional full-dose antagonist protocol for IVF. The Chi-square test was used to compare the clinical pregnancy rate, miscarriage rate as well as live birth rate, while the Mann-Whitney U test was utilized to analyze the cost per clinical pregnancy between the two groups. A p<0.05 was considered statistically significant. Results: The two studied groups showed similar outcomes regarding clinical pregnancy rate, miscarriage rate, as well as live birth rate (p=0.966, p=0.310, and p=0.469, respectively). Cost analysis of subjects who underwent mild ovarian stimulation followed by Embargo revealed the high cost of the protocol compared to conventional full-dose antagonist protocol ($10.507±6.181 vs. $9.533±2.530, p=0.002). Conclusion: The clinical outcomes of both protocols were comparable. Embargo procedure was not efficient in improving the overall clinical outcomes in patients who were expected poor ovarian responders as the protocol costed more comparing with conventional full-dose antagonist protocol. A larger prospective randomized control trial is needed to evaluate this finding.
Keywords
Embryo freezing
In vitro fertilization
Mild ovarian stimulation
Poor ovarian response
Reed BG, Babayev SN, Bukulmez O. Shifting paradigms in diminished ovarian reserve and advanced reproductive age in assisted reproduction: Customization instead of conformity. Semin Reprod Med. 2015;33(3):169-78.
Cobo A, Garrido N, Crespo J, José R, Pellicer A. Accumulation of oocytes: a new strategy for managing low-responder patients. Reprod Biomed Online. 2012;24(4):424-32.
Ubaldi FM, Rienzi L, Ferrero S, Baroni E, Sapienza F, Cobellis L, et al. Management of poor responders in IVF. Reprod Biomed Online. 2005;10(2):235-46.
Loutradis D, Drakakis P, Vomvolaki E, Antsaklis A. Different ovarian stimulation protocols for women with diminished ovarian reserve. J Assist Reprod Genet. 2007;24(12):597-611.
Jirge PR. Poor ovarian reserve. J Hum Reprod Sci. 2016;9(2):63-9.
Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, et al. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update. 2013;19(1):26-36.
van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update. 2010;16(6):577-89.
Revelli A, Chiadò A, Dalmasso P, Stabile V, Evangelista F, Basso G, et al. “Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial. J Assist Reprod Genet. 2014;31(7):809-15.
Tarlatzis BC, Zepiridis L, Grimbizis G, Bontis J. Clinical management of low ovarian response to stimulation for IVF: a systematic review. Hum Reprod Update. 2003;9(1):61-76.
Siristatidis C, Salamalekis G, Dafopoulos K, Basios G, Vogiatzi P, Papantoniou N. Mild versus conventional ovarian stimulation for poor responders undergoing IVF/ICSI. In Vivo. 2017;31(2):231-7.
Bastu E, Buyru F, Ozsurmeli M, Demiral I, Dogan M, Yeh J. A randomized, single-blind, prospective trial comparing three different gonadotropin doses with or without addition of letrozole during ovulation stimulation in patients with poor ovarian response. Eur J Obstet Gynecol Reprod Biol. 2016;203:30-4.
Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, et al. A randomized single-blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: a preliminary report. Hum Reprod. 2004;19(9):2031-5.
Deb S, Campbell BK, Clewes JS, Pincott-Allen C, Raine-Fenning NJ. Intracycle variation in number of antral follicles stratified by size and in endocrine markers of ovarian reserve in women with normal ovulatory menstrual cycles. Ultrasound Obstet Gynecol. 2013;41(2):216-22.
Alper MM, Fauser BC. Ovarian stimulation protocols for IVF: is more better than less? Reprod Biomed Online. 2017;34(4):345-53.
Racowsky C, Stern JE, Gibbons WE, Behr B, Pomeroy KO, Biggers JD. National collection of embryo morphology data into society for assisted reproductive technology clinic outcomes reporting system: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate. Fertil Steril. 2011;95(6):1985-9.
Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The international glossary on infertility and fertility care, 2017. Hum Reprod. 2017;32(9):1786-801.
Karande V, Gleicher N. A rational approach to the management of low responders in in-vitro fertilization. Hum Reprod. 1999;14(7):1744-8.
Shrestha D, La X, Feng HL. Comparison of different stimulation protocols used in in vitro fertilization: a review. Ann Transl Med. 2015;3 (10):137.
Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C. Clinical rationale for cryopreservation of entire embryo cohorts in lieu of fresh transfer. Fertil Steril. 2014;102(1):3-9.
Çelik S, Turgut NE, Cengiz Çelik D, Boynukalın K, Abalı R, Purisa S, et al. The effect of the pooling method on the live birth rate in poor ovarian responders according to the Bologna criteria. Turk J Obstet Gynecol. 2018;15(1):39-45.
Journal of Reproduction & Infertility
Volume 21, Issue 3
Summer 2020
Pages 176-182