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
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Journal of Reproduction & Infertility
Volume 21, Issue 3
Summer 2020
Pages 176-182