%0 Journal Article
%T Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve
%A Tal Lazer
%A Shir Dar
%A Ekaterina Shlush
%A Basheer S. Al Kudmani
%A Kevin Quach
%A Agata Sojecki
%A Karen Glass
%A Prati Sharma
%A Ari Baratz
%A Clifford L. Librach
%J International Journal of Reproductive Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/581451
%X We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR). Inclusion criteria included patients with an anti-M¨¹llerian hormone (AMH) ¡Ü8£¿pmol/L and/or antral follicle count (AFC) ¡Ü5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5£¿mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14£¿mm or larger. The HS group received gonadotropins (¡Ý300£¿IU/day) throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (). Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (). In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage) and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders. 1. Introduction Patients with poor ovarian response (POR) are both challenging to treat and represent a large proportion of patients presenting with infertility [1, 2]. Patients with POR, who are often of advanced maternal age, have a high cycle cancellation rate, higher miscarriage rate, and significantly reduced live birth rate per cycle. To date, there is no universally accepted definition for POR. These patients generally have one or more of the following characteristics: advanced maternal age, low AMH levels, high FSH in the early follicular phase (~day 3) (¡Ý10£¿mIU/mL), low early follicular phase antral follicle count (AFC) (3¨C7) [3, 4], low number of mature retrieved oocytes (<4) after superovulation with a moderate to high-dose protocol, low peak E2 levels (<3300£¿pmol/L), and prior cycle cancellation(s) due to poor response [5¨C7]. The European Society of Human Reproduction and Embryology (ESHRE) attempted to standardize the definition of POR in 2010 and this resulted in a consensus definition called the Bologna criteria. At least two of the following three features must be present: (1) advanced maternal age (¡Ý40 years) or any other risk factors for POR, (2) a previous POR (¡Ü3 oocytes) with a conventional stimulation protocol,
%U http://www.hindawi.com/journals/ijrmed/2014/581451/