Suboptimal response to controlled ovarian stimulation in IVF / ICSI cycles

Cong Tuan Nguyen; Dariko A. Niauri; Lyailya Kh. Dzhemlikhanova; Igor Yu. Kogan; Inna O. Krikheli; Irina D. Mekina; Elena A. Lesik; Evgenia M. Komarova; Maria A. Ishchuk; Alexander M. Gzgzyan

doi:10.17816/JOWD69661-70

Journal of obstetrics and women's diseases ›› 2020, Vol. 69 ›› Issue (6) : 61 -70. DOI: 10.17816/JOWD69661-70

Original study articles

research-article

Suboptimal response to controlled ovarian stimulation in IVF / ICSI cycles

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Saint Petersburg State University

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Saint Petersburg State University

MD, Post-Graduate Student. The Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty

MD, PhD, DSci (Medicine), Professor, Head of the Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty; Leading Researcher. The Gynecological Department with the Operation Unit

MD, PhD, Associate Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty; the Department of Assisted Reproductive Technologies

MD, PhD, DSci (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences. The Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty; Director

MD, PhD, Senior Researcher. The Department of Assisted Reproductive Technologies

PhD, Senior Researcher. The Laboratory of Early Embryogenesis; Senior Embryologist. The Assisted Reproduction Technology Department

PhD, Senior Researcher. The Laboratory of Early Embryogenesis; Embryologist. The Assisted Reproduction Technology Department

PhD, Head of the Laboratory of Early Embryogenesis, Embryologist. The Assisted Reproduction Technology Department

MD, Junior Researcher. The Laboratory of Early Embryogenesis, the Department of Assisted Reproductive Technologies, the Department of Reproductology

MD, PhD, DSci (Medicine), Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty; Head of the Department of Reproductology, Head of the Department of Assisted Reproductive Technologies

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Abstract

Hypothesis/Aims of study. Currently, the frequency of suboptimal response (4-9 retrieved oocytes) to controlled ovarian stimulation (COS) in woman is quite high; however, its efficacy is poorly studied. The aim of this study was to evaluate the main characteristics of IVF / ICSI programs in patients with a suboptimal response to COS.

Study design, materials and methods. We performed a retrospective study of 412 IVF / ICSI cycles in women with a suboptimal response to COS, including a comparative analysis of clinical and embryological parameters, ovarian reserve and the efficacy of IVF / ICSI protocols.

Results. Clinical pregnancy rate in ovarian stimulation cycles with a suboptimal response to COS was 27.9%. The efficacy of assisted reproductive technology (ART) programs in women with uterine fibroids was significantly lower than in patients without fibroids (19.1% vs. 30.5%, p = 0.03; OR = 0.54; 95% CI: 0.31-0.95). Clinical pregnancy rate in patients with male factor infertility was significantly higher than in women with anovulation (37.1% vs. 20.9%, р = 0.005; OR = 2.24; 95% CI: 1.27-3.94) or tubal factor infertility (37.1% vs. 24.8%, р = 0.02; OR = 1.79; 95% CI: 1.09-2.94). There were significant correlations between the number of retrieved oocytes with serum anti-Müllerian hormone (AMH) concentration (r = 0.32, p < 0.001) and antral follicle count (AFC) (r = 0.38, p < 0.001). In addition, the need for follicle-stimulating hormone (FSH) preparations during COS correlated significantly with ovarian reserve parameters (AMH and AFC) (r = –0.45 and –0.44, both p < 0.001, respectively) and the age of patients (r = 0.47; p < 0.001).

Conclusion. The clinical pregnancy rate in women with a suboptimal response to COS was low. Concomitant uterine fibroids represented an additional factor of negative influence on IVF / ICSI outcomes in women with a suboptimal response to COS. The male factor of infertility in patients with a suboptimal response did not reduce the efficacy of ART programs. Ovarian reserve parameters in women with a suboptimal response correlated with the need for FSH preparations during COS and the number of retrieved oocytes.

Keywords

suboptimal response / IVF / ICSI / controlled ovarian stimulation / clinical pregnancy rate

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Cong Tuan Nguyen, Dariko A. Niauri, Lyailya Kh. Dzhemlikhanova, Igor Yu. Kogan, Inna O. Krikheli, Irina D. Mekina, Elena A. Lesik, Evgenia M. Komarova, Maria A. Ishchuk, Alexander M. Gzgzyan. Suboptimal response to controlled ovarian stimulation in IVF / ICSI cycles. Journal of obstetrics and women's diseases, 2020, 69(6): 61-70 DOI:10.17816/JOWD69661-70

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