Article

Predictors of low response to mild ovarian stimulation initiated on cycle day 5 for IVF.

Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CS Utrecht, The Netherlands.
Human Reproduction (impact factor: 4.47). 08/2007; 22(7):1919-24. DOI:10.1093/humrep/dem089
Source: PubMed

ABSTRACT Milder stimulation protocols are being developed to minimize adverse effects of ovarian stimulation in in vitro fertilization (IVF) programs. A drawback is the possibility of an increased rate of insufficient ovarian response. This study aimed to develop a prognostic model for the prediction of cycle cancellation due to insufficient response to mild stimulation.
A total of 174 IVF patients aged<38 years and with a body mass index (BMI)<28 Kg/m2 were treated with mild ovarian stimulation using a fixed daily dose (150 IU) of recombinant follicle-stimulating hormone (rFSH) from cycle day 5 and GnRH antagonist from the late follicular phase. In women with mono- or bifollicular growth (17%), the cycle was cancelled and the treatment was adjusted in a second treatment cycle by starting rFSH on cycle day 2.
In a multivariable logistic regression analysis, duration of infertility, menstrual cycle length, secondary infertility and BMI were included in the prediction model. The area under the receiver-operating characteristics curve of the model was 0.69. A probability cut-off for cancellation of 0.3 yielded an expected sensitivity of 33% and specificity of 92%. Analysis of ovarian response in the subsequent treatment cycle showed an improved ovarian response and a significant reduction in the cancellation rate.
With the presented model, it is possible to identify patients at risk for cycle cancellation, during mild ovarian stimulation, due to insufficient response. The contributing factors of the model suggest that ovarian aging and BMI are related to insufficient response to mild stimulation.

0 0
 · 
0 Bookmarks
 · 
28 Views
  • Source
    Article: Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization.
    Alberto Revelli, Simona Casano, Francesca Salvagno, Luisa Delle Piane
    [show abstract] [hide abstract]
    ABSTRACT: In the last decades, several steps have been made aiming at rendering human IVF more successful on one side, more tolerable on the other side. The "mild" ovarian stimulation approach, in which a lower-than-average dose of exogenous gonadotropins is given and gonadotropin treatment is started from day 2 to 7 of the cycle, represents a significant step toward a more patient's friendly IVF. However, a clear view of its virtues and defects is still lacking, because only a few prospective randomized trials comparing "mild" vs. conventional stimulation exist, and they do not consider some important aspects, such as, e.g., thawing cycles. This review gives a complete panorama of the "mild" stimulation philosophy, showing its advantages vs. conventional ovarian stimulation, but also discussing its disadvantages. Both patients with a normal ovarian responsiveness to exogenous gonadotropins and women with a poor ovarian reserve are considered. Overall, we conclude that the level of evidence supporting the use of "mild" stimulation protocols is still rather poor, and further, properly powered prospective studies about "mild" treatment regimens are required.
    Reproductive Biology and Endocrinology 02/2011; 9:25. · 2.05 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

174 IVF patients aged<38 years
 
bifollicular growth
 
body mass index
 
cancellation rate
 
cycle cancellation
 
cycle day 2
 
follicular phase
 
increased rate
 
insufficient ovarian response
 
mild ovarian stimulation
 
mild stimulation
 
Milder stimulation protocols
 
minimize adverse effects
 
multivariable logistic regression analysis
 
ovarian stimulation
 
receiver-operating characteristics curve
 
recombinant follicle-stimulating hormone
 
second treatment cycle
 
subsequent treatment cycle
 
vitro fertilization