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The stimulation protocol in poor responder IVF; a minimal or high-dose stimulation? – A meta-analysis

  • Ridzuan Jamaludin EMAIL logo , Mohd Faizal Ahmad , Dae-Keun Park , Murizah Mohd Zain , Tae-Ki Yoon , Woo-Sik Lee , Mi Kyoung Koong and Kyung-Ah Lee
Published/Copyright: November 29, 2019
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Hormone Molecular Biology and Clinical Investigation
From the journal Hormone Molecular Biology and Clinical Investigation Volume 41 Issue 1

Abstract

Background

To determine whether a minimal stimulation (MS) or high-dose stimulation (HDS) protocol is a better option for patients classified as poor ovarian responders (POR) in terms of reproductive and pregnancy outcomes.

Materials and methods

A database search for evaluation of the study outcome by using meta-analysis method was carried out. The primary outcome was the clinical pregnancy (CP) rate for each of two groups, namely, the MS and HDS groups. The secondary outcomes were the gonadotropin dose used, duration of stimulation, cancellation rate, number of oocytes retrieved, number of fertilized oocytes, number of embryos transferred and live birth rates.

Results

Across five databases, 4670 potential studies for further screening were selected. But ultimately only six studies, three RCTs and three retrospective or case control studies were selected that meet the Bologna criteria for POR. In all there were 624 cycles. Our meta-analysis indicated that the CP rates, cycle cancellation rates, durations of stimulation, numbers of oocytes fertilized and numbers of embryos transferred were not statistically significant. Clearly, the number of oocytes retrieved in the MS group was significantly lower than in the HDS group, while the HDS group consumed significantly higher doses of gonadotropins than the MS group. The live birth rates were significantly higher in the MS group than in the HDS group.

Conclusion

MS should be the first-line protocol for managing POR because the live birth rate is significantly higher, even with fewer oocytes retrieved.

Keywords: conventional protocol; fertilization; high-dose stimulation; minimal stimulation; poor ovarian responder; stimulation protocol

Funding source: National Research Foundation (NRF)

Award Identifier / Grant number: NRF-2017M3A9B4061854

Funding statement: This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) and funded by the Ministry of Science, ICT & Future Planning (NRF-2017M3A9B4061854).

Acknowledgments

The authors thank Ummu Izzati Al Yahya (Korea University) and Su-Yeon Lee and Eun-Young Kim (CHA University) for their help in writing the manuscript and Dr. Hye Ok Kim (Dankook University College of Medicine, Korea) for her keen review of this manuscript.

Author Statement

  1. Conflict of interest: No potential conflicts of interest relevant to the above topic are declared.

  2. Informed consent: Not applicable.

  3. Ethical approval: Not applicable.

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Supplementary Material

The online version of this article offers supplementary material (DOI: https://doi.org/10.1515/hmbci-2019-0018).

Received: 2019-04-28
Accepted: 2019-06-20
Published Online: 2019-11-29

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/hmbci-2019-0018
Keywords for this article
conventional protocol; fertilization; high-dose stimulation; minimal stimulation; poor ovarian responder; stimulation protocol

Articles in the same Issue

  1. Special Issue: ‘Liver Metabolic Diseases and Hepatocellular Carcinoma: New Hormonal and Clinical Insights’ / Editors: Gérard S. Chetrite and Bruno Féve
  2. Editorial Preface
  3. Preface to special issue on “Liver Metabolic Diseases and Hepatocellular Carcinoma: New Hormonal and Clinical Insights”
  4. Original Article
  5. Aromatase in normal and diseased liver
  6. Review Articles
  7. Hepatocellular carcinoma in the context of non-alcoholic steatohepatitis (NASH): recent advances in the pathogenic mechanisms
  8. Studying non-alcoholic fatty liver disease: the ins and outs of in vivo, ex vivo and in vitro human models
  9. Metalloproteinases in non-alcoholic fatty liver disease and their behavior in liver fibrosis
  10. Hypothyroidism and nonalcoholic fatty liver disease – a chance association?
  11. Mini-Review Article
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  14. Original Articles
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  21. Review Articles
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  23. Genitourinary syndrome of menopause (GSM) and laser VEL: a review
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