The Challenge of Improving IVF Results in Normogonadotrophic Unexpected Young Poor Ovarian Responders: The Predictive Value of a Flexible Treatment Protocol Based on the -Biophysical Profile of the UterusReportar como inadecuado




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Objective: To study whether the unexpected poor ovarian respondersoptimization of uterine receptivity with a flexible controlled ovarian hyper stimulationprotocol based on the Biophysical Profile of the Uterus, has an impact on theirreproductive performance. Design: Observational Prospective study. Settings:i General hospital-IVF and Infertility Centre; ii University hospital.Patients: 44 normogonadotrophic young women 26 -38 yrs with previous -unexpected- poor ovarian response underwent IVF-ICSItreatment on a protocol based on the Biophysical Profile of their uterus GroupA. The same patients were used as controls in a preceded IVF cycle on theconventional stimulation protocol. Interventions: None. Main outcomemeasures: Pregnancy, miscarriage and home take baby rates, amount andduration of gonadotropins required, number andquality of embryos resulted, Biophysical Profile of the Uterus score.Results. Treatment in Group A in comparison to Group B resulted insignificantly larger number of eggs retrieved per patient,and improved fertilization rates and higher number of embryos-ET p = 0.011, 0.010and 0.034 respectively. Group A alsodemonstrated a trend for higher rates of clinical pregnancy 29.5% v.s.15.9%, viable stage pregnancies ≥ 24 weeks 33.3% v.s. 20% and home takebabies 26.6% v.s. 16%. The amount of gonadotropins used per patient IU wassimilar in the two groups p = 0.264. Cancellation, implantation andmiscarriage rates as well as embryos quality, although superior in thetreatment Group A, showed no significant difference. The number of pregnanciesachieved in Group A, were directly related with the score in the BiophysicalProfile of the Uterus 12 point scale. Conclusions: Unexpected Poor OvarianResponders on the flexible IVF-ICSI protocol Group A, adjusting themanagement according to the Biophysical Profile of their uterus duration ofstimulation, day of HCG and day of embryo transfer, had a significantly betterperformance in comparison to the Group B managed on the conventional protocol inthis difficult to manage and so far, rather understudied population.

KEYWORDS

Normo-Gonadotrophic Unexpected Young Poor Ovarian Responders, Biophysical Profile of the Uterus, Ovarian Stimulation, in Vitro Fertilization

Cite this paper

Tzafetas, M. , Tantanasis, T. , Zournatzi, V. , Lathouras, K. and Loufopoulos, A. 2015 The Challenge of Improving IVF Results in Normogonadotrophic Unexpected Young Poor Ovarian Responders: The Predictive Value of a Flexible Treatment Protocol Based on the -Biophysical Profile of the Uterus-. Open Journal of Obstetrics and Gynecology, 5, 654-664. doi: 10.4236-ojog.2015.511092.





Autor: Menelaos J. Tzafetas1,2*, Theoharis Tantanasis1, Vassiliki Zournatzi1, Konstantinos Lathouras1, Aristotle Loufopoulos1,2

Fuente: http://www.scirp.org/



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