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• W2103248615 abstract "ObjectivePoor response to ovarian hyperstimulation is a complication in 5–18% of all IVF cycles. Through a search of the literature, we could find no published manuscript which evaluated a luteal estradiol protocol in poor responders. Two published manuscripts have evaluated the luteal estradiol protocol in normal responders. We therefore undertook a retrospective paired analysis evaluating patients at our center who had been treated with a luteal estradiol protocol and a standard poor-responder protocol.DesignThis is a two-phase retrospective cohort analysis: (1) a paired analysis of 60 couples undergoing 120 fresh IVF cycles and (2) a matched cohort analysis of 57 women less than 43 years of age who underwent a luteal estradiol protocol were compared to 228 matched control patients.Materials and methodsControls were matched (4:1) for date of IVF procedure, patient age, basal antral follicle count, infertility diagnosis, ICSI or conventional insemination, embryos transferred, and stimulation protocol. The main outcome measures were (1) embryo quality for the paired analysis and (2) outcome rates for the matched cohort analysis.ResultsIn both analyses, the luteal phase estrace protocol was noted to have require more total gonadotropins (P<0.01), more days of stimulation (P<0.01) and have higher peak estradiol levels (P<0.01). The luteal phase estradiol protocol resulted in significantly greater number and percentage of embryos ≥7 cells on day 3 (3.3 embryos vs. 1.9 embryos) (P<0.05). In the paired analysis, the luteal phase estradiol protocol had significantly more oocytes retrieved, mature oocytes, and embryos that did the standard protocol (P<0.05). In the matched cohort analysis, a trend towards improved delivery rates was seen in the luteal estradiol protocol (28.1% vs. 22.4%) (P=0.36) (RR = 1.25; 95% CI: 0.78–2.03). A power analysis was performed that determined a need for 946 subjects to confirm a statistical difference in the live birth rates between the two protocols.ConclusionsThe luteal estradiol protocol may represent a novel and more successful way to treat poor responders during IVF cycles.These data support an improvement in the quality and number of embryos in IVF poor responders when treated with a luteal phase estradiol protocol. Such a protocol could represent an important method for treating poor responding patients and may ultimately optimize outcome success for these patients. ObjectivePoor response to ovarian hyperstimulation is a complication in 5–18% of all IVF cycles. Through a search of the literature, we could find no published manuscript which evaluated a luteal estradiol protocol in poor responders. Two published manuscripts have evaluated the luteal estradiol protocol in normal responders. We therefore undertook a retrospective paired analysis evaluating patients at our center who had been treated with a luteal estradiol protocol and a standard poor-responder protocol. Poor response to ovarian hyperstimulation is a complication in 5–18% of all IVF cycles. Through a search of the literature, we could find no published manuscript which evaluated a luteal estradiol protocol in poor responders. Two published manuscripts have evaluated the luteal estradiol protocol in normal responders. We therefore undertook a retrospective paired analysis evaluating patients at our center who had been treated with a luteal estradiol protocol and a standard poor-responder protocol. DesignThis is a two-phase retrospective cohort analysis: (1) a paired analysis of 60 couples undergoing 120 fresh IVF cycles and (2) a matched cohort analysis of 57 women less than 43 years of age who underwent a luteal estradiol protocol were compared to 228 matched control patients. This is a two-phase retrospective cohort analysis: (1) a paired analysis of 60 couples undergoing 120 fresh IVF cycles and (2) a matched cohort analysis of 57 women less than 43 years of age who underwent a luteal estradiol protocol were compared to 228 matched control patients. Materials and methodsControls were matched (4:1) for date of IVF procedure, patient age, basal antral follicle count, infertility diagnosis, ICSI or conventional insemination, embryos transferred, and stimulation protocol. The main outcome measures were (1) embryo quality for the paired analysis and (2) outcome rates for the matched cohort analysis. Controls were matched (4:1) for date of IVF procedure, patient age, basal antral follicle count, infertility diagnosis, ICSI or conventional insemination, embryos transferred, and stimulation protocol. The main outcome measures were (1) embryo quality for the paired analysis and (2) outcome rates for the matched cohort analysis. ResultsIn both analyses, the luteal phase estrace protocol was noted to have require more total gonadotropins (P<0.01), more days of stimulation (P<0.01) and have higher peak estradiol levels (P<0.01). The luteal phase estradiol protocol resulted in significantly greater number and percentage of embryos ≥7 cells on day 3 (3.3 embryos vs. 1.9 embryos) (P<0.05). In the paired analysis, the luteal phase estradiol protocol had significantly more oocytes retrieved, mature oocytes, and embryos that did the standard protocol (P<0.05). In the matched cohort analysis, a trend towards improved delivery rates was seen in the luteal estradiol protocol (28.1% vs. 22.4%) (P=0.36) (RR = 1.25; 95% CI: 0.78–2.03). A power analysis was performed that determined a need for 946 subjects to confirm a statistical difference in the live birth rates between the two protocols. In both analyses, the luteal phase estrace protocol was noted to have require more total gonadotropins (P<0.01), more days of stimulation (P<0.01) and have higher peak estradiol levels (P<0.01). The luteal phase estradiol protocol resulted in significantly greater number and percentage of embryos ≥7 cells on day 3 (3.3 embryos vs. 1.9 embryos) (P<0.05). In the paired analysis, the luteal phase estradiol protocol had significantly more oocytes retrieved, mature oocytes, and embryos that did the standard protocol (P<0.05). In the matched cohort analysis, a trend towards improved delivery rates was seen in the luteal estradiol protocol (28.1% vs. 22.4%) (P=0.36) (RR = 1.25; 95% CI: 0.78–2.03). A power analysis was performed that determined a need for 946 subjects to confirm a statistical difference in the live birth rates between the two protocols. ConclusionsThe luteal estradiol protocol may represent a novel and more successful way to treat poor responders during IVF cycles.These data support an improvement in the quality and number of embryos in IVF poor responders when treated with a luteal phase estradiol protocol. Such a protocol could represent an important method for treating poor responding patients and may ultimately optimize outcome success for these patients. The luteal estradiol protocol may represent a novel and more successful way to treat poor responders during IVF cycles.These data support an improvement in the quality and number of embryos in IVF poor responders when treated with a luteal phase estradiol protocol. Such a protocol could represent an important method for treating poor responding patients and may ultimately optimize outcome success for these patients." @default.
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• W2103248615 date "2007-09-01" @default.
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• W2103248615 title "A luteal estradiol stimulation protocol improves embryo number and quality for poor-responders undergoing ART" @default.
• W2103248615 doi "https://doi.org/10.1016/j.fertnstert.2007.07.975" @default.
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