Effectiveness of in vitro fertilization (IVF/ICSI) programs in patients with a predicted poor ovarian response





infertility, assisted reproductive technologies, ovarian stimulation, urinary and recombinant gonadotropins, effectiveness of pregnancy onset


Purpose - to show the effectiveness of in vitro fertilization (IVF) programs in infertile women with a predicted poor ovarian response to stimulation with various gonadotropins and to study the course of pregnancy, childbirth and the condition of their newborns.

Materials and methods. The Group І is 75 women, the controlled stimulation of superovulation in which by urinary gonadotropins was performed in the protocol with the use of gonadotropin-releasing hormone antagonist. The Group ІІ (comparison) is 65 women, the stimulation of superovulation in which was carried out according to an analogical scheme with recombinant gonadotropins. Confirmation or exclusion of biochemical pregnancy was carried out by determining the level of total human chorionic gonadotropin in blood serum 14 days after embryo transfer. Data processing was carried out using the Stat Soft Statistica 8.0 software package.

Results. The frequency of cancellation of IVF cycle (IVF/ICSI) in the patients of the Group І was reliably lower than among the patients of the Group ІІ: in the Group І it was 2 (2.7%) cases against 8 (12.3%) cases in the Group ІІ (p<0.05). IVF cycle cancellations among the patients of the Group І was reliably lower than among the women of the Group ІІ (OR=0.205; 95% СІ: 0.048-0.87; p<0.05). Embryo transfer procedure was performed for 73 women of the Group І and 57 patients of the Group ІІ. The frequency of pregnancy on the IVF protocol and embryo transfer was 41.1% (30/73) and 36.8% (21/57), respectively. Absence of the further embryo development after implantation (biochemical pregnancy) was registered in 1 (3.3%) woman of the Group І and 1 (4.8%) patient of the Group ІІ. Non-developing pregnancy up to 12 weeks was diagnosed in 2 (6.6%) women of the Group І and 3 (14.2%) patients of the Group ІІ. Pregnancy that occurred after the IVF/ICSI program resulted in childbirth in 24 (32.9%) women out of 73 of the Group І and 13 patients out of 57 (22.8%) of the Group ІІ.

Conclusions. In women who underwent the controlled stimulation of superovulation by urinary gonadotropins in the protocol using gonadotropin-releasing hormone antagonist compared to women who underwent the stimulation of superovulation with recombinant gonadotropins according to an analogical scheme, the frequency of pregnancy and completion of pregnancy by childbirth was reliably higher.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the author.


Aboubakr M, Elnashar A. (2017). Progesterone rise on the day of HCG administration (premature luteinisation) in IVF: an overdue update. J. Assist. Reprod. Genet. 27 (4): 149-155. https://doi.org/10.1007/s10815-010-9393-8; PMid:20177771 PMCid:PMC2854984

Al‐Inany HG, Abou‐Setta AM, Aboulghar MA, Mansour RT, Serour GI. (2008). Efficacy and safety of human menopausal gonadotrophins versus recombinant FSH: a meta‐analysis. Reprod Biomed Online. 16: 81‐88. https://doi.org/10.1016/S1472-6483(10)60559-7; PMid:18252052

Amirova AA, Nazarenko TA, Kolesnichenko TV, Mishieva NG. (2011). Analiz vzaimosvyazi mezhdu kliniko-anamnesticheskimi, kliniko-laboratornyimi dannyimi, osobennostyami induktsii superovulyatsii i ishodami EKO i EKO/IKSI. Problemyi reproduktsii. 1: 73-77.

Coomarasamy A, Afnan M, Cheema D, Veen F, Bossuyt PM, Wely M. (2008). Urinary HMG versus recombinant FSH for controlled ovarian hyperstimulation following an agonist long down‐regulation protocol in IVF or ICSI treatment: a systematic review and meta‐analysis. Hum Reprod. 23: 310‐315. https://doi.org/10.1093/humrep/dem305; PMid:18056719

Eskandar M, Jaroudi K, Jambi A, Archibong EI, Coskun S, Sobande AA. (2004, Jan). Is recombinant follicle-stimulating hormone more effective in IVF poor responders than human menopausal gonadotrophins? Med Sci Monit. 10 (1): PI6-9.

Ferraretti AP, La Marca A, Fauser BC et al. (2011). ESHRE consensus on definition of poor response‖ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum. Reprod. 26 (7): 1616-1624. https://doi.org/10.1093/humrep/der092; PMid:21505041

Ferraretti AP. (2014). Exogenous luteinizing hormone in controlled ovarian hyperstimulation for assisted reproduction techniques. 82: 1521-1526. https://doi.org/10.1016/j.fertnstert.2004.06.041; PMid:15589853

Ji Z, Quan X, Lan Y, Zhao M, Tian X, Yang X. (2019). Gonadotropin versus Follicle-Stimulating Hormone for Ovarian Response in Patients Undergoing in vitro Fertilization: A Retrospective Cohort Comparison. Curr Ther Res Clin Exp: 92. https://doi.org/10.1016/j.curtheres.2019.100572; PMid:31908689 PMCid:PMC6940711

Jirge PR. (2016). Poor ovarian reserve. J Hum Reprod Sci. 9 (2): 63-69. https://doi.org/10.4103/0974-1208.183514; PMid:27382229 PMCid:PMC4915288

Kett KDzh. (1998). Gonadotropnyie gormonyi adenogipofiza. Reproduktivnaya endokrinologiya (perevod s angl.). 1: 109-159.

Kogan IYu, Gzgzyan EA, Lesik. (2018). Protokolyi stimulyatsii yaichnikov v tsiklah EKO. Rukovodstvo dlya vrachey. GEOTAR-Media: 160.

Kolibianakis EM, Kalogeropoulou L, Griesinger G et al. (2017). Among patients treated with FSH and GnRH analogues for in vitro fertilization, is the addition of recombinant LH associated with the probability of live birth? A systematic review and meta-analysis. Hum. Reprod. Update. 13: 445-452. https://doi.org/10.1093/humupd/dmm008; PMid:17586849

Lang TA, Sesik M. (2011). Kak opisyivat statistiku v meditsine. Rukovodstvo dlya avtorov, redaktorov i retsenzentov. Moskva: Prakticheskaya Meditsina: 480.

Leão RB, Esteves SC. (2014). Gonadotropin therapy in assisted reproduction: an evolutionary perspective from biologics to biotech. Clinics (Sao Paulo). 69 (4): 279-293. https://doi.org/10.6061/clinics/2014(04)10; PMid:24714837

Lehert P, Kolibianakis EM, Venetis CA, Schertz J, Saunders H, Arriagada P, Copt S, Tarlatzis B. (2014. Feb). Recombinant human follicle-stimulating hormone (r-hFSH) plus recombinant luteinizing hormone versus r-hFSH alone for ovarian stimulation during assisted reproductive technology: systematic review and meta-analysis. Reprod Biol Endocrinol. 20 (12): 17. https://doi.org/10.1186/1477-7827-12-17; PMid:24555766 PMCid:PMC4015269

Lunenfeld B. (2004). Historical perspectives in gonadotrophin therapy. Hum Reprod Update. 10 (6): 453-467. https://doi.org/10.1093/humupd/dmh044; PMid:15388674

Matorras R, Prieto B, Exposito A et al. (2019). Mid-follicular LH supplementation in women 35-39 years undergoing ICSI cycles: a randomized controlled study. Reprod. Biomed. Online. 19: 879-887. https://doi.org/10.1016/j.rbmo.2009.09.016; PMid:20031032

Mennini FS, Marcellusi A, Viti R et al. (2018). Probabilistic cost-effectiveness analysis of controlled ovarian stimulation with recombinant FSH plus recombinant LH vs. human menopausal gonadotropin for women undergoing IVF. Reprod Biol Endocrinol. 16 (1): 68. https://doi.org/10.1186/s12958-018-0386-2; PMid:30021630 PMCid:PMC6052706

Mintser AP. (2010). Statisticheskie metodyi issledovaniya v klinicheskoy meditsine. Prakticheskaya meditsina. 3: 41-45.

Nazarenko TA. (2008). Stimulyatsiya funktsii yaichnikov. MEDpress-inform: 272.

Nazarenko TA. (2013). «Bednyiy otvet». Taktika vedeniya patsientok so snizhennoy reaktsiey na stimulyatsiyu gonadotropinami v programmah EKO. MEDpress- inform: 80.

Podzolkova NM. (2012). Preodolenie «bednogo» otveta v programmah VRT: novyie vozmozhnosti terapii. Problemyi reproduktsii. 18 (2): 77-82.

Revelli A, Pettinau G, Basso G et al. (2015). Controlled Ovarian Stimulation with recombinant-FSH plus recombinant-LH vs. human Menopausal Gonadotropin based on the number of retrieved oocytes: results from a routine clinical practice in a real-life population. Reprod Biol Endocrinol. 13: 77. https://doi.org/10.1186/s12958-015-0080-6; PMid:26209525 PMCid:PMC4514947

Ruiz BJA, Caballero JL, Roque A, Ezcurra D. (2009). Clinical experience with Pergoveris, a new formulation of rFSH and rLH in a 2:1 ratio, for treatment of suboptimal patient populations: Spanish preliminary results. Fertil. Steril. 92: S163. https://doi.org/10.1016/j.fertnstert.2009.07.1304

Wang Y, Li L, Deng K, Liu J, Liu Y, Zou K, Hao G, Sun X. (2020, Aug). Comparison of the combination of recombinant follicle-stimulating hormone and recombinant luteinizing hormone protocol versus human menopausal gonadotropin protocol in controlled ovarian stimulation: A systematic review and meta-analysis. J Evid Based Med. 13 (3): 215-226. https://doi.org/10.1111/jebm.12390; PMid:32627395

Youssef MA, Al-Inany HG, Aboulghar M, Mansour R, Abou-Setta AM. (2011, Apr). Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles. Cochrane Database Syst Rev. 13: 4. https://doi.org/10.1002/14651858.CD003719.pub3