ANDRO-IVF: a novel protocol for poor responders to IVF controlled ovarian stimulation

被引:10
作者
Bercaire, Ludmila [1 ]
Nogueira, Sara M. B. [1 ]
Lima, Priscila C. M. [1 ]
Alves, Vanessa R. [1 ]
Donadio, Nilka [1 ]
Dzik, Artur [1 ]
Cavagna, Mario [1 ]
Fanchin, Renato [2 ]
机构
[1] Hosp Perola Byington, IVF Ctr, Sao Paulo, SP, Brazil
[2] Hosp Foch, IVF Ctr, Suresnes, France
来源
JORNAL BRASILEIRO DE REPRODUCAO ASSISTIDA | 2018年 / 22卷 / 01期
关键词
Fertilization in vitro; androgens; ovulation induction; oocyte retrieval; fertility agents; primary ovarian insufficiency;
D O I
10.5935/1518-0557.20180011
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: This study aimed to assess a novel protocol designed to improve poor ovarian response through intra-ovarian androgenization. The endpoints were: number of oocytes and mature oocytes retrieved, fertilization, cancellation and pregnancy rates. Methods: This prospective crossover study enrolled poor responders from previous ovarian stimulation cycles submitted to a novel protocol called ANDRO-IVF. The protocol included pretreatment with transdermal AndroGel(r) (Besins) 25 mg, oral letrozole 2.5 mg and subcutaneous hCG 2500 IU; cycle control was performed with estradiol valerate and micronized progesterone; ovarian stimulation was attained with gonadotropins FSH/LH 450 IU, GnRH antagonist and hCG 5000 IU. Results: Fourteen poor responders were enrolled. One patient did not meet the inclusion criteria. Thirteen patients previously summited to the standard protocol were offered the ANDRO-IVF Protocol.-Standard Protocol: Mean age: 35.30 years; cancellation rate: 61.53%; mean number of MII oocytes retrieved per patient: 1.8; fertilization rate: 33.33%. Only two patients had embryo transfers, and none got pregnant.-ANDRO-IVF Protocol: Mean age: 35.83 years; cancellation rate: 7.69%; mean number of oocytes retrieved per patient: 5.58, MII oocytes: 3.91. ICSI was performed in 84.61% of the patients and a mean of 1.5 embryos were transferred per patient. Fertilization rate: 62.5%; cumulative pregnancy rate: 16.66%; mean duration of stimulation: 9.77 days. Conclusion: ANDRO-IVF allows intra-ovarian androgenization by increasing serum and intra-follicular androgen levels and preventing androgen aromatization. This protocol apparently improved clinical outcomes of poor responders in parameters such as number of oocytes retrieved and clinical pregnancy rates. Further randomized controlled trials are needed to confirm these findings.
引用
收藏
页码:52 / 55
页数:4
相关论文
共 21 条
[1]   Pretreatment with transdermal testosterone may improve ovarian response to gonadotrophins in poor-responder IVF patients with normal basal concentrations of FSH [J].
Balasch, Juan ;
Fabregues, Francisco ;
Penarrubia, Joana ;
Carmona, Francisco ;
Casamitjana, Roser ;
Creus, Montserrat ;
Manau, Dolors ;
Casals, Gemma ;
Vanrell, Juan A. .
HUMAN REPRODUCTION, 2006, 21 (07) :1884-1893
[2]   The use of androgens or androgen-modulating agents in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis [J].
Bosdou, J. K. ;
Venetis, C. A. ;
Kolibianakis, E. M. ;
Toulis, K. A. ;
Goulis, D. G. ;
Zepiridis, L. ;
Tarlatzis, B. C. .
HUMAN REPRODUCTION UPDATE, 2012, 18 (02) :127-145
[3]   The follicular hormonal profile in low-responder patients undergoing unstimulated cycles: is it hypoandrogenic? [J].
de los Santos, M. J. ;
Garcia-Laez, V. ;
Beltran, D. ;
Labarta, E. ;
Luis Zuzuarregui, Jose ;
Alama, P. ;
Gamiz, P. ;
Crespo, J. ;
Bosch, E. ;
Pellicer, A. .
HUMAN REPRODUCTION, 2013, 28 (01) :224-229
[4]   Transdermal testosterone may improve ovarian response to gonadotrophins in low-responder IVF patients: a randomized, clinical trial [J].
Fabregues, Francisco ;
Penarrubia, Joana ;
Creus, Montserrat ;
Manau, Dolors ;
Casals, Gemma ;
Carmona, Francisco ;
Balasch, Juan .
HUMAN REPRODUCTION, 2009, 24 (02) :349-359
[5]   ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria [J].
Ferraretti, A. P. ;
La Marca, A. ;
Fauser, B. C. J. M. ;
Tarlatzis, B. ;
Nargund, G. ;
Gianaroli, L. .
HUMAN REPRODUCTION, 2011, 26 (07) :1616-1624
[6]   Is there a role for DHEA supplementation in women with diminished ovarian reserve? [J].
Fouany, Mazen R. ;
Sharara, Fady I. .
JOURNAL OF ASSISTED REPRODUCTION AND GENETICS, 2013, 30 (09) :1239-1244
[7]   The aromatase inhibitor letrozole increases the concentration of intraovarian androgens and improves in vitro fertilization outcome in low responder patients:: a pilot study [J].
Garcia-Velasco, JA ;
Moreno, L ;
Pacheco, A ;
Guillén, A ;
Duque, L ;
Requena, A ;
Pellicer, A .
FERTILITY AND STERILITY, 2005, 84 (01) :82-87
[8]   FSH receptor in vitro modulation by testosterone and hCG in human luteinized granulosa cells [J].
Garcia-Velasco, Juan A. ;
Rodriguez, Sara ;
Agudo, David ;
Pacheco, Alberto ;
Schneider, Jose ;
Pellicer, Antonio .
EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 2012, 165 (02) :259-264
[9]   Serum anti-Mullerian hormone levels are negatively related to Follicular Output RaTe (FORT) in normo-cycling women undergoing controlled ovarian hyperstimulation [J].
Genro, V. K. ;
Grynberg, M. ;
Scheffer, J. B. ;
Roux, I. ;
Frydman, R. ;
Fanchin, R. .
HUMAN REPRODUCTION, 2011, 26 (03) :671-677
[10]   Effects of transdermal testosterone in poor responders undergoing IVF: systematic review and meta-analysis [J].
Gonzalez-Comadran, Mireia ;
Duran, Montserrat ;
Sola, Ivan ;
Fabregues, Francisco ;
Carreras, Ramon ;
Checa, Miguel A. .
REPRODUCTIVE BIOMEDICINE ONLINE, 2012, 25 (05) :450-459