Abstract

Purpose:Women with diminished ovarian reserve have low live birth rates following assisted reproduction treatment. In this study, we investigate whether modified natural cycle IVF (MNC), involving Clomiphene Citrate and low dose gonadotrophins, can enhance clinical pregnancy rate (CPR) over conventional IVF for diminished ovarian reserve patients who prefer fresh embryo transfer.

Methods:We conducted a retrospective analysis to compare conventional IVF (GnRH antagonist protocol) versus MNC in the treatment of 72 patients with markedly diminished ovarian reserve.

Results:46 patients had conventional IVF and 26 patients had MNC. Patients with conventional IVF had significantly more follicles: 5.5 (1–11) vs 2.5 (1–6), P<0.0001; more retrieved oocytes: 4 (0–8) vs 1.68 (0–5), P<0.0001; and more fertilized oocytes: 2.4 (0–8) vs 0.8 (0–4), P<0.0001. No oocytes were retrieved in 5 (10.9%) patients in the conventional group, compared with 13 (50%) in the MNC group, P=0.0005. CPR per embryo transfer in the conventional group was 43.2%, while none of the patients in the MNC group achieved pregnancy. Within the conventional group, there was no significant difference between the total FSH used in pregnant and non-pregnant patients (3129±307 IUs vs 2984±497 IUs, P=0.3933).

Conclusions:This study demonstrates that using conventional IVF in the treatment of markedly reduced ovarian reserve patients who prefer fresh embryo transfer is associated with more follicles; more retrieved and fertilized oocytes, a higher CPR and a lower chance of cycle cancellation compared with MNC.

Keywords

diminished ovarian reserve, modified natural cycle, conventional IVF, clomiphene citrate, fresh embryo transfer, follicles, ovarian stimulation, chorionic gonadotropin, reproductive potential, menopausal gonadotropin, ovarian reserve, frozen embryo, estradiol