Cover
Vol. 12 No. 2 (2022)

Published: August 31, 2022

Pages: 103-117

Research Article

Comparison Between Soft and Conventional Flexible Antagonist Protocols Regarding Endometrial Receptive Parameters for Women With Poor Ovarian Response and Effect on Pregnancy Rate.

Nidhal Salim Alwan 1 Manal Taha Al-Obaidi Lubna Al-Anbari
1High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq.
History
  • Received: September 7, 2022
  • Accepted: September 30, 2022
  • Available Online: October 8, 2022
DOI

https://doi.org/10.28969/IJEIR.v12.i2.r8.22

Abstract

Poor ovarian responders (PORs) are characterized by decreased the response of the ovaries to stimulation. Nowadays, using soft protocol of low doses of Gn with/without oral compounds such as letrozole was accepted as a good option. The endometrium receptive parameters include sub endometrial resistance, pulsatility index and endometrial thickness. Eighty infertile POR women divided to two equal groups and undergoing IVF/ICSI antagonist protocols. One group underwent soft protocol using letrozole 2.5mg twice daily for 5 days starting from cycle day 2-3 overlapped low-dose Gn (225 IU) from cycle day 4-5. Other group received high dose Gn only (450 IU) from cycle day 2-3. Both groups continued stimulation cycle until the day of trigger using the flexible antagonist protocol. Estimation of values of sub endometrial RI and PI with endometrial thickness by 2 Color Doppler ultrasound was performed at day of trigger, OCP and ET. There was no significant difference for endometrial thickness at day of trigger, OCP and ET. There was significant difference in means of sub endometrial RI and PI at day of trigger, OCP and ET (P>0.05). This study showed evidence in favor of soft protocol for POR regarding pregnancy rates in spite of the statically difference in means of sub endometrial RI and PI associated with much less cost effectiveness.

Keywords

References

  1. Drakopoulos P., Blockeel C., Stoop D., Camus M., De Vos M., Tournaye H., and Polyzos, N.P. Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos? Human reproduction, Feb. 2016, 31 (2), pp.370-376. Doi: 10.1093/humrep/dev316
  2. Errázuriz, J., Drakopoulos, P., Pening, D., Racca, A., Romito, A., De Munck, N., Tournaye, H., De Vos, M., and Blockeel, C. Pituitary suppression protocol among Bologna poor responders undergoing ovarian stimulation using corifollitropin alfa: does it play any role? Reproductive biomedicine online, Jun 2019, 38 (6), pp.1010-1017. Doi: 10.1016/j.rbmo.2018.12.030
  3. Silva Martins, R., Helio Oliani, A., Vaz Oliani, D. and Martinez de Oliveira, J., 2019. Subendometrial resistence and pulsatility index assessment of endometrial receptivity in assisted reproductive technology cycles. Reproductive Biology and Endocrinology, Aug.2019, 17 (1), pp.1-7. Doi: 10.1186/s12958-019-0507-6.
  4. Ali zarad C, Mohamed M, Shanab W, Role of uterine artery Doppler in the assessment of unexplained infertility. Egyptian Journal of Radiology and Nuclear Medicine. Feb. 2021, 52:59.
  5. Zhang C. Chen C., Wang J, Wang Y, Wen S, Cao Y, P, and Qian W, An endometrial receptivity scoring system basing on the endometrial thickness, volume, echo, peristalsis, and blood flow evaluated by ultrasonography. Frontier Endocrinology Aug. 2022, 13: 907874. Doi: 10.3389/fendo.2022.907874.
  6. McLernon et al. . Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population- based study of linked cycle data from 113 873 women. Nov. 2016, BMJ. 355:i5735–i5735. Doi: 10.1136/bmj.i5735.
  7. Lee C, Su S, Chiang C, Chien C, Hsu C, Yu Z, Huang S, Shieh Y, Kao H, Tsai C, Hung Y, and Lin C, Estrogen modulates vascular smooth muscle cell function through downregulation of SIRT1 Oncotarget. Dec. 2017, 15; 8 (66): 110039–110051. Doi: 10.18632/oncotarget.22546
  8. Yu Ng E,H , Wai Chan CC, Tang OS, Biu Yeung WS, Ho PC. Factors affecting endometrial and sub-endometrial blood flow measured by three-dimensional power Doppler ultrasound during IVF treatment. Human Reproduction, Apr, 2006, (4):1062-9. Doi: 10.1093/humrep/dei442.
  9. Hu YJ, Chen YZ, Zhu YM, Huang HF, Letrozole stimulation in endometrial preparation for cryopreserved-thawed embryo transfer in women with polycystic ovarian syndrome: a pilot study. Clincle Endocrinology (Oxf). Feb, 2014, 80 (2):283- 9. Doi: 10.1111/cen.12280.
  10. Tal Lazer, Dar S, Shlush E, Al Kudmani BS, Quach K, Sojecki A, Glass K, Sharma P, Baratz A, Librach CL. Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve", International Journal of Reproductive Medicine, Oct 2014, Article ID 581451, 5 pages. Doi: 10.1155/2014/581451.
  11. Bülow NS Skouby SO, Warzecha AK, Udengaard H, Andersen CY, Holt MD, Grøndahl ML, Nyboe Andersen A, Sopa N, Mikkelsen ALE, Pinborg A, Macklon NS. Impact of Letrozole Co-Treatment During Ovarian Stimulation With Gonadotrophins for IVF: A Multicentre, Randomized, Double- Blinded Placebo-Controlled Trial. Human Reproduction. Jan, 2022, 37:309–21.