Efficiency of ovarian stimulation protocols in different phases of menstrual cycle in patients with diminished ovarian reserve


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Abstract

Objective. To investigate the efficiency of protocols for ovarian stimulation in the follicular phase of the menstrual cycle and for double stimulation in patients with diminished ovarian reserve. Subjects and methods. The investigation enrolled 148 patients aged 25 to 42 years with diminished ovarian reserve. The patients were divided into two groups according to the phase of ovarian stimulation. Group 1 included 72 patients who underwent superovulation in the follicular phase; Group 2 (subgroups a and b) consisted of 76 patients who received an in vitro fertilization (IVF) program in the follicular and luteal phases. Results. There were no significant differences between the groups in the blood level of follicle-stimulating hormone on the first day of stimulation and on the day of transvaginal ovarian puncture (TVOP) (p > 0.05). The groups showed no statistically significant differences in luteinizing hormone (LH) levels throughout function stimulation either (p > 0.05). There was a gradual serum estradiol increase that accompanied follicular growth; however, no noticeable differences in the estradiol levels were noted in the groups (p > 0.05). Progesterone levels were much higher in Group 2b on the day of starting the ovarian stimulation (p < 0.001) and on day 6 of treatment (p < 0.001), which was due to the continuing hormonal activity of the corpus luteum; however, by the day of ovulation triggering, progesterone concentrations leveled off in the examined groups; on the day of TVOP, the progesterone levels were also comparable regardless of the phase of stimulation. Analysis of embryological indicators in Group 2 revealed that Group 1 and 2 had a statistically significantly larger number of retrieved oocytes (4.4±2.1 and 8.8±4.2, respectively (p < 0.001), mature oocytes (3.8±2.0and 7.4±2.6 (p < 0.001), as well as obtained embryos (1.8+1.5 and 2.7±2.7 (p = 0.039) and top quality embryos (1.0+0.5 and 2.1+1.1 (p = 0.018). The pregnancy rate per embryo transfer was statistically significantly higher in Group 2 and amounted to 55.3 and to 48.6% in Group 1 (p = 0.041). Conclusion. The findings can lead to the conclusion that luteal phase stimulation does not affect the embryological outcome of the IVF program, therefore double stimulation in a single menstrual cycle results in a larger number of mature oocytes and top quality embryos, which is shown by the high rate of pregnancy.

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About the authors

Kh. A Bogatyreva

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: bogatyreva-khava@bk.ru
postgraduate of 1st gynecology department

N. G Mishieva

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: nondoc555@mail.ru
PhD, MD, Senior researcher of 11st gynecology department

B. A Martazanova

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: bellamart88@mail.ru
PhD, Junior Researcher of 1st gynecology department

V. S Lapina

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: tifaniwow@gmail.com
postgraduate of 1st gynecology department

A. N Abubakirov

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: nondoc555@yahoo.com
PhD, Head of 1st gynecology department

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