Human Menopausal Gonadotropin Commenced on Early Follicular Period Increases Live Birth Rates in POSEIDON Group 3 and 4
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INFERTILITY: ORIGINAL ARTICLE
Human Menopausal Gonadotropin Commenced on Early Follicular Period Increases Live Birth Rates in POSEIDON Group 3 and 4 Poor Responders Bülent Berker 1 & Yavuz Emre Şükür 1 & Eda Üreyen Özdemir 2 & Batuhan Özmen 1 & Murat Sönmezer 1 & Cem Somer Atabekoğlu 1 & Ruşen Aytaç 1 Received: 4 June 2020 / Accepted: 17 August 2020 # Society for Reproductive Investigation 2020
Abstract Human menopausal gonadotropin (hMG) has LH activity, and it may have beneficial effects in terms of oocyte quality and endometrial receptivity similar to recombinant LH supplementation. The aim of this study was to assess the effects of hMG, and its commencement time on the outcome of assisted reproductive technology (ART) cycles of POSEIDON group 3 and 4 poor responders. Data of 558 POSEIDON group 3 and 4 poor responders who underwent ART treatment following a GnRH antagonist cycle at a university-based infertility clinic between January 2014 and December 2019 were reviewed. hMG was commenced at the early follicular phase or mid-follicular phase in the study groups. The control group did not receive hMG stimulation. Live birth rate (LBR) was the main outcome measure. The mean duration of stimulation was significantly shorter in early follicular hMG group than in mid-follicular hMG group (11.9 ± 3.6 days vs. 12.8 ± 4 days, respectively; P = 0.027). The mean numbers of oocytes retrieved and MII oocytes were comparable between the groups. The LBRs per embryo transfer in early follicular hMG, mid-follicular hMG, and control groups were 21.9%, 11.7%, and 11.6%, respectively (P = 0.035). In conclusion, there is a significant association between the commencement time of hMG and live birth chance in ART cycles of POSEIDON group 3 and 4 poor responders. Early initiation of hMG together with rFSH seems to be beneficial in this specific population. Keywords Human menopausal gonadotropin (hMG) . Poor response . POSEIDON criteria
Introduction Poor ovarian response (POR) is defined as a reduced ovarian response to ovarian stimulation by gonadotropins either expectedly or unexpectedly and results in a low number of oocytes and low pregnancy rates [1]. Until the adoption of Bologna criteria by the European Society for Human Reproduction and Embryology (ESHRE) and POSEIDON classification, many different definitions have been made by several studies [2, 3]. And, due to those different definitions,
* Yavuz Emre Şükür [email protected] 1
Department of Obstetrics and Gynecology, Ankara University School of Medicine, Cebeci Hospital, 06100 Dikimevi/ Ankara, Turkey
2
Department of Obstetrics and Gynecology, Halil Şıvgın Çubuk State Hospital, Ankara, Turkey
its prevalence widely varied between 5.6 and 35.1% [4]. However, beyond its prevalence, POR remains to be one of the main issues for infertility clinics dealing with assisted reproductive technology (ART) treatments. Several different gonadotropin-releasing hormone (GnRH) agonist and antagonist ovarian stimulation protocols have been investigated to achieve a better outcome an
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