Comparison between follicular stimulation and luteal stimulation protocols with clomiphene and HMG in women with poor ovarian response

Abstract

This retrospective study is to compare the follicular mild stimulation and luteal simulation protocols for poor responders undergoing in vitro fertilization (IVF). A total of 131 women were diagnosed as poor responders. Thirty-three women started ovarian stimulation in early-luteal phase and 98 women started in early follicular phase with 100 mg/d clomiphene citrate and 75–150 IU/d HMG. There were more oocytes retrieved (2.8 ± 2.0 versus 2.0 ± 1.2, p < 0.05), more available embryos (1.8 ± 1.4 versus 1.3 ± 1.1, p < 0.05) and top-quality embryos (0.9 ± 0.9 versus 0.4 ± 0.6, p < 0.05), and reduced cycle cancellation rate (12.1% versus 30.6%, p < 0.05) in luteal group than in follicular group. The clinical pregnancy (17.7%, 20.0% and 41.2%) and live-birth rates (10.78%, 20.0% and 29.4%) after transferring embryos obtained from luteal, follicular and mixed stages were comparable (p > 0.05). For poor responders, luteal phase stimulation could be an option because of increasing the chance to obtain competent embryos and reducing the cycle cancellation rate.

Chinese abstract

该项回顾性研究的目的是比较体外受精中低反应患者卵泡期微刺激方案与黄体方案。一共有131例女性被诊断为低反应。33例患者在黄体早期开始刺激卵巢，98例患者在卵泡早期开始，使用的是100mg/天的克罗米芬和75-150IU/天的促性腺激素。黄体期组较卵泡组可以获取更多的卵细胞（2.8 ± 2.0 vs2.0 ± 1.2, p＜0.05）、更多可用的胚胎（1.8 ± 1.4 vs 1.3 ± 1.1, p＜0.05）、更多高质量的胚胎（0.9 ± 0.9 vs0.4 ± 0.6, p＜0.05）和更低的周期取消率（12.1% vs 30.6%, p＜0.05）。从黄体期、卵泡期和混合阶段获得的胚胎移殖后，其临床妊娠率(17.7%, 20.0% 和41.2%)、活产率（10.78%, 20.0% 和29.4%）是相当的（P＞0.05）。对于低反应的患者，在黄体期刺激卵巢可以是一种选择，因为可以增加获得足够胚胎的机会，同时降低周期取消率。

• Assisted reproductive technology
• in vitro fertilization
• luteal phase
• ovarian stimulation
• poor ovarian response

Acknowledgements

The authors thank the academy of Public Health, Sun-Yat-Sen University for support in providing assistance with statistical analyses.

Declaration of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.