Estrogen or anti-estrogen for Bologna poor responders?

Abstract

The current study aims to compare cycle outcomes of two ovarian stimulation protocols in poor responders according to the Bologna criteria; luteal estrogen priming (LE) or letrozole (LZ) co-treatment in antagonist protocol. Following retrospective chart review of a single center, 162 cycles were found eligible for the comparison of two ovarian stimulation protocols. After interpreting data, significantly higher serum estradiol levels, longer duration of cycle, higher number of fertilized oocytes and good quality embryos were detected in patients who received LE. Despite any statistical significance, higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) per embryo transfer (ET) were detected with LE protocol compared with LZ (12.3% versus 18.2% and 9.6% versus 12.7%, respectively). Younger patients (<40 years) revealed higher CPR and OPR per started cycle compared with older patients (≥40 years) where only OPR was statistically significant. Multivariable analysis demonstrated that basal antral follicle count, peak serum estradiol levels and number of fertilized oocytes were independent variables significantly associated with clinical pregnancies (p < 0.05). In the current analysis, LE or LZ protocols revealed comparable but quite low pregnancy rates in poor responders according to the Bologna criteria. Younger patients were more likely to achieve pregnancy compared to older patients with both protocols.

Chinese abstract

本研究旨在比较两种卵巢刺激方案：黄体雌激素激发（LE）或来曲唑（LZ）联合拮抗剂方案治疗卵巢反应不良者（根据博洛尼亚标准）的结果。通过单中心回顾性分析，发现162个周期符合两种卵巢刺激方案的比较。分析数据后，接受LE的患者有着显著升高的血清雌二醇水平，较长的周期，较高的受精卵母细胞数和较高质量的胚胎。尽管没有统计学意义，与LZ相比，LE方案有较高的每胚胎移植（ET）临床妊娠率（CPR）和继续妊娠率（OPR），分别为12.3% vs 18.2%和9.6% vs 12.7%。与年龄较大((≥40 岁)患者相比，较年轻患者(＜40岁)显示较高的每周期临床妊娠率（CPR）和继续妊娠率（OPR），然而只有继续妊娠率有统计学意义。多因素分析显示，基础窦卵泡数，血清雌二醇峰值水平和受精卵母细胞的数量是与临床妊娠明显相关的自变量(p＜0.05)。目前分析中，在反应不良者（根据博洛尼亚标准）中，LE或LZ方案显示类似但较低的妊娠率。两种方案中，较年轻患者比年龄较大患者更可能怀孕。

Keywords:

• Bologna criteria
• letrozole
• luteal estrogen
• poor responder

Declaration of interest

The authors report no declarations of interest.