الفهرس 
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Abstract
Summary
Controlled ovarian hyper stimulation (COH) is the routine protocol to achieve sufficient follicles during in vitro fertilization (IVF) treatment. Poor ovarian responsiveness is a challenge met by many clinicians during COH, these patients usually have higher FSH level, lower levels of AMH and few oocyte retrieved, which mainly due to advanced maternal age and poor follicles reserve or any reason that could impair the ovarian response during the ovarian stimulation.
Poor ovarian response (POR) is defined as failed to develop sufficient number of follicles following COH in women undergoing assisted reproductive technology (ART) treatment. This is observed in about 9–24% of the total women who undergo ART treatment. However, until now, uniform definition has not been accepted. Criteria for “poor response” diagnosis usually include peak estradiol (E2) level of <300 pg/ml, retrieved oocytes ≤ 3, and a day 3 follicle-stimulating hormone (FSH) circulating level >12 IUs following a conventional stimulation protocol. Clinically, according to the POR definition proposed by the Bologna criteria, the ESHRE Working Group, POR patients should exhibit two of the following symptoms at least: (i) being over the age of 40 or any other risk factors for POR; (ii) previous POR with conventional stimulation protocol ≤3 oocytes; (iii) an abnormal ovarian reserve test.
Clinical decisions of COH protocol on POR patients during IVF treatment is always a subject for debate. POR patients usually exhibit diminished ovarian response to standard gonadotrophins (Gn) stimulation, and the efficiency of high dose of Gn administration for such patients has also been questioned.Study reported that increasing exogenous Gn dosage for POR patients during ovarian stimulation could not improve IVF outcomes.
The main aim of this study was to assess the efficacy& safety of mild ovarian stimulation using CC& low dose of Gn with antagonist protocol in comparison to the conventional ovarian stimulation with mid-luteal GnRH agonist protocol in women with poor ovarian reserve undergoing IVF/ICSI cycles.
This prospective clinical study was conducted in the Department of Obstetrics and Gynecology at Beni-suef University Hospital. The study included 352 who were been assigned randomly who were eligible, willing to comply with the study protocol, participants were randomized into 2 groups: group (A) – Mild stimulation protocol: 176 Women. group (B) –Long Agonist Protocol: 176 Women.
The main results of the study revealed that:
Regarding the baseline characteristics of the patients (group A- Mild stimulation Group) and (group B- Long protocol Group), our results showed that there was no statistically significant difference between the 2 groups regarding age, BMI, period of infertility and type of infertility.
There is statistically significant difference between the two groups was detected in number of days of stimulation. As the mean of days of stimulation 12.2 ± 1.5 in group A (Mild stimulation group) and group B (long protocol) 13.3 ± 1.4 in group B, with (P = 0.0001).
As well, There was marked statistically significant difference between the two groups regarding the amount of exogenous gonadotropins used for ovarian stimulation; the mean in group A (Mild stimulation group) was 2814 ± 577 and 4187 ± 1183 in group B (Long protocol Group), with (P = 0.0001).
There was statistically significant difference between the two groups regarding the peak level of E2; the mean in group A (Mild stimulation group) was 1294 ± 305 and 1365 ± 333 in group B (Long protocol Group), with (P = 0.034).
There was statistically significant difference between the two groups regarding Serum Progesterone at Day of Trigger; the mean in group A (Mild stimulation group) was 0.87 ± 0.63 and 0.83 ± 0.66 in group B (Long protocol Group), with (P = 0.0.58).
There was obvious statistically significant difference between the two groups regarding the Endometrial thickness at OPU; the mean in group A (Mild stimulation group) was 8 ± 1.5 and 10.9 ± 1.4 in group B (Long protocol Group), with (P = 0.0001).
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.