IVF Lite – A new strategy for managing poor ovarian responders, Gandhi, G et al., ivflite 2014
Dr. Daiter’s summary of this research article
Target: Poor ovarian responders (PORs)
Goal: To determine whether reproductive success with PORs is increased (compared to conventional IVF) when accumulating embryos with serial minimal stimulation cycles, cryopreserving the resulting embryos by vitrification, and transferring the embryos in a subsequent menstrual cycle (“IVF Lite protocol”).
A retrospective analysis of 222 patients treated at Rotunda- The Center for Human Reproduction (Mumbai, India) from June 2010 to November 2012, 97 patients had serial minimal stimulation cycles with vitrification and embryo banking (IVF Lite Group) and 125 patients had conventional IVF, and the IVF Lite Group had embryos vitrified (Cryotec protocol: Dr. Kuwayama’s improved protocols with new solutions and instruments) on Day 3 and once 6 embryos were banked a frozen embryo transfer (using a maximum of 3 thawed embryos) was scheduled.
The minimal stimulation protocol used Clomiphene Citrate (50 mg a day starting on cycle day 2 or cycle day 3 and continued for at least 10 days) until the follicles were mature (21-22 mm diameter), 150 IU hMG a day was added on day 5 until follicles were mature, GnRH antagonist (centrorelix 0.25 mg a day) was added once lead follicle was 18-19 mm diameter and hMG was increased by 75-150 IU/day and GnRH antagonist was continued to the day of ovulation trigger with hCG (10,000 Units), oocyte retrieval was 32-34 hours after hCG trigger.
Results included no significant difference in the number of metaphase II oocytes (mature eggs) retrieved between the two groups, a highly significant difference in the number of gonadotropin units used during ovarian stimulation (680 IU for IVF Lite Group and 4,956 IU for conventional IVF group), the IVF Lite Group patients needed an average of 3 cycles to accumulate the 6 (target number of) embryos, the clinical pregnancy rate per embryo transfer was higher for the IVF Lite Group (28%) compared to the conventional IVF group (15%), and the clinical pregnancy rate per patient in the IVF Lite Group was higher (48%) compared to the conventional IVF group (24%).
Conclusion: The IVF Lite protocol is very successful in treating PORs in terms of clinical pregnancy rates.
Dr. Daiter’s review of this research article
“Goral Gandhi is the Laboratory Director and Vice President (Operations) at Rotunda – Center for Human Reproduction, and has many years of experience in the design and establishment of successful assisted conception laboratories in India, for all the franchisee centers of Rotunda Group.” (Rotunda website) Rotunda- The Center for Human Reproduction is an internationally recognized and acclaimed infertility clinic in Mumbai, India
This article presents a review of data collected retrospectively, so there may be some inclusion criteria into the IVF Lite Group and/or the conventional IVF group that constitutes a bias in the results. However, the article should be reassuring to those patients with POR who may be considering minimal stimulation IVF since the results from this clinic demonstrate that these patients may improve their ability to successfully conceive with these protocols. This article also points out that the protocols for Assisted Reproductive Technology (ART) are very dynamic and frequent re-examination of these protocols being used is very important.