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Luteal Phase Ovarian Stimulation May Improve Oocyte Retrieval and Oocyte Quality in Poor Ovarian Responders Undergoing In Vitro Fertilization: Preliminary Results from a Single-Center Prospective Pilot Study

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Abstract

Introduction

Luteal phase ovarian stimulation (LPOS) has been proven a feasible protocol for infertile patients. High progesterone level in the luteal phase could physiologically inhibit premature luteinizing hormone surge, from which poor ovarian responders (PORs) could obtain benefits. Therefore, we aimed to compare clinical outcomes between LPOS and follicular phase ovarian stimulation (FPOS) protocol in PORs undergoing in vitro fertilization (IVF).

Methods

This prospective pilot study was performed at one tertiary center from January 2016 to October 2017. A total of 60 PORs who met Bologna criteria and undergoing IVF were enrolled. Thirty PORs were allocated to the LPOS group and 30 PORs were allocated to the FPOS group. Basic characteristics, cycle characteristics, and pregnancy outcomes were compared between the two groups.

Results

The length of stimulation was significantly longer in the LPOS group than in the FPOS group. The numbers of retrieved oocytes, metaphase II oocytes, fertilized oocytes, and day-3 embryos were significantly higher in the LPOS group than in the FPOS group. Conversely, we could not find any significant difference for clinical pregnancy rate, ongoing pregnancy rate, abortion rate, and cancellation rate. The multivariate analysis showed that only LPOS (p = 0.007) was significantly associated the possibility to retrieve three or more oocytes, whereas basal follicle-stimulating hormone (FSH) < 8 IU/l (p = 0.103) and antral follicle count (AFC) ≥ 3 (p = 0.143) did not significantly affect this event.

Conclusion

LPOS allows improved oocyte retrieval and oocyte quality in PORs with respect to FPOS, despite comparable pregnancy outcomes. LPOS may be considered a feasible option for oocytes accumulation in PORs.

Trial Registration

ClinicalTrials.gov identifier, NCT03238833

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Acknowledgements

We are very grateful to our study participants for their cooperation. The authors wish to acknowledge Dr. Antonio Simone Laganà for his role in data analysis and for the insightful suggestions aimed at improving the manuscript.

Funding

No funding or sponsorship was received for this study or publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Li-Te Lin, Salvatore Giovanni Vitale, San-Nung Chen, Zhi-Hong Wen, Hsiao-Wen Tsai, Chyi-uei Chern, and Kuan-Hao Tsui have nothing to disclose. The authors alone are responsible for the content and writing of the paper.

Compliance with Ethics Guidelines

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institution ethical committee of Kaohsiung Veterans General Hospital and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Data Availability

Available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Li-Te Lin, San-Nung Chen, Hsiao-Wen Tsai, Chyi-uei Chern & Kuan-Hao Tsui

  2. Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Li-Te Lin, Hsiao-Wen Tsai & Kuan-Hao Tsui

  3. Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan

    Li-Te Lin

  4. Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy

    Salvatore Giovanni Vitale

  5. Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy

    Salvatore Giovanni Vitale

  6. Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan

    Zhi-Hong Wen

  7. Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County, Taiwan

    Kuan-Hao Tsui

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  1. Li-Te Lin
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Corresponding authors

Correspondence to Salvatore Giovanni Vitale or Kuan-Hao Tsui.

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Lin, LT., Vitale, S.G., Chen, SN. et al. Luteal Phase Ovarian Stimulation May Improve Oocyte Retrieval and Oocyte Quality in Poor Ovarian Responders Undergoing In Vitro Fertilization: Preliminary Results from a Single-Center Prospective Pilot Study. Adv Ther 35, 847–856 (2018). https://doi.org/10.1007/s12325-018-0713-1

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  • DOI: https://doi.org/10.1007/s12325-018-0713-1

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