IVF Lite

Dubai based IVF expert Gautam Allahbadia talks about IVF Lite, a new strategy for managing Poor Ovarian Responders (PORs)

Garcia et al. described the first poor responder patient in 1983, nearly 30 years ago. Since then, numerous studies on potential treatment approaches for poor ovarian responders have been published (PORs). However, no satisfactory treatment strategy for improving outcomes for this specific group of patients has been identified. Dr Gautam Allahbadia, Dubai based IVF expert shares the study of IVF Lite and how the technique manages poor ovarian responders.

“The European Society for Human Reproduction and Embryology (ESHRE) reached an agreement on the minimum criteria needed to define poor ovarian response (POR). At the same meeting, ESHRE proposed that the acronyms POR and PORs be added to conventional assisted reproduction treatment terminology to define poor ovarian response and poor ovarian responders, respectively,” says Dr Gautam Allahbadia, Mumbai based IVF specialist.

Minimal stimulation protocols were developed in order to provide more natural stimulation for IVF. These protocols have been shown to have numerous advantages over traditional ovarian stimulation protocols, the most important of which is the production of fewer but higher quality oocytes. Kyrou et al. compared different protocols in a systematic review and meta-analysis of 22 randomised controlled trials in poor responders. “This meta-analysis concluded that none of the protocols examined significantly increased the success rates for PORs,” informs Dr Gautam Allahbadia, Dubai based IVF expert.

The scarcity of embryos available for transfer presents a significant challenge in the management of PORs.  A potential management strategy for poor responders is to accumulate vitrified good-grade embryos over several minimal stimulation cycles to create a sufficient pool of embryos. This could potentially make poor responders’ chances of success comparable to those of normal responders. Dr Gautam Allahbadia says that this management, is unthinkable without an excellent vitrification programme. With the advent of vitrification technologies, the option of accumulating embryos has become a promising reality. The current study compared the efficacy of serial minimal stimulation IVF (msIVF) cycles with vitrification and accumulation (ACCU-VIT) of embryos followed by a remote frozen embryo transfer to conventional IVF protocols for the treatment of poor responders.

IVF Lite protocol

The IVF Lite protocol consists of msIVF + ACCU-VIT + rET

msIVF

Clomiphene citrate 50 mg per day was started on day 2 or 3 of the menstrual cycle and continued for 12 days until follicle maturity was determined using ultrasound guidance. Maturity was defined as the lead follicle size reaching 21-22 mm; on day 5, 150 IU of human menopausal gonadotropin (hMG) was added and continued until the desired follicular size was achieved. When the lead follicle size was 18 to 19 mm in diameter, 0.25 mg of gonadotropin-releasing hormone (GnRH) antagonist Cetrorelix  was added to the stimulation.

Cetrorelix was continued until the day of the hCG trigger; 10,000 IU of hCG was administered when the lead follicle size was 21 to 22 mm in diameter. The oocytes were extracted under ultrasound guidance 32 to 34 hours after the hCG trigger.

ACCU-VIT

The retrieved eggs were fertilised with IVF or intracytoplasmic sperm injection (ICSI), and the resulting embryos were vitrified on day 3 using vitrification techniques. Back-to-back msIVF cycles were followed by ACCU-VIT until approximately six top-grade (grades A and B) embryos were accumulated per patient.

rET

When there were enough embryos, a remote Embryo Transfer (rET)was performed. The embryos were warmed using the vitrification warming protocol. The warmed embryos were transferred on day 4 after preparing the endometrium with estradiol valerate tablets that were started on day 3 or 4 of the menstrual cycle following a baseline scan to rule out any ovarian cysts and measure endometrial lining. Standard luteal support began four days before embryo transfer and was continued for 12 days. Embryo transfers were performed using a Wallace Sureview embryo transfer catheter under transabdominal ultrasound guidance.

Leave a Reply

Your email address will not be published.

skin Previous post Can skin cleansers cause pimples?
ultimate guide to clear pores Next post Ways to clear pores naturally