In a nutshell
This review compared medication protocols for in vitro fertilization (IVF) for women with a poor ovarian response (POR). It found that delayed start antagonist (DSA) protocol may improve IVF outcomes for patients with POR.
The infertility treatment IVF is a method to collect oocytes (eggs), fertilize them artificially, and implant the embryo(s) in the uterus. IVF first involves stimulating the ovaries to produce multiple oocytes. However, for patients with POR, the ovaries produce few oocytes in response to stimulation. Patients can be diagnosed with POR based on their age, hormone levels, and/or past IVF outcomes. It is more difficult to treat infertility for patients with POR.
A delayed start antagonist (DSA) is a medication protocol designed for POR. During IVF, it is necessary to block or reduce the body’s own hormones so they do not cause early ovulation before the oocytes can be collected. There are multiple medication protocols currently in use. The DSA protocol uses a medication that directly blocks the GnRH hormone from interacting with the pituitary hormone gland. This antagonist medication is taken at the start of the cycle but is stopped during ovarian stimulation until the ovarian follicles reach a certain size. It is thought that this method may improve and synchronize the growth of the ovarian follicles. However, it is not well studied whether DSA improves outcomes for patients with POR.
Methods & findings
This study included 5 trials with 514 patients with POR who were undergoing IVF. Half of the patients were randomly assigned to use the DSA protocol. The other patients used a different IVF protocol.
If there are not enough ovarian follicles of sufficient size visible on ultrasound, the egg collection and IVF cycle may be cancelled. Patients using DSA had a 37% lower risk of cycle cancellations than patients using a control (comparison) protocol.
Among completed IVF cycles, those using DSA had significantly more mature oocytes (an 0.85 additional oocyte on average). However, the two groups had a similar number of embryos per cycle.
Patients using DSA had 2.3 times higher pregnancy rates than conventional protocols.
The bottom line
This review found that the DSA protocol may lead to better IVF outcomes for patients with POR.
The fine print
The studies included both patients with POR due primarily to age, and due to other causes. The best protocol may be different depending on the cause of POR.
Talk to your doctor about the protocols available and whether DSA is right for you.
Published By :
Archives of Gynecology and Obstetrics
Nov 24, 2020