Therapeutic options for assisted reproduction in patients with impaired ovarian reserve
Authors:
R. Hudeček; I. Prokopová; M. Sviteková; R. Krajčovičová
Authors‘ workplace:
Gynekologicko-porodnická klinika LF MU a FN Brno
Published in:
Prakt Gyn 2010; 14(1): 26-35
Category:
Review Article
Overview
The paper provides a literature review of pathophysiological, epidemiological and etiological factors associated with impaired ovarian function in women. The association between ovarian dysfunction and age, the role of genetics in impaired ovarian function, autoimmune and iatrogenic as well as other potential causes of impaired ovarian reserve are discussed. The authors present own clinical project focussing on the options for assisted reproduction in the group of patients with age‑related impaired ovarian reserve. Aims of the study: Clinical analysis of therapeutic options within the programme of assisted reproduction (AR) in patients above 40 years of age and evaluation of effectiveness of the selected approaches. Materials: The cohort consisted of patients cared for at the Centre for Assisted Reproduction CAR 01 of the Clinic of Gynaecology and Obstetrics, University Hospital in Brno, above 40 years of age who underwent an AR treatment cycle between 1st Jan 2003 and 30th Sep 2004 (total of 118 AR cycles at CAR 01 CGO UH in Brno). The patients within the cohort were stratified according to the approach to infertility treatment. IVF group: Patients who underwent a cycle with ovulation induction and aspiration of own oocytes (38 cycles, 3.7 % of all AR cycles). OD group: patients who utilised the oocyte donation programme (65 cycles, 6.4 % of all AR cycles). ED group: patients who utilised the embryo donation programme (15 cycles, 1.4 % of all AR cycles). Methods: The effectiveness of the specific treatment approach in the respective treatment group of patients was evaluated – the total use of gonadotropic hormones (rFSH), % cycles with oocyte aspiration (OR), the mean number of oocytes obtained (OO), the mean % of fertilized oocytes (Fertilization Rate, FR), % of cycles resulting in embryo transfer (ET), % of cycles with cryopreservation of excess embryos (KRYO) and % of obtained clinical pregnancies on ET (GR/ ET). The optimum therapeutic approach in patients above the age of 40 was defined. Results: IVF group: Total of 38 cycles in patients who underwent ovulation induction, the mean use of 2550IU rec- FSH, aspiration of own oocytes in 89.5 % of patients with an average yield of 6 oocytes per aspiration. At the fertilization rate of 76.2 %, 74.3 % of patients underwent embryotransfer. Good quality excess oocytes were cryopreserved in 15.8 % of cycles. Pregnancy rate in this group was 7.00 %. OD group: Total of 65 cycles in oocyte donation patients. The patients received a mean of 4.5 oocytes per cycle and, at the fertilization rate of 83.1 %, 100.0 % of patients underwent embryotransfer. Good quality excess oocytes were cryopreserved in 1.5 % of cycles. Pregnancy rate in this group was 26.2 %. ED group: Total of 15 cycles in embryo donation patients. 100 % of patients underwent embryotranfer. No embryos were cryopreserved. Pregnancy rate in this group was 13.3 %. Conclusion: The oocyte donation programme represents the most effective approach to infertility treatment in patients with age‑related impaired ovarian reserve (40 years and above). Oocyte donation represents a rational approach that from an ethical perspective represents an exclusive and specific entity. The number of patients with impaired ovarian function within the assisted reproduction programme increases. Demographic and epidemiological data from the Czech Republic suggest that the importance of this issue will increase with time. Considering the variety of etiological factors that might alter ovarian function, careful differential diagnosis is crucial. The efficacy of therapeutic management might be improved following identification of the underlying cause. Even though treatment success is limited in patients with impaired ovarian function and their management is highly demanding with respect to diagnostics and therapy, the options currently available in assisted reproduction provide this group of women with real chance for fulfilment of their reproductive functions.
Key words:
impaired ovarian reserve – premature ovarian failure – disorders of reproduction – assisted reproduction – oocyte donation
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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Practical Gynecology
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