IVF and New Approaches to Low Prognosis Patients
A challenging group of patients who attempt assisted reproduction are low responders who, are over 41 years, or have had a low response to gonadotropin previously, have elevated FSH levels or other poor prognosis signals from their pre IVF treatment assessment. Many of these patients have no low cost option as the results of any kind of fertility treatment, including IVF, may be in the 5-10% range. The egg donation option is the far more successful option, using the eggs from a young woman and the sperm of the husband. An egg recipient has success rates approaching 80% including frozen embryos. It is as difficult for a woman to give up on her own eggs as it is for a man to consider using a sperm donor. For that reason, New York Fertility Services does not have an age “cut off” – there are always treatments which can be tried with the woman’s own eggs.
An approach for ovarian stimulation which has been shown to be useful in low prognosis categories is the microdose Lupron flare gonadotropin regimen (Padilla 1996). Because the dose of gonadotropin drugs utilized is high, this now standard regimen is expensive to administer and the outcomes are low in terms of cost effectiveness. Modified natural cycle IVF management of these cases has been both advocated (Check 2004) and criticized (Kolbianaksis 2004).Two other helpful strategies which are promising for low prognosis patients have been noted. Patients with low ovarian reserve have improved outcomes after pre-treatment with dehydroepiandrostenedione (Barad 2007). This is a simple method with the requirement of a delay in starting IVF therapy required for the effectiveness of the method to be maximized. Estrogen priming strategies have been applied in normal responders and poor responders in one published study (Fraterelli et al 2008).
References available on request.