Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy and.
Gynecol Endocrinol. 2013 Nov;29(11):997-1001. doi: 10.3109/09513590.2013.822063. Epub 2013 Aug 2.
To investigate whether laboratory strategies can improve in vitro fertilization (IVF) outcome in poor responder patients. We compared the effectiveness of conventional IVF and intra cytoplasmic sperm injection (ICSI) in assisted reproductive technologies cycles in which only one or two oocytes were retrieved at ovarian pick up, in the absence of male infertility.
Retrospective analysis of 425 cycles in 386 poor responder patients.
INTERVENTION(S): Standard stimulation protocol with gonadotropins and gonadotropin releasing hormone (GnRH) antagonist.
MAIN OUTCOME MEASURE(S): Fertilization rate, cleavage rate, good-quality embryo rate, implantation rate, clinical pregnancy rate (PR) and miscarriage rate.
IVF was found to be more advantageous for implantation and PR, especially in patients under 35 years and in women aged between 35 and 38 years. No differences were noted in the other parameter evaluated. Patients aged over 38 years showed no difference using the two techniques.
The employment of ICSI in the absence of a male factor can reduce reproductive outcome in poor responder. Probably because of aging-related defects overcoming the advantage of sperm selection, the choice of IVF technique is not relevant to reproductive success when oocyte quality is compromised by reproductive aging. Although further randomized trials are needed to confirm our results, we propose that, in absence of male infertility, conventional IVF might be the technique of choice in young patients, especially in those aged below 35 years.
研究实验室策略是否能改善卵巢低反应患者的体外受精（IVF）结局。我们比较了在卵巢取卵时仅获得 1 或 2 个卵的情况下，在不存在男性不育的情况下，辅助生殖技术周期中常规 IVF 和卵胞浆内单精子注射（ICSI）的有效性。
对 386 例卵巢低反应患者的 425 个周期进行回顾性分析。
使用促性腺激素和促性腺激素释放激素（GnRH）拮抗剂的标准刺激方案。
受精率、卵裂率、优质胚胎率、着床率、临床妊娠率（PR）和流产率。
IVF 更有利于着床和 PR，尤其是在 35 岁以下和 35-38 岁之间的女性。在评估的其他参数方面没有差异。38 岁以上的患者使用这两种技术没有差异。
在不存在男性因素的情况下，ICSI 的应用可能会降低卵巢低反应患者的生殖结局。可能是因为与年龄相关的缺陷克服了精子选择的优势，当卵母细胞质量因生殖衰老而受损时，选择 IVF 技术与生殖成功无关。尽管需要进一步的随机试验来证实我们的结果，但我们建议，在不存在男性不育的情况下，对于年轻患者，尤其是年龄在 35 岁以下的患者，常规 IVF 可能是首选技术。
