title: Natural cycle as first approach in aged patients with elevated follicle-stimulating hormone undergoing intracytoplasmic sperm injection: a pilot study.
abstract: BACKGROUND
  Poor ovarian response to standard in vitro fertilization-embryo transfer (IVF-ET) protocols or different regimens of treatment, as consequence of a diminished ovarian reserve, correlates strictly with patient age, elevated follicle-stimulating hormone (FSH) and reduced antral follicle count. The aim of the present pilot study was to evaluate the outcome of patients with poor prognostic features undergoing IVF-ET with natural cycles as a first approach and not as a consequence of a previous failure treatment.
  
  
  METHODS
  Eighteen aged patients (mean +/- standard deviation 40.2 +/- 0.7 years, range 37-43 years) with elevated serum FSH and reduced antral follicle count underwent intracytoplasmic sperm injection (ICSI) after spontaneous ovulation.
  
  
  RESULTS
  A total of 26 natural cycles with ICSI were analyzed. Pregnancy was observed in three patients, of which two were ongoing as assessed by fetal heart beat at ultrasound scan performed 4-5 weeks after ET.
  
  
  CONCLUSIONS
  The overall pregnancy rates achieved (11.5% per cycle, 20.0% per ET) are comparable with those of conventional IVF-ET in aged patients, and not impaired by a single embryo transferred. Better embryo quality, as a consequence of natural selection of oocytes, better endometrium receptivity and monthly repeatability of the procedure, can balance the relatively low chance to perform ET.
authors.affiliation: IVF Unit, Gynaecological-Obstetric Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy. papaleo.enrico@hsr.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Papaleo
authors.forename: Lucia
authors.initials: L
authors.lastname: De Santis
authors.forename: Francesco
authors.initials: F
authors.lastname: Fusi
authors.forename: Nicola
authors.initials: N
authors.lastname: Doldi
authors.forename: Claudio
authors.initials: C
authors.lastname: Brigante
authors.forename: Guido
authors.initials: G
authors.lastname: Marelli
authors.forename: Paola
authors.initials: P
authors.lastname: Persico
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cino
authors.forename: Augusto
authors.initials: A
authors.lastname: Ferrari
mesh_terms: D000328:Adult; D000367:Age Factors; D004624:Embryo Transfer; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D008597:Menstrual Cycle; D010060:Ovulation / Q000097:blood; D010062:Ovulation Induction; D010865:Pilot Projects; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005640:Follicle Stimulating Hormone