How to improve the probability of pregnancy in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis.
OBJECTIVE
To systematically review the literature to identify randomized controlled trials, which evaluate interventions aiming to improve the probability of pregnancy in poor responders undergoing in vitro fertilization (IVF).


METHODS
Systematic review and meta-analysis.


METHODS
University-based hospital.


METHODS
None.


METHODS
Pregnancy rate.


RESULTS
Twenty-two eligible randomized controlled trials were identified that evaluated in total 15 interventions to increase pregnancy rates in poor responders. Based on limited evidence, the only interventions that appear to increase the probability of pregnancy were the addition of GH to ovarian stimulation (odds ratio for live birth: 5.22, confidence interval: 95% 1.09-24.99) and the performance of embryo transfer on day 2 compared with day 3 (ongoing pregnancy rate: 27.7% vs. 16.3%, respectively; difference: +11.4, 95% confidence interval: +1.6 to +21.0).


CONCLUSIONS
Insufficient evidence exists to recommend most of the treatments proposed to improve pregnancy rates in poor responders. Currently, there is some evidence to suggest that addition of GH, as well as performing embryo transfer on day 2 versus day 3, appear to improve the probability of pregnancy.
Kyrou
Dimitra
D
First Department of Obstetrics & Gynecology, Unit for Human Reproduction, Papageorgiou General Hospital, Thessaloniki, Greece.
Kolibianakis
Efstratios M
EM
Venetis
Christos A
CA
Papanikolaou
Evangelos G
EG
Bontis
John
J
Tarlatzis
Basil C
BC
D000279:Administration, Cutaneous; D000284:Administration, Oral; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D046149:Embryo Culture Techniques; D004624:Embryo Transfer; D019317:Evidence-Based Medicine; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005307:Fertilization in Vitro; D013006:Growth Hormone / Q000008:administration & dosage; D006801:Humans; D007315:Insemination, Artificial; D016017:Odds Ratio; D054315:Oocyte Retrieval; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011336:Probability; D020554:Sperm Injections, Intracytoplasmic; D013997:Time Factors; D016896:Treatment Outcome
D005300:Fertility Agents, Female; D013006:Growth Hormone