title: Synchronization of ovarian stimulation with follicle wave emergence in patients undergoing in vitro fertilization with a prior suboptimal response: a randomized, controlled trial.
abstract: OBJECTIVE
  To test the hypothesis that synchronizing initiation of ovarian stimulation with follicle wave emergence would optimize IVF/intracytoplasmic sperm injection (ICSI) outcomes in patients with a prior suboptimal response.
  
  
  METHODS
  Prospective, randomized, controlled trial.
  
  
  METHODS
  Academic and private reproductive endocrinology and infertility centers.
  
  
  METHODS
  Eighty women ≤ 43 years of age with a history of a suboptimal response.
  
  
  METHODS
  Initiation of recombinant FSH/GnRH antagonist/recombinant LH/hCG on day 1 (n = 39) or day 4 (n = 41).
  
  
  METHODS
  Numbers of clinical and biochemical pregnancies, follicles ≥ 10 and ≥ 15 mm, oocytes collected, fertilized oocytes, cleavage stage embryos, and blastocysts; serum E(2) concentrations. Outcomes were compared between treatment groups.
  
  
  RESULTS
  The numbers of follicles that developed to ≥ 10 and ≥ 15 mm and serum E(2) were greater when recombinant FSH was initiated on day 1 (5.4, 4.3, 5,827.2 pmol/L) versus day 4 (3.6, 2.5, 4,230.1 pmol/L). The numbers of collected, metaphase II, and fertilized oocytes; cleavage stage embryos; and blastocysts were not different between groups. When we evaluated only those cycles that proceeded to oocyte pick-up, a lower implantation rate (16.1%, 56.0%), biochemical pregnancy rate (PR) (16.1%, 48.0%), and clinical PR (12.9% vs. 36.0%) were detected in the day 1 group versus day 4 group.
  
  
  CONCLUSIONS
  Synchronizing initiation of ovarian stimulation with follicle wave emergence in patients with a prior suboptimal response resulted in an increase in the number of dominant follicles and serum E(2) concentrations; however, improvements in oocyte, embryo, or pregnancy outcomes did not occur.
  
  
  BACKGROUND
  NCT00439829.
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. angela.baerwald@usask.ca
authors: Angela
authors: A
authors: Baerwald
authors: Paula
authors: P
authors: Anderson
authors: Albert
authors: A
authors: Yuzpe
authors: Allison
authors: A
authors: Case
authors: Margo
authors: M
authors: Fluker
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D043373:Follicle Stimulating Hormone, Human / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006801:Humans; D007986:Luteinizing Hormone / Q000008:administration & dosage; D054315:Oocyte Retrieval / Q000379:methods; D006080:Ovarian Follicle / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013997:Time Factors
chemical_list: D043373:Follicle Stimulating Hormone, Human; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone