title: Conventional IVF as a laboratory strategy to rescue fertility potential in severe poor responder patients: the impact of reproductive aging.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective analysis of 425 cycles in 386 poor responder patients.
  
  
  METHODS
  Standard stimulation protocol with gonadotropins and gonadotropin releasing hormone (GnRH) antagonist.
  
  
  METHODS
  Fertilization rate, cleavage rate, good-quality embryo rate, implantation rate, clinical pregnancy rate (PR) and miscarriage rate.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy and.
authors.forename: Paolo Giovanni
authors.initials: PG
authors.lastname: Artini
authors.forename: Maria Elena Rosa
authors.initials: ME
authors.lastname: Obino
authors.forename: Elena
authors.initials: E
authors.lastname: Carletti
authors.forename: Sara
authors.initials: S
authors.lastname: Pinelli
authors.forename: Maria
authors.initials: M
authors.lastname: Ruggiero
authors.forename: Giovanna
authors.initials: G
authors.lastname: Di Emidio
authors.forename: Vito
authors.initials: V
authors.lastname: Cela
authors.forename: Carla
authors.initials: C
authors.lastname: Tatone
mesh_terms: D000328:Adult; D000375:Aging; D015331:Cohort Studies; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology*; D005307:Fertilization in Vitro / Q000009:adverse effects; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006062:Gonadotropins / Q000494:pharmacology; D006801:Humans; D007247:Infertility, Female / Q000503:physiopathology / Q000628:therapy*; D007558:Italy / Q000453:epidemiology; D054315:Oocyte Retrieval; D009866:Oogenesis / Q000187:drug effects; D010053:Ovary / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone