[Medically Assisted Reproduction in Natural Cycle: Outcome Evaluation of a Reproductive Medicine Department].

INTRODUCTION Medically assisted reproduction in natural cycle has been investigated, especially in women with poor response to conventional ovarian stimulation, with endometrial receptivity improvement, lower cost and possibility of successive cycles. The disadvantages are: lower profitability per treatment cycle and higher cancellation rate. The aim of this study was to determine the rate of clinical pregnancy in infertile women subjected to medically assisted reproduction in natural cycle. MATERIAL AND METHODS Retrospective study of 149 medically assisted reproduction without ovarian stimulation of 50 infertile women, between January/2011 and October/2014. RESULTS The mean age of women undergoing medically assisted reproduction in natural cycle was 36.1 years. Approximately half (46.0%) of the cycles were performed in poor responders. On the day of ovulation trigger, the mean diameter of the follicle was 17.5 mm. Twenty-three cycles (15.4%) were canceled prior to ovulation trigger. In 8 cycles (5.3%), ovulation occurred between ovulation trigger and oocyte retrieval. In the majority of cycles (n = 118; 79.2%) oocyte retrieval was executed, a medically assisted reproduction technique was performed in 71 (47.6%), mostly intracytoplasmic injection. The overall fertilization rate was 77.5%. In 40 cycles (26.8%) there was embryo transfer. The implantation rate and the clinical pregnancy rate by embryo transfer was 35.0% and 25.0%, respectively. Most pregnancies occurred in poor responders, according to Bologna criteria. DISCUSSION Although the pregnancy rate per cycle started was 6.7%, the rate of clinical pregnancy per embryo transfer is quite satisfactory, being a group of women with unfavorable responses in previous treatments. The relatively high rates of cycle cancellation are mitigated by the greater simplicity and lower cost of these cycles. CONCLUSION The results obtained in this study demonstrate that Medically Assisted Reproduction in natural cycle may be an alternative treatment for ovarian stimulation in patients with poor prognosis, whose only alternative would be oocyte donation.

[1]  N. Gleicher,et al.  Insights from clinical experience in treating IVF poor responders. , 2018, Reproductive biomedicine online.

[2]  R. Paulson,et al.  Modified natural cycle in in vitro fertilization. , 2017, Fertility and sterility.

[3]  Qiuju Chen,et al.  Controlled ovulation of the dominant follicle using progestin in minimal stimulation in poor responders , 2017, Reproductive Biology and Endocrinology.

[4]  S. Esteves,et al.  The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome , 2016, F1000Research.

[5]  M. Payson,et al.  Natural cycle IVF reduces the risk of low birthweight infants compared with conventional stimulated IVF. , 2016, Human reproduction.

[6]  B. Ata,et al.  Does the use of gonadotropin-releasing hormone antagonists in natural IVF cycles for poor responder patients cause more harm than benefit? , 2016, Human fertility.

[7]  Z. Blumenfeld.  Why more is less and less is more when it comes to ovarian stimulation , 2015, Journal of Assisted Reproduction and Genetics.

[8]  C. Venetis,et al.  Live birth rates after modified natural cycle compared with high-dose FSH stimulation using GnRH antagonists in poor responders. , 2015, Human reproduction.

[9]  H. Fatemi,et al.  Implantation in assisted reproduction: a look at endometrial receptivity. , 2013, Reproductive biomedicine online.

[10]  C. Farquhar,et al.  Natural cycle in vitro fertilisation (IVF) for subfertile couples. , 2013, Cochrane Database of Systematic Reviews.

[11]  O. Ishihara,et al.  Implications of assisted reproductive technologies on term singleton birth weight: an analysis of 25,777 children in the national assisted reproduction registry of Japan. , 2013, Fertility and sterility.

[12]  M. Payson,et al.  Utilization and success rates of unstimulated in vitro fertilization in the United States: an analysis of the Society for Assisted Reproductive Technology database. , 2010, Fertility and sterility.

[13]  H. Tournaye,et al.  Live birth rates following natural cycle IVF in women with poor ovarian response according to the Bologna criteria. , 2012, Human reproduction.

[14]  C. Rubio,et al.  Moderate ovarian stimulation does not increase the incidence of human embryo chromosomal abnormalities in in vitro fertilization cycles. , 2012, The Journal of clinical endocrinology and metabolism.

[15]  D. Bodri,et al.  Minimal ovarian stimulation combined with elective single embryo transfer policy: age-specific results of a large, single-centre, Japanese cohort , 2012, Reproductive Biology and Endocrinology.

[16]  H. Holzer,et al.  Fertilization, embryo development, and clinical outcome of immature oocytes obtained from natural cycle in vitro fertilization , 2012, Journal of Assisted Reproduction and Genetics.

[17]  L. Gianaroli,et al.  ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. , 2011, Human reproduction.

[18]  Charulata Chatterjee,et al.  A friendly IVF protocol , 2011 .

[19]  A. Revelli,et al.  Milder is better? advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization , 2011, Reproductive biology and endocrinology : RB&E.

[20]  B. Tarlatzis,et al.  Mild ovarian stimulation for IVF: 10 years later. , 2010, Human reproduction.

[21]  M. Pelinck,et al.  Perinatal outcome in singletons after modified natural cycle IVF and standard IVF with ovarian stimulation. , 2010, European journal of obstetrics, gynecology, and reproductive biology.

[22]  R. Frydman,et al.  Mild ovarian stimulation for IVF. , 2008, Human reproduction update.

[23]  B. Couturier,et al.  Controlled natural cycle IVF: experience in a world of stimulation. , 2007, Reproductive biomedicine online.

[24]  S. Hamamah,et al.  [Natural cycle in vitro fertilization cycle in poor responders]. , 2007, Gynecologie, obstetrique & fertilite.

[25]  L. Giudice,et al.  The science behind 25 years of ovarian stimulation for in vitro fertilization. , 2006, Endocrine reviews.

[26]  F. Fusi,et al.  Natural cycle as first approach in aged patients with elevated follicle-stimulating hormone undergoing intracytoplasmic sperm injection: A pilot study , 2006, Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology.

[27]  P. Devroey,et al.  Multiple birth resulting from ovarian stimulation for subfertility treatment , 2005, The Lancet.

[28]  I. Cooke,et al.  Is analgesia required for transvaginal single-follicle aspiration in in vitro fertilization? A double-blind study , 1990, Journal of in Vitro Fertilization and Embryo Transfer.

[29]  C. Aragona,et al.  A controlled trial of natural cycle versus microdose gonadotropin-releasing hormone analog flare cycles in poor responders undergoing in vitro fertilization. , 2004, Fertility and sterility.

[30]  A. Loft,et al.  Embryo quality in natural versus stimulated IVF cycles. , 2004, Human reproduction.

[31]  P. Devroey,et al.  Reproductive biology and IVF: ovarian stimulation and endometrial receptivity , 2004, Trends in Endocrinology & Metabolism.

[32]  I. Kadoch.  [Natural cycle IVF (nIVF) in women with implantation failure]. , 2004, Journal de gynecologie, obstetrique et biologie de la reproduction.

[33]  M. Pelinck,et al.  Efficacy of natural cycle IVF: a review of the literature. , 2002, Human reproduction update.

[34]  C. la Vecchia,et al.  Use of fertility drugs and risk of ovarian cancer. , 2001, Human reproduction.

[35]  S. Campbell,et al.  Cumulative conception and live birth rates in natural (unstimulated) IVF cycles. , 2001, Human reproduction.

[36]  D. Valbuena,et al.  Clinical evidence for a detrimental effect on uterine receptivity of high serum oestradiol concentrations in high and normal responder patients. , 1995, Human reproduction.