"Ovarian age-based" stimulation of young women with diminished ovarian reserve results in excellent pregnancy rates with in vitro fertilization

Objective: To determine whether pregnancy outcome can be positively affected if the ovarian stimulation in women with diminished ovarian reserve (DOR) is changed. Design: Case control study. Setting: Medical school-affiliated private infertility center. Patient(s): Sixty-two women, aged 26-35 years, with the diagnosis of DOR (study group) and 62 age-matched controls with apparently normal ovarian function (control group). Intervention(s): Study group patients received a modified (ovarian age-based) stimulation with microdose GnRH agonist (GnRH-a) and 450-600 IU of gonadotropin daily. Women in the control group received a standard "chronological age-based" stimulation with long luteal phase GnRH-a and up to 300 IU of gonadotropins (two patients in this group received an antagonist in place of an agonist). Main Outcome Measure(s): The IVF cycle outcome parameters, including pregnancy rates (PR). Result(s): Women with DOR and controls did not differ significantly in patient profiles or underlying infertility conditions and received identical embryo numbers at transfer. The DOR patients demonstrated a strong trend toward lower gravidity. Peak E₂ levels were similar between groups but controls produced significantly more oocytes, a strong trend toward more embryos and significantly more cycles of cryopreservation. Both groups achieved a 47% rate of first positive pregnancy test (hCG), with controls demonstrating a 39% and DOR patients a 32% ongoing PR. Conclusion(s): Women with DOR, if treated with an ovarian age-based rather than chronological age-based ovarian stimulation protocols, will demonstrate surprisingly good PR with IVF in comparison to women with normal ovarian function.