The prognostic importance of the number of oocytes retrieved and estradiol levels in poor and normal responders in in vitro fertilization (IVF) treatment

  • Jehoshua Dor
  • Daniel S. Seidman
  • Izhar Ben-Shlomo
  • David Levran
  • Avraham Karasik
  • Shlomo Mashiach
Clinical Assisted Reproduction


A low response to ovarian stimulation in in vitro fertilization poses a unique therapeutic challenge. Gonadotropin-releasing hormone agonists (GnRHa) have been suggested as a modality for treatment of this condition. In this study, we analyzed the results of 880 in vitro fertilization treatment cycles with respect to modality of ovarian stimulation, degree of hormonal response, and number of oocytes retrieved. In patients with estradiol (E 2 )levels less than 501 pg/ml on the day of human chorionic gonadotropin administration, 27% pregnancy rate was achieved with clomiphene citrate (CC) combined with human menopausal gonadotropin (hMG), compared to 15.1% (P <0.005) with hMG alone and 20.8% (NS) with GnRHa and hMG. Pregnancy rates were not lower in these patients compared to patients with higher estradiol levels in the different stimulation protocols, but pregnancy rates were significantly lower in cycles during which three or fewer oocytes were retrieved, compared to those in which four or more oocytes were retrieved (10.8 vs 23.8%; P <0.0005). In low-retrieval cycles pregnancy rates actually decreased with increasing levels of estradiol. Our results indicate that the number of oocytes retrieved is a better prognostic parameter than E 2 levels in predicting the outcome of in vitro fertilization treatment and that GnRHa in the long protocol do not seem to be superior to CC combined with hMG for the treatment of poor responders.

Key words

poor responders ovarian stimulation in vitro fertilization 


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Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Jehoshua Dor
    • 1
  • Daniel S. Seidman
    • 1
  • Izhar Ben-Shlomo
    • 1
  • David Levran
    • 1
  • Avraham Karasik
    • 2
  • Shlomo Mashiach
    • 1
  1. 1.Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center and Sackler School of MedicineTel Aviv UniversityTel HashomerIsrael
  2. 2.Institute of EndocrinologyThe Chaim Sheba Medical CenterTel HashomerIsrael

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