RESUMO
Out of the many challenges in management of female factor infertility, poor responders and low response to stimulation in aged and even younger women, seems to be a common problem. It is very difficult to offer one particular management strategy or treatment protocol for optimum outcome in this group of women of poor responders. In a low resource set up, IVF (In vitro Fertilization) specialist doctors usually face a challenge in treating women with poor/ low ovarian reserve as ovum / gamete donation is considered as a taboo in various sections of society even today. Hence women insist on having an offspring of "their own" and vehemently deny ovum / gamete donations. In this article we discuss 2 cases of poor ovarian reserve retrospectively, who underwent multiple cycles of controlled ovarian hyperstimulation for embryo banking and ultimately achieved pregnancy. Both patients achieved pregnancy with the method of embryo banking. Embryo banking should be considered and discussed. Various articles have discussed the advantages and disadvantages of embryo banking or even oocytes accumulation. The advantages of this technique is patients with poor/low ovarian reserve get a chance to be pregnant with their own oocytes and also have a chance for vitrification of residual embryos. Another advantage in such patients is that the embryos can undergo PGS (Preimplantation Genetic Screening) techniques in cases of suspected genetic disorders. The disadvantage in a low resource set up like India is the cost of the treatment. Nevertheless, embryo banking and accumulation of oocytes should be given as an option for treatment of poor/ low ovarian reserve and could be considered as a ray of hope for all future mothers hoping for a child of "their own".
RESUMO
[Objective]To determine whether all-blastocyst-culture can benefit elderly infertile patients with low ovarian reserve.[Methods]To retrospectively analyze elderly patients with low ovarian reserve undergoing IVF/ICSI in Reproductive Medicine Re?search Center of the Sixth Affiliated Hospital of Sun Yat-sen University from May 2016 to April 2017.We divide them into group A (All-blastocyst-culture)and group B(None-blastocyst-culture)based on different culture approach of D3 transferrable embryo. To compare the cumulative biochemical pregnancy rate ,cumulative clinical pregnancy rate between them.[Results]A total of 231 eligi?ble patients are included,with130 in group A and 101 in group B. The basic conditions of the two groups show no difference. Cumula?tive biochemical pregnancy rate/clinical pregnancy rate in group A is higher than that of group B ,though the difference is not statisti?cally significant(P>0.05). After removing patients who did not undergo embryo transfer due to failure in blastocyst culture ,the cumu?lative biochemical pregnancy rate/clinical pregnancy rate in group A is significantly higher than group B(P<0.05). Multivariate analy?sis of the patient′s basic condition and the outcome of blastocyst culture showed that the number of D3 transferrable embryo was a risk factor for the failure of blastocyst culture(OR=0.277,95%CI:0.103~0.744,P<0.05).[Conclusion]All-blastocyst-culture will not adversely affect the pregnancy outcome of elderly infertile patients with low ovarian reserve. On the contrary ,once they obtain transfer?rable embryos, pregnancy outcome in All-Blastocyst-Culture group are better than None-Blastocyst-Culture group. A small number of D3 transferrable embryo is a risk factor for failure to culture blastocyst. If the patients were fully informed consent ,we can consider implementing all-blastocyst-culture for elderly infertile patients with low ovarian reserve.