«DOUBLE STIMULATION» OF OVARIAN FUNCTION IN PATIENTS WITH DECREASED OVARIAN RESPONSE AND UTERINE MYOMA COMPARED WITH STIMULATION IN THE FOLLICULAR PHASE: A NON-RANDOMISED CONTROLLED TRIAL.

Krutova Victoria A., Golovko Anfisa K.

To increase the rate of clinical pregnancy in assisted reproductive technology programs in patients with reduced ovarian response and uterine myoma by ovarian stimulation in different phases of the same menstrual cycle. Materials and Methods: This prospective, controlled, non-randomized trial was conducted at the clinic of the Kuban State Medical University, Ministry of Health Care of Russia. The study enrolled 100 patients with reduced ovarian response and uterine myoma. Patients in the first group (n=50) with uterine myoma up to 4 cm underwent ovarian stimulation with a gonadotropin-releasing hormone antagonist (antGnRH) protocol during the follicular phase of the menstrual cycle. Patients in the second group (n=50) with uterine myomas 4-6 cm in diameter underwent 'double stimulation' in both the follicular and luteal phases of the menstrual cycle. All patients underwent cryopreservation of the embryos obtained. Blastocyst transfer was performed in the cryocycle. Group 2 patients underwent blastocyst transfer after surgical correction of uterine myoma. The number of oocytes, number of mature oocytes, number of blastocysts, and frequency of clinical pregnancy in the two groups were comparable. Results: Analysis of embryological data from the IVF/ICSI programme revealed a statistically significant increase in the number of oocytes received (p<0.002), mature oocytes (p<0.01), and mature blastocysts (p<0.01), high quality blastocysts (p<0.01) and cryopreserved blastocysts (p<0.01) in the 'double stimulation' group, which was higher than in the ovarian stimulation group during the follicular phase of the menstrual cycle. Conclusion: "Double stimulation" yields higher clinical pregnancy rates, сumulative-live-birth-delivery-rate and is effective for patients with decreased ovarian response and uterine myoma to preserve fertility.

Keywords:'double stimulation', in vitro fertilisation, decreased ovarian response, uterine myoma.