Poor Ovarian Stimulation Response in In Vitro Fertilization (IVF) Program
Infertility
About this trial
This is an interventional screening trial for Infertility focused on measuring in vitro fertilization, controlled ovarian hyperstimulation, poor ovarian response, estrogen receptor 2 gene polymorphism, follicle stimulating hormone receptor gene polymorphism, anti-mullerian hormone
Eligibility Criteria
Inclusion Criteria:
- Women at or under the age of 35 years.
- Normal thyroid stimulating hormone and prolactin levels.
- Normal ovulatory cycles (25-35 interval days), together with proven patent fallopian tubes at hysterosalpingography or laparoscopy done within six cycles preceding the ICSI cycle.
- Presence of both ovaries with normal findings as assessed by trans-vaginal ultrasound and laparoscopy.
- All male partners had a normal semen analysis according to WHO criteria (WHO, 2010), done within 6 months preceding the ICSI cycle
Exclusion Criteria
- Chronic medical disorders such as diabetes.
- Previous inadequate response to ovulation induction.
- Polycystic ovary syndrome.
- Women who performed ovarian surgery and cases of endometriosis diagnosed by laparoscopy or suspected by ultrasound or CA-125 assay.
- Abnormal pelvic pathology or congenital anomalies.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Poor responders
Good responders
This group will include women who underwent IVF/ICSI cycle and produced 4 oocytes or less. intervention: fixed daily morning dose of Human menopausal gonadotrophin (HMG) Merional® intra-muscular injection ,starting on cycle day 2 and will be maintained for 9-11 days according to each individual ovarian response,at a dose of (300 IU). On cycle day 7, the GnRH antagonist Cetrorelix 0.25 mg Cetrotide® will be introduced as daily subcutaneous injections and continued till the day of ovulation triggering. Finally, when at least 3 follicles will reach 17 mm in diameter, ovulation will be triggered by a single intra-muscular injection of 10,000 IU of Human chorionic gonadotrophin (hCG) Choriomon®.
This group will include women who produced (5 or more oocytes) after COH. Intervention: fixed daily morning dose of Human menopausal gonadotrophin (HMG) Merional® intra-muscular injection ,starting on cycle day 2 and will be maintained for 9-11 days according to each individual ovarian response,at a dose of (225 IU) for participants with AMH levels > 1.5 ng/ml and/or FSH levels ≤ 8 mIU/ml On cycle day 7, the GnRH antagonist Cetrorelix 0.25 mg Cetrotide® will be introduced as daily subcutaneous injections and continued till the day of ovulation triggering. When at least 3 follicles will reach 17 mm in diameter, ovulation will be triggered by a single intra-muscular injection of 10,000 IU of Human chorionic gonadotrophin (hCG) Choriomon®.