Comparison of ‘poor’ responders with ‘good’ responders using a standard buserelin/human menopausal gonadotrophin regime for in-vitro fertilization

This study identifies a group of 87 patients, who demonstrated a ‘poor’ response to a standard buserelin/human menopausal gonadotrophin (HMG) regime. The subsequent outcome in 61 of these ‘poor’ responders when treated with a higher dose of HMG to achieve a satisfactory response was compared with 250 patients, who showed a ‘good’ response to the standard regime. ‘Poor’ responders were significantly older than ‘good’ responders (P < 0.001), but no significant difference was demonstrated in the indication for in-vitro fertilization (IVF). Even on higher doses of HMG, ‘poor’ responders took longer for their follicles to achieve maturity than the ‘good’ responders (P < 0.01). ‘Poor’ responders produced 8.9 oocytes per oocyte collection compared to 11.8 in the ‘good’ responders (P < 0.01). The fertilization rate was significantly lower in the ‘poor’ responders compared to the ‘good’ responders (P < 0.01). Although there was no significant difference in morphometric grading between ‘poor’ responder embryos and ‘good’ responder embryos, the rate of cell division was significantly slower in embryos of the ‘poor’ responders than the ‘good’ responders (P < 0.01). The pregnancy rate per oocyte retrieval was 9% in the ‘poor’ responders compared to 29% in the ‘good’ responders (P < 0.01). The implantation rate in the ‘poor’ responders was 4.4% compared to 16.1% in the ‘good’ responders (P < 0.001).