The aim of this study is to compare the effectiveness of testosterone,estradiol and a combined treatment with estrogens/progestagens prior to IVF-ICSI in previously diagnosed low responder patients.
During controlled ovarian hyperstimulation (COH), most of the early antral follicles are required to grow coordinately. Marked follicular size discrepancies during COH imply that an important number of follicles undergo unsatisfactory maturation. It has been proved that follicular priming with estradiol during the luteal phase of the cycle prior to COH or testosterone treatment during the early follicular phase of the COH cycle may increase the amount of oocytes and embryos retrieved. Nevertheless there are no prospective studies comparing such approaches. The present study consist of two phases: The present study consists of two different phases: * Phase I: (Non randomized) Identification of confirmed low responder patients. Potential low responder patients will be subjected to an standardized ovarian hyperstimulation protocol * Phase II: (Randomized) those patients, once confirmed as low responders, will be offered the opportunity to enter the interventional part of the study, being randomized to three different treatment groups: estradiol, testosterone or combined progestagens and estrogens prior to the IVF-ICSI cycle. The previous cycle (phase I) will be used as a self-control for each patient.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
66
Transdermal testosterone (20µg/kg/day)from day 24 of the previous cycle to day 2 of the ICSI cycle
Transdermal estradiol (200µg/day)from day 20 of the previous cycle to day 3 of the ICSI cycle
(150µg Desogestrel + 30µg Ethinylestradiol)/day during the luteal phase of the two cycles prior to the ICSI. Valerate estradiol 4mg/day during 10 days, starting the second day of the cycle prios to the ICSI cycle.
La Fe University Hospital. Department of Obstetrics and Gynecology
Valencia, Spain
Number of MII oocytes retrieved
Time frame: 36h after GnRH analogue administration
Total number of follicles punctured
Time frame: 36h after GnRH analogue administration
Total number of oocytes retrieved
Time frame: 36h after GnRH analogue administration
Total number of viable embryos
Time frame: 48h after follicular puncture
Serum and Follicular hormonal levels (testosterone, androstenedione, estradiol)
Time frame: 36h after GnRH analogue administration
Granulosa cells genetic expression profile
Time frame: 36h after GnRH analogue administration
Implantation rate
Time frame: 15 days after embryo transfer
Pregnancy rate
Time frame: 15 days after embryo transfer
Clinical pregnancy rate
Time frame: 5 weeks after embryo transfer
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