Role of Embryo pooling in Low ovarian reserve
Main Article Content
Abstract
Objective: To study the role of embryo pooling in low ovarian reserve.
Design: Retrospective analysis
Subjects: Forty-six (46) infertility patients with low ovarian reserve
Intervention: We had assessed 46 infertility patients with low ovarian reserve. All patients were started on dehydroepiandrosterone (DHEA) supplements. We had advised IVF with high dose hormones with pooling of embryo for 2 to 3 cycles with the criteria for getting at least 2 grade A embryos. First ovarian stimulation was done with antagonist protocol using Gonadotropins. Second stimulation was started in immediate next cycle with long agonist protocol. In 18 patients out of 46, third ovarian stimulation was done with antagonist protocol.
Main outcome measures: Pregnancy rate, clinical pregnancy rate and live birth rate were assessed.
Results: In 29 females, ovarian stimulation was done twice and in 18, three ovarian stimulations were done to pool embryos. In 3 patients, embryo transfer was not done as response was not good. Overall pregnancy rate was 44.4%, the clinical pregnancy rate was 35.5% and live birth rate was 26.6%.
Conclusions: Fertility treatment of patients with low ovarian reserve is challenging for fertility experts and assisted reproduction technologies are best option for these patients. Embryo pooling is the best option in these cases. But the couples should be properly counselled for the whole process, duration of treatment and the success rate of procedure. Further well-designed studies are required to predict the pregnancy rate and the clinical pregnancy rate more precisely.
Keywords:
Low ovarian reserve, embryo pooling, pregnancy rate and the clinical pregnancy rate
Article Details
How to Cite
BANERJEE, Dr Kaberi; SINGLA, Dr Bhavana; VERMA, Dr Priyanka.
Role of Embryo pooling in Low ovarian reserve.
Medical Research Archives, [S.l.], v. 13, n. 2, feb. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6325>. Date accessed: 17 mar. 2025.
doi: https://doi.org/10.18103/mra.v13i2.6325.
Section
Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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3. Abu-Musa A, Haahr T, Humaidan P. Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations. Int J Mol Sci. 2020 Mar 19;21(6):2110. doi: 10.3390/ijms210 62110. PMID: 32204404; PMCID: PMC7139860.
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5. Revelli A, Biasoni V, Gennarelli G, Canosa S, Dalmasso P, Benedetto C. IVF results in patients with very low serum AMH are significantly affected by chronological age. J Assist Reprod Genet. 2016 May;33(5):603-609. doi: 10.1007/s10815-016-067 5-7. Epub 2016 Feb 18. PMID: 26888025; PMCID: PMC4870438.
6. Rasool S, Shah D. Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel's back. Fertil Res Pract. 2017 Oct 11;3:15. doi: 10.1186/s40738-017-0041-1. PMID: 29046817; PMCID: PMC5637249.
7. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011 Jul;26(7): 1768-74. doi: 10.1093/humrep/der106. Epub 2011 May 10. PMID: 21558332.
8. Cobo A, Garrido N, Crespo J, José R, Pellicer A. Accumulation of oocytes: a new strategy for managing low-responder patients. Reprod Biomed Online. 2012 Apr;24(4):424-32. doi: 10.1016/j.rbm o.2011.12.012. Epub 2012 Jan 8. PMID: 22386762.
9.https://dhr.gov.in/sites/default/files/ART%20Rules%202022%20notification%20dated%2007062022%20published%20on%2008%20june.pdf
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11. Vermey BG, Chua SJ, Zafarmand MH et al. Is there an association between oocyte number and embryo quality? A systematic review and meta-analysis. Reprod Biomed Online. 2019 Nov;39(5): 751-763. doi: 10.1016/j.rbmo.2019.06.013. Epub 2019 Jul 3. PMID: 31540848.
12. Liu R, Zhang Q, Geng L et al. What is the optimal number of embryos to transfer for POSEIDON group 1 and group 2? A retrospective study. J Ovarian Res. 2024 May 31;17(1):117. doi: 10.1186/s13048-024-01443-y. PMID: 38822354; PMCID: PMC1114 0960.
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14. Kamath MS, Mascarenhas M, Kirubakaran R, Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev. 2020 Aug 21;8(8):CD003416. doi: 10.1002/14651858.C D003416.pub5. PMID: 32827168; PMCID: PMC80 94586.
15. Neblett MF 2nd, Kim T, Jones TL et al. Is there still a role for a cleavage-stage embryo transfer? F S Rep. 2021 Jun 29;2(3):269-274. doi: 10.1016/j.xfr e.2021.06.004. PMID: 34553150; PMCID: PMC844 1559.
16. Fernández-Shaw S, Cercas R, Braña C, Villas C, Pons I. Ongoing and cumulative pregnancy rate after cleavage-stage versus blastocyst-stage embryo transfer using vitrification for cryopreservation: impact of age on the results. J Assist Reprod Genet. 2015 Feb;32(2):177-84. doi: 10.1007/s10815-014-0387-9. Epub 2014 Nov 18. PMID: 25403438; PMCID: PMC4354180.
17. Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2016 Jun 30;(6):CD002118. doi: 10.1002/146 51858.CD002118.pub5. Update in: Cochrane Database Syst Rev. 2022 May 19;5:CD002118. PMID: 27357126.
18. Gleicher N, Kushnir VA, Barad DH. Risks of spontaneously and IVF-conceived singleton and twin pregnancies differ, requiring reassessment of statistical premises favoring elective single embryo transfer (eSET). Reprod Biol Endocrinol. 2016 May 3;14(1):25. doi: 10.1186/s12958-016-0160-2. PMID: 27142226; PMCID: PMC4855800.
19. Practice Committee of the American Society for Reproductive Medicine. Electronic address: [email protected]; Practice Committee of the Society for Assisted Reproductive Technology. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2017 Apr;107(4):901-903. doi: 10.1016/j.fertnstert.201 7.02.107. Epub 2017 Mar 11. PMID: 28292618.
20. Masschaele T, Gerris J, Vandekerckhove F, De Sutter P. Does transferring three or more embryos make sense for a well-defined population of infertility patients undergoing IVF/ICSI? Facts Views Vis Obgyn. 2012;4(1):51-8. PMID: 24753889; PMCID: PMC3991445.
21. Greco E, Litwicka K, Arrivi C et al. Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study. J Assist Reprod Genet. 2013 Nov;30(11):1465-70. doi: 10.1007/s10815-013-0103-1. PMID: 24077861; PMCID: PMC3879935.
22. Vora AV, Nadkarni P, Singh P N, Nadkarni V, Nadkarni A.Case reports for embryo banking - for women who want their own. Int JReprod Contracept Obstet Gynecol 2019;8:2926-31.
23. Lee KS, Lin MH, Hwu YM, Yang JH, Lee RK. The live birth rate of vitrified oocyte accumulation for managing diminished ovarian reserve: a retrospective cohort study. J Ovarian Res. 2023 Mar 3;16(1):49. doi: 10.1186/s13048-023-01128-y. PMID: 36869354; PMCID: PMC9983267.
24. Trokoudes KM, Pavlides C, Zhang X. Comparison outcome of fresh and vitrified donor oocytes in an egg-sharing donation program. Fertil Steril. 2011 May;95(6):1996-2000. doi: 10.1016/j.fe rtnstert.2011.02.035. Epub 2011 Mar 15. PMID: 21406304.
25. Domingues TS, Aquino AP, Barros B et al. Egg donation of vitrified oocytes bank produces similar pregnancy rates by blastocyst transfer when compared to fresh cycle. J Assist Reprod Genet. 2017 Nov;34(11):1553-1557. doi: 10.1007/s10815-017-1017-0. Epub 2017 Aug 16. PMID: 28815355; PMCID: PMC5699994.
26. Setti AS, Braga DPAF, Iaconelli A, Borges E. Fresh oocyte cycles yield improved embryo quality compared with frozen oocyte cycles in an egg-sharing donation programme. Zygote. 2021 Jun;29(3):234-238. doi: 10.1017/S0967199420000842. Epub 2021 Jan 18. PMID: 33455591.
27. Sadeghi MR. Oocytes/Embryos Banking: A Vague Hope for Poor Responder Women. J Reprod Infertil. 2018 Jul-Sep;19(3):123-124. PMID: 30167391; PMCID: PMC6104429.
28. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. Electronic address: [email protected]. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2021 Sep;116(3):651-654. doi: 10.1016/j.fertnstert.202 1.06.050. Epub 2021 Jul 28. PMID: 34330423.
29. Çelik S, Turgut NE, Cengiz Çelik D et al. The effect of the pooling method on the live birth rate in poor ovarian responders according to the Bologna criteria. Turk J Obstet Gynecol. 2018 Mar; 15(1):39-45. doi: 10.4274/tjod.62447. Epub 2018 Mar 29. PMID: 29662715; PMCID: PMC5894535
30. McCormack CD, Leemaqz SY, Furness DL, Dekker GA, Roberts CT. Anti-Müllerian hormone levels in recurrent embryonic miscarriage patients are frequently abnormal, and may affect pregnancy outcomes. J Obstet Gynaecol. 2019 Jul;39(5):623-627. doi: 10.1080/01443615.2018.1552669. Epub 2019 Mar 27. PMID: 30917731.
31. Busnelli A, Somigliana E, Cirillo F, Levi-Setti PE. Is diminished ovarian reserve a risk factor for miscarriage? Results of a systematic review and meta-analysis. Hum Reprod Update. 2021 Oct 18;27(6):973-988. doi:10.1093/humupd/dmab018. PMID: 34254138.
32. Blumenfeld Z. What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF? Front Endocrinol (Lausanne). 2020 Apr 17;11:192. doi: 10.3389/fendo.2020.00192. PMID: 32362870; PMCID: PMC7180183.
33. Davis OK. IVF stimulation: protocols for poor responders. Methods Mol Biol. 2014;1154: 329-41. doi: 10.1007/978-1-4939-0659-8_15. PMID: 24782017.
34. Jeve YB, Bhandari HM. Effective treatment protocol for poor ovarian response: A systematic review and meta-analysis. J Hum Reprod Sci. 2016 Apr-Jun;9(2):70-81. doi: 10.4103/0974-1208.183515. PMID: 27382230; PMCID: PMC4915289.
35. Katsika ET, Bosdou JK, Goulis DG, Grimbizis GF, Kolibianakis EM. Higher live birth rate following transdermal testosterone pretreatment in poor responders: a systematic review and meta-analysis. Reprod Biomed Online. 2023 Jan;46(1):81-91. doi: 10.1016/j.rbmo.2022.09.022. Epub 2022 Oct 7. PMID: 36369150.
36. Caligara C, Navarro J, Vargas G, Simón C, Pellicer A, Remohí J. The effect of repeated controlled ovarian stimulation in donors. Hum Reprod. 2001 Nov;16(11):2320-3. doi: 10.1093/humrep/16.11.2320. PMID: 11679512.
37. Pailis M, Sapir O, Lande Y et al. Consecutive ovarian stimulation is beneficial in patients with a poor response to high-dose follicle-stimulating hormone. Gynecol Endocrinol. 2021 Nov;37(11): 995-999. doi: 10.1080/09513590.2021.1908991. Epub 2021 Apr 9. PMID: 33834936.
38. Silverberg KM, Klein NA, Burns WN, Schenken RS, Olive DL. Consecutive versus alternating cycles of ovarian stimulation using human menopausal gonadotrophin. Hum Reprod. 1992 Aug;7(7):940-4. doi: 10.1093/oxfordjournal s.humrep.a137775. PMID: 1430133.
39. Ron-El R, Raziel A, Herman A et al. Ovarian response in repetitive cycles induced by menotrophin alone or combined with gonadotrophin releasing hormone analogue. Hum Reprod. 1990 May;5(4): 427-30. doi: 10.1093/oxfordjournals.humrep.a137116. PMID: 2141846.
2. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L; ESHRE working group on Poor Ovarian Response Definition. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011 Jul;26(7):1616-24. doi: 10.1093/humrep/der092. Epub 2011 Apr 19. PMID: 21505041.
3. Abu-Musa A, Haahr T, Humaidan P. Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations. Int J Mol Sci. 2020 Mar 19;21(6):2110. doi: 10.3390/ijms210 62110. PMID: 32204404; PMCID: PMC7139860.
4. Zhao D, Fan J, Wang P, Jiang X, Yao J, Li X. Age-specific definition of low anti-Mullerian hormone and associated pregnancy outcome in women undergoing IVF treatment. BMC Pregnancy Childbirth. 2021 Mar 5;21(1):186. doi: 10.1186/s12 884-021-03649-0. PMID: 33673814; PMCID: PMC7 936413.
5. Revelli A, Biasoni V, Gennarelli G, Canosa S, Dalmasso P, Benedetto C. IVF results in patients with very low serum AMH are significantly affected by chronological age. J Assist Reprod Genet. 2016 May;33(5):603-609. doi: 10.1007/s10815-016-067 5-7. Epub 2016 Feb 18. PMID: 26888025; PMCID: PMC4870438.
6. Rasool S, Shah D. Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel's back. Fertil Res Pract. 2017 Oct 11;3:15. doi: 10.1186/s40738-017-0041-1. PMID: 29046817; PMCID: PMC5637249.
7. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011 Jul;26(7): 1768-74. doi: 10.1093/humrep/der106. Epub 2011 May 10. PMID: 21558332.
8. Cobo A, Garrido N, Crespo J, José R, Pellicer A. Accumulation of oocytes: a new strategy for managing low-responder patients. Reprod Biomed Online. 2012 Apr;24(4):424-32. doi: 10.1016/j.rbm o.2011.12.012. Epub 2012 Jan 8. PMID: 22386762.
9.https://dhr.gov.in/sites/default/files/ART%20Rules%202022%20notification%20dated%2007062022%20published%20on%2008%20june.pdf
10. Tal R, Seifer DB, Wantman E, Baker V, Tal O. Antimüllerian hormone as a predictor of live birth following assisted reproduction: an analysis of 85,062 fresh and thawed cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for 2012-2013. Fertil Steril. 2018 Feb;109(2):258-265. doi: 10.1016/j.fert nstert.2017.10.021. Epub 2018 Jan 11. PMID: 2933 1235.
11. Vermey BG, Chua SJ, Zafarmand MH et al. Is there an association between oocyte number and embryo quality? A systematic review and meta-analysis. Reprod Biomed Online. 2019 Nov;39(5): 751-763. doi: 10.1016/j.rbmo.2019.06.013. Epub 2019 Jul 3. PMID: 31540848.
12. Liu R, Zhang Q, Geng L et al. What is the optimal number of embryos to transfer for POSEIDON group 1 and group 2? A retrospective study. J Ovarian Res. 2024 May 31;17(1):117. doi: 10.1186/s13048-024-01443-y. PMID: 38822354; PMCID: PMC1114 0960.
13. Hu X, Ding C, Zhang D et al. Embryo pooling: a promising strategy for managing insufficient number of embryos in preimplantation genetic diagnosis. Gynecol Endocrinol. 2017 Nov; 33(11):867-871. doi: 10.1080/09513590.2017.134 7778. Epub 2017 Jul 6. PMID: 28682646.
14. Kamath MS, Mascarenhas M, Kirubakaran R, Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev. 2020 Aug 21;8(8):CD003416. doi: 10.1002/14651858.C D003416.pub5. PMID: 32827168; PMCID: PMC80 94586.
15. Neblett MF 2nd, Kim T, Jones TL et al. Is there still a role for a cleavage-stage embryo transfer? F S Rep. 2021 Jun 29;2(3):269-274. doi: 10.1016/j.xfr e.2021.06.004. PMID: 34553150; PMCID: PMC844 1559.
16. Fernández-Shaw S, Cercas R, Braña C, Villas C, Pons I. Ongoing and cumulative pregnancy rate after cleavage-stage versus blastocyst-stage embryo transfer using vitrification for cryopreservation: impact of age on the results. J Assist Reprod Genet. 2015 Feb;32(2):177-84. doi: 10.1007/s10815-014-0387-9. Epub 2014 Nov 18. PMID: 25403438; PMCID: PMC4354180.
17. Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2016 Jun 30;(6):CD002118. doi: 10.1002/146 51858.CD002118.pub5. Update in: Cochrane Database Syst Rev. 2022 May 19;5:CD002118. PMID: 27357126.
18. Gleicher N, Kushnir VA, Barad DH. Risks of spontaneously and IVF-conceived singleton and twin pregnancies differ, requiring reassessment of statistical premises favoring elective single embryo transfer (eSET). Reprod Biol Endocrinol. 2016 May 3;14(1):25. doi: 10.1186/s12958-016-0160-2. PMID: 27142226; PMCID: PMC4855800.
19. Practice Committee of the American Society for Reproductive Medicine. Electronic address: [email protected]; Practice Committee of the Society for Assisted Reproductive Technology. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2017 Apr;107(4):901-903. doi: 10.1016/j.fertnstert.201 7.02.107. Epub 2017 Mar 11. PMID: 28292618.
20. Masschaele T, Gerris J, Vandekerckhove F, De Sutter P. Does transferring three or more embryos make sense for a well-defined population of infertility patients undergoing IVF/ICSI? Facts Views Vis Obgyn. 2012;4(1):51-8. PMID: 24753889; PMCID: PMC3991445.
21. Greco E, Litwicka K, Arrivi C et al. Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study. J Assist Reprod Genet. 2013 Nov;30(11):1465-70. doi: 10.1007/s10815-013-0103-1. PMID: 24077861; PMCID: PMC3879935.
22. Vora AV, Nadkarni P, Singh P N, Nadkarni V, Nadkarni A.Case reports for embryo banking - for women who want their own. Int JReprod Contracept Obstet Gynecol 2019;8:2926-31.
23. Lee KS, Lin MH, Hwu YM, Yang JH, Lee RK. The live birth rate of vitrified oocyte accumulation for managing diminished ovarian reserve: a retrospective cohort study. J Ovarian Res. 2023 Mar 3;16(1):49. doi: 10.1186/s13048-023-01128-y. PMID: 36869354; PMCID: PMC9983267.
24. Trokoudes KM, Pavlides C, Zhang X. Comparison outcome of fresh and vitrified donor oocytes in an egg-sharing donation program. Fertil Steril. 2011 May;95(6):1996-2000. doi: 10.1016/j.fe rtnstert.2011.02.035. Epub 2011 Mar 15. PMID: 21406304.
25. Domingues TS, Aquino AP, Barros B et al. Egg donation of vitrified oocytes bank produces similar pregnancy rates by blastocyst transfer when compared to fresh cycle. J Assist Reprod Genet. 2017 Nov;34(11):1553-1557. doi: 10.1007/s10815-017-1017-0. Epub 2017 Aug 16. PMID: 28815355; PMCID: PMC5699994.
26. Setti AS, Braga DPAF, Iaconelli A, Borges E. Fresh oocyte cycles yield improved embryo quality compared with frozen oocyte cycles in an egg-sharing donation programme. Zygote. 2021 Jun;29(3):234-238. doi: 10.1017/S0967199420000842. Epub 2021 Jan 18. PMID: 33455591.
27. Sadeghi MR. Oocytes/Embryos Banking: A Vague Hope for Poor Responder Women. J Reprod Infertil. 2018 Jul-Sep;19(3):123-124. PMID: 30167391; PMCID: PMC6104429.
28. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. Electronic address: [email protected]. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2021 Sep;116(3):651-654. doi: 10.1016/j.fertnstert.202 1.06.050. Epub 2021 Jul 28. PMID: 34330423.
29. Çelik S, Turgut NE, Cengiz Çelik D et al. The effect of the pooling method on the live birth rate in poor ovarian responders according to the Bologna criteria. Turk J Obstet Gynecol. 2018 Mar; 15(1):39-45. doi: 10.4274/tjod.62447. Epub 2018 Mar 29. PMID: 29662715; PMCID: PMC5894535
30. McCormack CD, Leemaqz SY, Furness DL, Dekker GA, Roberts CT. Anti-Müllerian hormone levels in recurrent embryonic miscarriage patients are frequently abnormal, and may affect pregnancy outcomes. J Obstet Gynaecol. 2019 Jul;39(5):623-627. doi: 10.1080/01443615.2018.1552669. Epub 2019 Mar 27. PMID: 30917731.
31. Busnelli A, Somigliana E, Cirillo F, Levi-Setti PE. Is diminished ovarian reserve a risk factor for miscarriage? Results of a systematic review and meta-analysis. Hum Reprod Update. 2021 Oct 18;27(6):973-988. doi:10.1093/humupd/dmab018. PMID: 34254138.
32. Blumenfeld Z. What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF? Front Endocrinol (Lausanne). 2020 Apr 17;11:192. doi: 10.3389/fendo.2020.00192. PMID: 32362870; PMCID: PMC7180183.
33. Davis OK. IVF stimulation: protocols for poor responders. Methods Mol Biol. 2014;1154: 329-41. doi: 10.1007/978-1-4939-0659-8_15. PMID: 24782017.
34. Jeve YB, Bhandari HM. Effective treatment protocol for poor ovarian response: A systematic review and meta-analysis. J Hum Reprod Sci. 2016 Apr-Jun;9(2):70-81. doi: 10.4103/0974-1208.183515. PMID: 27382230; PMCID: PMC4915289.
35. Katsika ET, Bosdou JK, Goulis DG, Grimbizis GF, Kolibianakis EM. Higher live birth rate following transdermal testosterone pretreatment in poor responders: a systematic review and meta-analysis. Reprod Biomed Online. 2023 Jan;46(1):81-91. doi: 10.1016/j.rbmo.2022.09.022. Epub 2022 Oct 7. PMID: 36369150.
36. Caligara C, Navarro J, Vargas G, Simón C, Pellicer A, Remohí J. The effect of repeated controlled ovarian stimulation in donors. Hum Reprod. 2001 Nov;16(11):2320-3. doi: 10.1093/humrep/16.11.2320. PMID: 11679512.
37. Pailis M, Sapir O, Lande Y et al. Consecutive ovarian stimulation is beneficial in patients with a poor response to high-dose follicle-stimulating hormone. Gynecol Endocrinol. 2021 Nov;37(11): 995-999. doi: 10.1080/09513590.2021.1908991. Epub 2021 Apr 9. PMID: 33834936.
38. Silverberg KM, Klein NA, Burns WN, Schenken RS, Olive DL. Consecutive versus alternating cycles of ovarian stimulation using human menopausal gonadotrophin. Hum Reprod. 1992 Aug;7(7):940-4. doi: 10.1093/oxfordjournal s.humrep.a137775. PMID: 1430133.
39. Ron-El R, Raziel A, Herman A et al. Ovarian response in repetitive cycles induced by menotrophin alone or combined with gonadotrophin releasing hormone analogue. Hum Reprod. 1990 May;5(4): 427-30. doi: 10.1093/oxfordjournals.humrep.a137116. PMID: 2141846.