ART Outcomes in WHO Class I Anovulation: A Case-control Study

Han, Ae Ra; Park, Chan Woo; Cha, Sun Wha; Kim, Hye Ok; Yang, Kwang Moon; Kim, Jin Young; Koong, Mi Kyoung; Kang, Inn Soo; Song, In Ok

Abstract

OBJECTIVE
To investigate assisted reproductive technology (ART) outcomes in women with WHO class I anovulation compared with control group. DESIGN: Retrospective case-control study.
METHODS
Twenty-three infertile women with hypogonadotropic hypogonadism (H-H) who undertook ART procedure from August 2003 to January 2009 were enrolled in this study. A total of 59 cycles (H-H group) were included; Intra-uterine insemination with super-ovulation (SO-IUI, 32 cycles), in vitro fertilization with fresh embryo transfer (IVF-ET, 18 cycles) and subsequent frozenthawed embryo transfer (FET, 9 cycles). Age and BMI matched 146 cycles of infertile women were collected as control group; 64 cycles of unexplained infertile women for SO-IUI and 54 cycles of IVF-ET and 28 cycles of FET with tubal factor. We compared ART and pregnancy outcomes such as clinical pregnancy rate (CPR), clinical abortion rate (CAR), and live birth rate (LBR) between the two groups.
RESULTS
There was no difference in the mean age (32.7+/-3.3 vs. 32.6+/-2.7 yrs) and BMI (21.0+/-3.1 vs. 20.8+/-3.1 kg/m2) between two groups. Mean levels of basal LH, FSH, and E2 in H-H group were 0.62+/-0.35 mIU/ml, 2.60+/-2.30 mIU/ml and 10.1+/-8.2 pg/ml, respectively. For ovarian stimulation, H-H group needed higher total amount of gonadotropin injected and longer duration for ovarian stimulation (p<0.001). In SO-IUI cycles, there was no significant difference of CPR, CAR, and LBR between the two groups. In IVF-ET treatment, H-H group presented higher mean E2 level on hCG day (3104.8+/-1020.2 pg/ml vs. 1878.3+/-1197.7 pg/ml, p<0.001) with lower CPR (16.7 vs. 37.0%, p=0.11) and LBR (5.6 vs. 33.3%, p=0.02) and higher CAR (66.7 vs. 10.0%, p=0.02) compared with the control group. However, subsequent FET cycles showed no significant difference of CPR, CAR, and LBR between the two groups.
CONCLUSION
H-H patients need higher dosage of gonadotropin and longer duration for ovarian stimulation compared with the control groups. Significantly poor pregnancy outcomes in IVF-ET cycles of H-H group may be due to detrimental endometrial factors caused by higher E2 level and the absence of previous hormonal exposure on endometrium.