Is the modified natural in vitro fertilization cycle justified in patients with "genuine" poor response to controlled ovarian hyperstimulation?

Alon Kedem, Abraham Tsur, Jigal Haas, Gil M. Yerushalmi, Ariel Hourvitz, Ronit Machtinger, Raoul Orvieto

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Objective To examine whether patients with poor ovarian response (POR) during conventional IVF/intracytoplasmic sperm injection (ICSI) treatment cycle may benefit from a modified natural cycle (MNC)-IVF. Design Cohort historic study. Setting Tertiary, university-affiliated medical center. Patient(s) One hundred eleven patients with POR, defined according to the Bologna criteria, who underwent a subsequent MNC-IVF within 3 months of the previous failed conventional IVF/ICSI cycle. The elimination of bias in this selection, for the purposes of this study, was achieved by including only a subgroup of "genuine" poor responder patients, those who yielded up to three oocytes after controlled ovarian hyperstimulation (COH) with a minimal gonadotropin daily dose of 300 IU. Intervention(s) Modified natural cycle IVF protocol with GnRH antagonist (GnRH-a) supplementation. Gonadotropin-releasing hormone antagonist treatment was started when a follicle of 13 mm was present. Two to three ampules of hMG were coadministered daily during the GnRH-a treatment. Main Outcome Measure(s) Live birth rate, pregnancy rate (PR), number of oocytes retrieved, and number of embryos transferred. Result(s) Live birth rate in "genuine" poor ovarian responders was <1%. Furthermore, in the subgroup of patients with POR who underwent a previous conventional IVF/ICSI cycle with a yield of only one oocyte, no pregnancies were achieved during the MNC-IVF cycle. Conclusion(s) Modified natural cycle-IVF is of no benefit for genuine poor ovarian responders and the option of egg donation should be seriously considered for this population.

Original languageEnglish
Pages (from-to)1624-1628
Number of pages5
JournalFertility and Sterility
Issue number6
StatePublished - 1 Jan 2014
Externally publishedYes


  • IVF
  • Modified natural cycle
  • poor response

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology


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