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Title: Interventions for poor responders undergoing in vitro fertilisation treatment
Author: Sunkara, Sesh
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2013
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This thesis examines the various interventions proposed for the management of poor responders undergoing IVF treatment. I began by performing a systematic review and meta-analysis to identify the ideal controlled ovarian hyperstimulation (COH) regimen for women with poor ovarian response undergoing IVF. The systematic review found the evidence to be inconsistent and inconclusive. The poor responders intervention trial (PRINT) was thus conceived. PRINT is an RCT comparing the gonadotrophin releasing hormone (GnRH) agonist long versus the GnRH agonist short versus the GnRH antagonist regimens for poor responders undergoing IVF. Results of PRINT showed the GnRH agonist long regimen to be efficacious. The relationship between egg numbers and live birth following IVF is poorly understood. I set out to investigate this by examining a large cohort of IVF cycles. I was able to demonstrate a strong association between egg numbers and live birth following IVF and justify the use of egg numbers as a primary outcome for PRINT. A frequent scenario faced in the management of women who have a poor response is whether to continue with their current IVF cycle or to cancel and start again on the assumption that there could be intercycle variability. I examined this hypothesis by comparing two consecutive IVF cycles with identical COH regimens. There was no significant intercycle variability in poor responders suggesting that the more cost effective option would be to continue with the IVF cycle Over the last decade a number of studies have been published on the use of androgen supplementation in poor responders. I conducted a systematic review and meta-analysis which demonstrated potential benefit from androgen supplementation but highlighted the shortcomings in the existing evidence. Finally, I conclude my thesis by examining the evidence behind some common clinical practices in the management of poor responders with suggestions for future research.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available