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Kahyaoglu I, Tutkun Kilinc EC, Gulerman C, Yilmaz N, Ceran MU, Bardakci Y, Engin Ustun Y. Early or late response in poor responders: does it make a difference in cycle outcome? HUM FERTIL 2023; 26:1485-1490. [PMID: 37325892 DOI: 10.1080/14647273.2023.2197627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/08/2022] [Indexed: 06/17/2023]
Abstract
Ovarian response to stimulation mainly determines the length of stimulation. However, there is no clarity in the literature regarding the optimal duration required to achieve oocyte maturity in patients with the poor ovarian response (POR) defined by Bologna criteria. Therefore, a total of 267 cycles that fulfilled the inclusion criteria were selected retrospectively. Group A constitute of patients with a stimulation period < 9 d (n = 70); and group B included patients with a stimulation period ≥ 9 d (n = 133). The results showed that antral follicle count (5.72 ± 1.82 vs. 5.10 ± 1.78, p = 0.023), serum oestradiol level on hCG day (1286.88 ± 778.18 pg/mL vs. 820.14 ± 479.04 pg/mL, p = 0.001), and total gonadotropin dose used (2949.53 ± 727.92 IU vs 2020.94 ± 415.17 IU, p = 0.0001) were higher in group B when compared to group A. Although the number of total (5.47 ± 3.32 vs 3.86 ± 2.15, p = 0.0001) and mature oocytes retrieved (4.34 ± 2.88 vs 2.84 ± 1.67, p = 0.0001) were higher in group B, no significant difference was observed in the pregnancy rates between groups (25.6 vs 15.7%, p > 0.05). In conclusion, no deleterious effect of a shorter duration of stimulation on cycle outcome was seen in patients with POR.
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Affiliation(s)
- Inci Kahyaoglu
- Department of Reproductive Endocrinology, Etlik Zubeyde Hanim Women's Health Hospital, University of Health Sciences, Ankara, Turkey
| | - Elif Ceren Tutkun Kilinc
- Department of Gynecology and Obstetrics, Gaziantep Abdulkadir Yuksel Government Hospital, Gaziantep, Turkey
| | - Cavidan Gulerman
- Department of Reproductive Endocrinology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Nafiye Yilmaz
- Department of Reproductive Endocrinology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Ufuk Ceran
- Department of Gynecology and Obstetrics, Baskent University School of Medicine, Konya Medical and Research Center, Selcuklu, Konya, Turkey
| | - Yesim Bardakci
- Department of Embryology, Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Ustun
- Department of Reproductive Endocrinology, Etlik Zubeyde Hanim Women's Health Hospital, University of Health Sciences, Ankara, Turkey
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Alvarado Franco CA, Bernabeu García A, Suñol Sala J, Guerrero Villena J, Albero Amorós S, Llacer J, Delgado Navas RA, Ortiz JA, Pitas A, Castillo Farfan JC, Bernabeu Pérez R. Conventional ovarian stimulation vs. delayed single dose corifollitropin alfa ovarian stimulation in oocyte donors: a prospective randomized study. Tail trial. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1239175. [PMID: 37965590 PMCID: PMC10642283 DOI: 10.3389/frph.2023.1239175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
The present study compares two protocols for ovarian controlled stimulation in terms of number of cumulus-oocyte complexes and metaphase II oocytes. We employed a single injection of 150mcg of corifollitropin alfa after a 7-day oral contraceptive pill-free interval for TAIL group and a conventional administration of corifollitropin alfa after a 5-day OCP-free interval with additional rFSH from 8th of ovarian controlled stimulation. Prospective, randomized, comparative, non-inferiority, opened and controlled trial carried out in 180 oocyte donors 31 were excluded, 81 were randomized to the control group and 68 to the TAIL group. No differences were found in the number of follicles larger than 14 and 17 mm at triggering day. However, a lower number of cumulus-oocyte complexes and metaphase II oocytes were obtained in TAIL group compared to the control group, expressed as median (interquartile range): 10.5 (5.5-19) vs. 14 [11-21] and 9 (4-13) vs. 12 (9-17) respectively. Additionally, the incidence of failed retrieval or metaphase II oocytes = 0 was higher in TAIL group 7(10.3%) vs. 1(1.2%) p = 0.024. The use of a single injection of corifollitropin alfa after a 7-day oral contraceptive pill-free interval in oocyte donors resulted in a lower number of cumulus-oocyte complexes and metaphase II oocytes. No additional rFSH was administered in this group. Clinical Trial Registration: https://www.clinicaltrialsregister.eu/ctr-search/trial/2019-001343-44/results.
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Affiliation(s)
| | | | - Jordi Suñol Sala
- Department of Gynecology, Instituto Bernabeu, Palma de Mallorca, Spain
| | | | | | - Joaquin Llacer
- Department of Gynecology, Instituto Bernabeu, Alicante, Spain
| | | | | | - Anna Pitas
- Clinical Trials Project Manager, Instituto Bernabeu, Alicante, Spain
| | - Juan Carlos Castillo Farfan
- Department of Gynecology, Instituto Bernabeu, Alicante, Spain
- Community Medicine and Reproductive Health Chair, Miguel Hernandez University, Elche, Spain
| | - Rafael Bernabeu Pérez
- Community Medicine and Reproductive Health Chair, Miguel Hernandez University, Elche, Spain
- Management Department, Instituto Bernabeu, Alicante, Spain
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Zhao X, Zhang X, Wu S, Tan J. Association Between the Ratio of Ovarian Stimulation Duration to Original Follicular Phase Length and In Vitro Fertilization Outcomes: A Novel Index to Optimise Clinical Trigger Time. Front Endocrinol (Lausanne) 2022; 13:862500. [PMID: 35957813 PMCID: PMC9361069 DOI: 10.3389/fendo.2022.862500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
The duration of ovarian stimulation which is largely dependent on the ovarian response to hormonal stimulation may influence in vitro fertilization (IVF) outcomes. Menstrual cycle length is potentially a good indicator of ovarian reserve and can predict ovarian response. Ovarian stimulation and the follicular phase of the menstrual cycle are both processes of follicular development. There is no published research to predict the duration of ovarian stimulation based on the length of the menstrual cycle. Our retrospective cohort study included 6110 women with regular menstrual cycles who underwent their first IVF treatment between January 2015 and October 2020. Cycles were classified according to quartiles of the ratio of ovarian stimulation duration to original follicular phase length (OS/FP). Multivariate generalized linear models were applied to assess the association between OS/FP and IVF outcomes. The odds ratio (OR) or relative risk (RR) was estimated for each quartile with the lowest quartile as the comparison group. OS/FP of 0.67 to 0.77 had more retrieved and mature oocytes (adjusted RR 1.11, 95% confidence interval [CI] 1.07-1.15, p for trend = 0.001; adjusted RR 1.14, 95% CI 1.09-1.19, p for trend = 0.001). OS/FP of 0.67 to 0.77 showed the highest rate of fertilization (adjusted OR 1.11, 95% CI 1.05-1.17, p for trend = 0.001). OS/FP > 0.77 had the lowest rate of high-quality blastocyst formation (adjusted OR 0.81, 95% CI 0.71-0.93, p for trend = 0.01). No apparent association was noted between OS/FP and clinical pregnancy, live birth, or early miscarriage rate. In conclusion, OS/FP has a significant effect on the number of oocytes, fertilization rate, and high-quality blastocyst formation rate. MCL could be used to predict the duration of ovarian stimulation with an OS/FP of 0.67 to 0.77, which provides a new indicator for the individualized clinical optimization of the trigger time.
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Affiliation(s)
- Xinyang Zhao
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Xu Zhang
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Shanshan Wu
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Jichun Tan
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
- *Correspondence: Jichun Tan,
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Hsu LT, Chin TH, Huang SY, Yang LY, Pan YB, Chang CL. A short length of gonadotropin hyperstimulation is sufficient to achieve an optimal IVF outcome in advance-aged women. Taiwan J Obstet Gynecol 2021; 60:1047-1053. [PMID: 34794736 DOI: 10.1016/j.tjog.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To analyze the duration of gonadotropin hyperstimulation's impacts on oocyte quality and clinical outcomes in aged in vitro fertilization (IVF) patients. MATERIALS AND METHODS This retrospective study was carried out using IVF records of the Chang Gung Memorial Hospital IVF center from January 2017 to December 2019. A total of 308 IVF cycles with patients aged 40-44 years were included. Clinical characteristics of patients who received a short controlled ovarian hyperstimulation (COH) (i.e., 6-7 days; s-COH group) or a long COH treatment (i.e., 9-10 days; l-COH group) were compared. In addition, analysis was conducted using data within two age subgroups: 40-42 years and 42-44 years subgroups. RESULTS The s-COH group received significantly lower total doses of gonadotropin and had smaller leading follicles at the time of ovulation trigger when compared to the l-COH group. The s-COH group also produced a significantly lower number of oocytes, mature metaphase II (MII) oocytes, and 2 PN zygotes compared to the l-COH group. However, there was no significant difference in the number of transferable and good-quality embryos between the two treatment groups. Likewise, the pregnancy rate and live birth rate were comparable in the s-COH and l-COH groups. Similar results were obtained when the analysis was limited to select age subgroups (i.e., 40-42 and 42-44 years subgroups). CONCLUSION While a long COH generates more oocytes per cycle, a 6-7 days COH treatment, which is at the lower end of the recommended window of stimulation, could achieve a pregnancy outcome comparable to that applied 9-10 days of COH in aged patients.
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Affiliation(s)
- Le Tien Hsu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
| | - Tzu Hsuan Chin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
| | - Shang Yu Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
| | - Lan Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu Bin Pan
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia Lin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan.
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