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Kim SW, Han SJ, Han JY, Kim H, Ku SY, Suh CS. Predictor for supraphysiologic serum estradiol elevation on hCG triggering day of controlled ovarian stimulation using letrozole and gonadotropins in women with estrogen-dependent cancers. PLoS One 2020; 15:e0240870. [PMID: 33085706 PMCID: PMC7577464 DOI: 10.1371/journal.pone.0240870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/04/2020] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to evaluate predicting factors for supraphysiologic serum estradiol elevation during controlled ovarian stimulation (COS) with administration of letrozole and gonadotropins in patients with estrogen-dependent cancer. Use of aromatase inhibitors is recommended to prevent the potential effects of elevated serum estradiol levels and recurrence of tumor in patients with estrogen-dependent cancers during COS. Although previous studies reported that letrozole have shown an effective lowering of peak estrogen levels, a part of patients shows supraphysiologic levels of estrogen associated with ovarian stimulation despite the administration of letrozole. From January 2009 to December 2019, patients with estrogen-dependent cancer who underwent COS with antagonist protocol using a letrozole (5 mg/ day) to keep estrogen levels low were included in this study. Early monitoring serum estradiol was measured in all patients on the 4-6th day of stimulation. Subjects were classified into two groups according to the serum estradiol level on hCG triggering day, physiologic estradiol group (≤400 pg/mL) and supraphysiologic estradiol group (>400 pg/mL). A total of 96 COS cycles were retrospectively analyzed. Supraphysiologic level of serum estradiol was found in 21.9% of the patients. Mean age, AMH, duration of stimulation, total dose of gonadotropins administered were not different between the two groups. However, early monitoring serum estradiol level was significantly higher in the supraphysiologic estradiol group (67.1±47.9 vs. 115.6±78.1, p = 0.001) and was associated with the occurrence of supraphysiologic elevation of serum estradiol on hCG triggering day. Patients with early monitoring serum estradiol ≥84.5 pg/mL had an odds ratio of 5.376 [95% CI, 1.613–17.913] for supraphysiologic elevation of serum estradiol compared to those with early monitoring serum estradiol below 84.5 pg/mL. In conclusion, early monitoring serum estradiol is an independent predicting factor for supraphysiologic level of serum estradiol on hCG triggering day in the COS cycles using letrozole and gonadotropins.
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Affiliation(s)
- Sung Woo Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Soo Jin Han
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Ji Yeon Han
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, South Korea
| | - Seung-Yup Ku
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, South Korea
- * E-mail:
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, South Korea
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Scheffer JAB, Scheffer B, Scheffer R, Florencio F, Grynberg M, Lozano DM. Are age and anti-Müllerian hormone good predictors of ovarian reserve and response in women undergoing IVF? JBRA Assist Reprod 2018; 22:215-220. [PMID: 29949322 PMCID: PMC6106624 DOI: 10.5935/1518-0557.20180043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Ovarian reserve evaluation has been the focus of substantial clinical
research for several years. This study aimed to examine the associations
between markers of ovarian reserve and ovarian response. Methods This prospective study included 132 infertile women aged 24-48 years
undergoing routine exploration during unstimulated cycles prior to the start
of assisted reproductive technology (ART) treatments at our center from July
2015 to January 2017. Descriptive parameters and patient characteristics
were reported as mean (SD) or median (range) values depending on the data
distribution pattern. Student’s t-test was performed for continuous
variables; the Wilcoxon and Pearson’s test were used for data not following
a normal distribution; and Fisher’s test was used for categorical variables.
p<0.05 was considered statistically significant. Results At the time of the study, the patients had a mean age of 35.7±3.84
years. On day 3 of the cycle, the mean anti-Müllerian hormone (AMH)
serum level was 2.84±1.57 ng/mL and the patients had 14.68±4.2
antral follicles (AFC). A significant correlation was observed between AMH
and age (r=-0.34 p<.01), follicle stimulating hormone
(FSH) serum levels (r=-0.32, p<.01), AFC (r=0.81,
p<.00001), total dose of medication during ovarian
stimulation (r=-0.28, p<.0003), and ongoing pregnancy
rate (p<.05). Age was significantly correlated with FSH
(r=0.46, p<.01), AFC (r=-0.34,
p<.00001), total dose of medication during ovarian
stimulation (r=0.43, p<.0003), and ongoing pregnancy
rate (p<.04). Conclusion Serum AMH and age are independent predictors of ovarian reserve and ovarian
stimulation outcome in infertile women. Age and serum AMH level may be used
to advise subfertile couples of their pregnancy prospects.
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Affiliation(s)
| | - Bruno Scheffer
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil
| | - Rafaela Scheffer
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil
| | - Fabio Florencio
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil
| | - Michael Grynberg
- Department of Reproductive Medicine, Hôpital Jean Verdier (AP-HP), University Paris XIII, and INSERM, Paris, France
| | - Daniel Mendez Lozano
- School of Medicine, Tecnologico de Monterrey and Center for Reproductive Medicine CREASIS, San Pedro Monterrey, Mexico
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Żelaźniewicz A, Bielawski T, Nowak J, Pawłowski B. Body symmetry and reproductive hormone levels in women. Women Health 2018; 59:391-405. [PMID: 29979937 DOI: 10.1080/03630242.2018.1492499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Fluctuating asymmetry (FA), a morphological marker of developmental stability, may be related to an individual's biological condition, e.g., health or fertility. The aim of this study was to test if the level of a woman's FA was related to her fertility and reproductive potential as measured by reproductive hormone levels. Fifty-three healthy, non-pregnant, naturally cycling women (mean age = 23.42, SD = 1.85 years), participated in the study, conducted in Wrocław (Poland) in May 2015. Early-follicular phase serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were measured. FA was calculated based on anthropometric measures of six bilateral body traits, and the composite FA index was used in statistical analyses. No relationship was observed between FA and the levels of FSH, LH, and AMH (p > .05), controlled for potential confounders. However, the level of E2 was positively correlated with FA (p < .05). Thus, in young women, FA was not related to hormones levels related to ovarian reserve, but more symmetrical women had lower E2 levels. As FA is an index of developmental stability, environmental, and genetic stress, the results of the study confirm previous research suggesting that developmental conditions may be related to women's endogenous estrogen levels.
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Affiliation(s)
| | - Tomasz Bielawski
- a Department of Human Biology , University of Wrocław , Wrocław , Poland
| | - Judyta Nowak
- a Department of Human Biology , University of Wrocław , Wrocław , Poland
| | - Bogusław Pawłowski
- a Department of Human Biology , University of Wrocław , Wrocław , Poland
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Added value today of hormonal measurements in ovarian stimulation in gonadotropin-releasing hormone antagonist treatment cycle. Curr Opin Obstet Gynecol 2018; 30:145-150. [DOI: 10.1097/gco.0000000000000459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Scheffer JB, Scheffer BB, de Carvalho RF, Rodrigues J, Grynberg M, Mendez Lozano DH. Age as A Predictor of Embryo Quality Regardless of The Quantitative Ovarian Response. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 11:40-46. [PMID: 28367304 PMCID: PMC5215710 DOI: 10.22074/ijfs.2016.4579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 08/11/2016] [Indexed: 11/23/2022]
Abstract
Background One determining factor of a successful in vitro fertilization (IVF) cycle
is embryo quality. The aim of the present study was to evaluate associations of embryo
quality and reserve markers like age, FSH and AMH. Materials and Methods In this prospective study, 120 infertile women, aged 21-44
years, undergoing routine exploration during an unstimulated cycle preceding assisted
reproductive technology (ART) at our center were studied prospectively, from February
2011 to December 2014. Descriptive parameters and patient characteristics were reported
as mean (SD) or median (range) depending on the distribution. Student’s t test was performed for continuous variables, Wilcoxon and Pearson’s Test were used for not distributed variables and Fisher’s Test was performed for categorical variables. P<0.05 was
considered statistically significant. Results Overall, at the time of investigation, patients had a mean age of 33.03 ± 4.15
years old. On cycle day three, serum anti-Mullerian hormone (AMH) level was 3.50
± 1.54 ng/mL, serum follicle-stimulating hormone (FSH) level was 6.29 ± 1.53 mUI/
mL, at baseline, women had 16.57 ± 7.0 antral follicles. The mean of collected oocytes
was 11.80 ± 5.25, embryo I+II was 2.46 ± 2.11. A greater number of embryos I+II was
observed in young patients. By evaluating 120 patients, a significant relationship was
observed between age and FSH (r=0.24, P=0.01), age with AMH (r=-0.22, P=0.02), age
with collected oocytes (r=-0.23, P=0.03) and age with embryo I+II (r=-0.22, P=0.03).
A significant relationship was also observed between antral follicle count (AFC) and
AMH (r=0.29, P=0.01), AFC and the number of transferred embryo (r=-0.18, P=0.03),
AFC and total dose of the drugs (r=-0.23, P=0.03). Significant relationship of FSH with
total dose of drugs (r=0.19, P=0.02) was also observed. In addition, we determined
significant relationships between AMH and the number of collected oocytes (r=0.38,
P=0.01), AMH and the number of metaphase II oocytes (r= 0.35, P=0.01), AMH and
the number of embryo (r=0.19, P=0.04) as well as AMH and total dose of the drugs
(r=-0.25, P=0.01). Conclusion Commonly used clinical markers of ovarian reserve are reflection of the
ovarian reserve, while the outcome measurements of ART and age are the best predictors
of embryo quality.
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Affiliation(s)
| | | | | | - Joyce Rodrigues
- Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil
| | - Michael Grynberg
- Department of Reproductive Medicine, Hospital Jean Verdier (AP-HP), University Paris XIII, and INSERM, Paris, France
| | - Daniel H Mendez Lozano
- School of Medicine, Tecnológico de Monterrey and Center for Reproductive Medicine CREASIS San Pedro Monterrey, México
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Devranoğlu B, Özdamar Ö, Köle E, Eken MK, Bozdağ H, Doğer E. Do younger women with elevated basal follicular stimulating hormone levels undergoing gonadotropin-stimulated intrauterine insemination cycles represent compromised reproductive outcomes? Eur J Obstet Gynecol Reprod Biol 2016; 199:141-5. [PMID: 26930042 DOI: 10.1016/j.ejogrb.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/04/2016] [Accepted: 01/29/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare stimulation characteristics and reproductive outcomes in women representing elevated and normal day 3 FSH levels and to evaluate the prognostic significance of day 3 FSH on the reproductive outcomes of gonadotropin-stimulated IUI (GS-IUI) cycles in women <35 years. STUDY DESIGN A cross-sectional study was designed. Unexplained infertility patients at the age ≤36 years, who underwent IUI, following gonadotropin stimulation (GS), were investigated. From 105 women with a day 3 FSH≥ 10U/L, 170GS/IUI cycles were assigned to Group EF; whereas a control group (Group NF, normal FSH) was constituted of 170 cycles with a day 3 FSH levels <10U/L. Demographic and stimulation characteristics as well as reproductive outcomes were compared. Primary outcome measure of this study was the biochemical, clinical and ongoing pregnancy rates. Secondary outcome measures were total gonadotropin dose, duration of gonadotropin stimulation, multiple pregnancy, miscarriage and cycle cancellation rates. RESULTS β-hCG positivity, clinical and ongoing pregnancy rates did not differ between women with normal and elevated FSH levels (p=0.234, 0.282 and 0.388, respectively). Total gonadotropin dose, multiple pregnancy and miscarriage rates were not significantly different between the groups (p=0,181, 0.652 and 0.415, respectively). Duration of stimulation was significantly longer and cycle cancellation rate was significantly higher in Group EF than in Group NF (p=0.005 and 0.021, respectively). CONCLUSION Younger women with elevated day 3 FSH represent comparable reproductive outcomes in GS-IUI cycles to those with normal FSH levels, although they may require longer periods of stimulation and are at higher risk of cycle cancellation. Thus, GS-IUI could be a possible treatment option in this patient group and should not be neglected.
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Affiliation(s)
- Belgin Devranoğlu
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology Division of Assisted Reproduction and Endocrinology, Istanbul, Turkey
| | - Özkan Özdamar
- Gölcük Military Hospital, Department of Obstetrics and Gynecology, Gölcük, Kocaeli, Turkey.
| | - Emre Köle
- Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Meryem K Eken
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology Division of Assisted Reproduction and Endocrinology, Istanbul, Turkey
| | - Halenur Bozdağ
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology Division of Assisted Reproduction and Endocrinology, Istanbul, Turkey
| | - Emek Doğer
- Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
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Kim J, Johnson L, Skrzynia C, Buchanan A, Gracia C, Mersereau JE. Prospective multicenter cohort study of estrogen and insulin-like growth factor system in BRCA mutation carriers. Cancer Causes Control 2015; 26:1087-92. [DOI: 10.1007/s10552-015-0601-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/15/2015] [Indexed: 12/20/2022]
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Elevated day 3 follicle-stimulating hormone in younger women: is gonadotropin stimulation/intrauterine insemination a good option? Am J Obstet Gynecol 2014; 211:62.e1-8. [PMID: 24487006 DOI: 10.1016/j.ajog.2014.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/15/2014] [Accepted: 01/21/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to determine the fecundity of young women (<35 years) with an elevated day 3 follicle stimulating hormone (FSH) undergoing gonadotropin-stimulation/intrauterine insemination. STUDY DESIGN This was a retrospective study. The study was conducted at an academic fertility center. A total of 1396 gonadotropin stimulation/intrauterine insemination cycles from 563 women were stratified by day 3 FSH levels (<10 vs ≥10 U/L) and outcomes were compared. Gonadotropin dose, treatment duration, peak estradiol (E2), number of preovulatory follicles (total, large, and medium size), E2/follicle, endometrial thickness, spontaneous abortion, clinical and multiple pregnancy rates were measured. The statistics included a Student t test, a χ(2), regression, and a discrete survival analysis. RESULTS An elevated day 3 FSH was found in 10.2% of the women, despite favorable age (31.9 ± 2.5 years). Women with a day 3 FSH of 10 U/L or greater when compared with women with a normal day 3 level required significantly more medication (1058.9 ± 1106.0 vs 632.7 ± 477.5 IU, P < .0001) were triggered a day earlier (10.6 ± 2.4 vs 11.5 ± 2.9 days, P = .0006) and had E2 levels (on the day of and the day prior to human chorionic gonadotropin administration) that were significantly higher (529.5 ± 244.3 vs 450.0 ± 244.2 and 359.6 ± 141.7 vs 306.8 ± 160.9 pg/mL, respectively, P < .05). Clinical pregnancy rates were comparable among the groups (14.6 vs 14%, respectively, P > .05). Spontaneous abortion and multiple pregnancy rates were higher among women with an FSH of 10U/L or greater but not significantly so (27.8% vs 12.0%, 22.2% vs 13.8% for FSH of ≥10 vs FSH < or >10 U/L, P > .05). CONCLUSION Women younger than 35 years with an elevated day 3 FSH, when treated aggressively with gonadotropins have pregnancy rates comparable with those of women with a normal baseline FSH. To achieve this outcome, they need higher doses of medication to stimulate the production of a larger preovulatory follicular cohort.
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Jirge PR. Ovarian reserve tests. J Hum Reprod Sci 2012; 4:108-13. [PMID: 22346076 PMCID: PMC3276943 DOI: 10.4103/0974-1208.92283] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 11/02/2011] [Accepted: 11/17/2011] [Indexed: 11/04/2022] Open
Abstract
Ovarian reserve plays a crucial role in achieving pregnancy following any treatment in subfertile women. The estimation of ovarian reserve is routinely performed through various ovarian reserve tests (ORTs) in an effort to predict the response and outcome in couples prior to In Vitro Fertilization and counsel them. Most widely used tests are basal follicle stimulating hormone and anti-Mullerian hormone and antral follicle count. The role of ORTs in our routine practice is discussed in this article. A MEDLINE search was done to identify suitable articles for review.
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Affiliation(s)
- Padma Rekah Jirge
- Department of Reproductive Medicine, Sushrut Assisted Conception Clinic, Kolhapur, India
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Ramalho de Carvalho B, Gomes Sobrinho DB, Vieira ADD, Resende MPS, Barbosa ACP, Silva AA, Nakagava HM. Ovarian reserve assessment for infertility investigation. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:576385. [PMID: 22474591 PMCID: PMC3302183 DOI: 10.5402/2012/576385] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 11/30/2011] [Indexed: 11/23/2022]
Abstract
The current trends to postpone motherhood and the increase in demand for assistance in reproductive medicine highlight the need for seeking guidelines for the establishment of individualized treatment protocols. Currently available ovarian reserve tests do not provide sufficient evidence to be solely considered ideal, but they may occupy important place in initial counseling, predicting unsatisfactory results that could be improved by individualized induction schemes and reducing excessive psychological and financial burdens, and adverse effects. In this paper, we revise the role of hormonal basal and dynamic tests, as well as ultrasonographic markers, as ovarian reserve markers, in order to provide embasement for propaedeutic strategies and their interpretation in order to have reproductive success.
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Affiliation(s)
- Bruno Ramalho de Carvalho
- GENESIS-Centre for Assistance in Human Reproduction, SHLS 716, Bloco "L", Salas "L" 328/331, Centro Clínico Sul, Ala Leste, 70.390 Brasília, DF, Brazil
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Musters AM, van Wely M, Mastenbroek S, Kaaijk EM, Repping S, van der Veen F, Mochtar MH. The effect of recombinant LH on embryo quality: a randomized controlled trial in women with poor ovarian reserve. Hum Reprod 2011; 27:244-50. [PMID: 22095792 DOI: 10.1093/humrep/der371] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Poor ovarian response is a common clinical problem, affecting up to 26% of IVF cycles. For these women, addition of recombinant luteinizing hormone (rLH) to ovarian hyperstimulation with recombinant FSH has a beneficial effect on ongoing pregnancy rates, but its effect on the yield of top-quality embryos is unknown. METHODS We conducted a randomized controlled trial in women expected to respond poorly under ovarian hyperstimulation during their first IVF cycle [all women aged 35-41 and women with FSH > 12 IU/ml and antral follicle count (AFC) ≤ 5]. Women were randomly allocated to rFSH and rLH (2:1 ratio) or rFSH alone (control group) after down-regulation with a GnRH agonist. The primary outcome was the proportion of top-quality embryos per woman on the day of transfer. Secondary outcomes were the number of stimulation days, the number of follicles ≥17 mm, the number of oocytes, the fertilization rate, the number of embryos, the number of women with ≥1 top-quality embryo, the biochemical, clinical and ongoing pregnancy rates and the miscarriage rate. RESULTS There were 116 women allocated to the rLH group and 128 allocated to the control group. The proportion of top-quality embryos per woman was 17% in the rLH group and 11% in the control group [mean difference 0.06; 95% confidence interval (CI) -0.01-0.14]. In the rLH and control groups respectively, 47 (41%) and 41 (32%) women had at least one top-quality embryo on the day of transfer (relative risk: 1.3, 95% CI 0.91-1.77). The ongoing pregnancy rate was 13 versus 12% (relative risk: 1.1; 95% CI 0.57-2.16) for the rLH group compared with the control group. CONCLUSIONS This study found no significant difference in embryo quality after the addition of rLH to rFSH for ovarian stimulation in women with poor ovarian reserve. CLINICAL TRIALS IDENTIFIER NTR1457.
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Affiliation(s)
- A M Musters
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology (H4-205), Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
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Hansen KR, Hodnett GM, Knowlton N, Craig LB. Correlation of ovarian reserve tests with histologically determined primordial follicle number. Fertil Steril 2010; 95:170-5. [PMID: 20522327 DOI: 10.1016/j.fertnstert.2010.04.006] [Citation(s) in RCA: 365] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 04/01/2010] [Accepted: 04/05/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the relationship between clinical markers of ovarian reserve and the true ovarian reserve as determined by the ovarian primordial follicle number. DESIGN Prospective investigation. SETTING Academic medical center. PATIENT(S) Forty-two healthy women (aged 26-52 years) undergoing oophorectomy for benign gynecologic indications. INTERVENTION(S) Transvaginal ultrasound examination for the determination of the ovarian antral follicle count (AFC) and serum measurements of clinical markers of ovarian reserve. All measurements were obtained within 2 weeks of surgery, irrespective of cycle day. Ovarian primordial follicle count was then determined using a validated fractionator/optical disector method. MAIN OUTCOME MEASURE(S) Univariate and partial correlations between ovarian reserve markers and ovarian primordial follicle count. RESULT(S) There were significant correlations between the ovarian primordial follicle count and AFC (r=0.78), anti-Müllerian hormone (AMH; r=0.72), FSH (r=-0.32), inhibin B (r=0.40), and chronological age (r=-0.80). After adjusting for age, significant correlations were identified between the ovarian primordial follicle count and AFC (r=0.53) and AMH (r=0.48). CONCLUSION(S) The ovarian AFC and serum levels of AMH correlate with the ovarian primordial follicle number even after adjustment for chronological age.
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Affiliation(s)
- Karl R Hansen
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA.
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Miao MF, Huang HF. Dynamic measurements of serum inhibin B and estradiol: a predictive evaluation of ovarian response to gonadotrophin stimulation in the early stage of IVF treatment. J Zhejiang Univ Sci B 2009; 10:35-45. [PMID: 19198021 DOI: 10.1631/jzus.b0820029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We dynamically measured serum inhibin B and estradiol in the early stage of hormonal stimulation to predict the ovarian response in in vitro fertilization (IVF) treatment. METHODS A total of 57 patients (<40 years of age) who underwent the first cycle of long protocol IVF or introcytoplasmic sperm injection (ICSI) treatment were included. Serum inhibin B, estradiol, follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured four times: (1) on Day 3 of the menstrual cycle (basal); (2) on the day before the first administration of gonadotrophin (Gn) (Day 0); (3) on Day 1 of Gn therapy; and (4) on Day 5 of Gn therapy. Comparisons of these measurements with ovarian responses and pregnancy outcomes were made and analyzed statistically. RESULTS (1) On Day 1 and Day 5 of recombinant FSH (rFSH) stimulation, ovarian response, i.e., numbers of follicles, oocytes, fertilized oocytes, and embryos, had a positive correlation (r(s)=0.46~0.61, P=0.000) with raised inhibin B and estradiol concentrations, but a negative correlation (r(s)=-0.67~-0.38, P=0.000 or P<0.01) with total rFSH dose and total days of rFSH stimulation. (2) No significant variation (P>0.05) between the pregnant and non-pregnant groups on the basis of mean age or on all hormone concentrations at four times of the IVF cycle was observed. However, all the seven patients aged >35 years did not reach pregnancy. CONCLUSIONS (1) Serum inhibin B and estradiol concentrations obtained shortly after Gn therapy may offer an accurate and early prediction of ovarian response; (2) Low levels of serum inhibin B and estradiol obtained shortly after Gn stimulation indicate the need for a longer period of Gn treatment and a higher daily dosage; (3) No obvious pregnancy difference among patients of age <35 years was found; however, IVF pregnancy outcome is significantly lower in women of age >35 years.
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Affiliation(s)
- Ming-fang Miao
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University, Hangzhou, China.
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Pinto F, Oliveira C, Cardoso MF, Teixeira-da-Silva J, Silva J, Sousa M, Barros A. Impact of GnRH ovarian stimulation protocols on intracytoplasmic sperm injection outcomes. Reprod Biol Endocrinol 2009; 7:5. [PMID: 19146685 PMCID: PMC2633006 DOI: 10.1186/1477-7827-7-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Accepted: 01/15/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although a large number of studies have been conducted in relation to ovarian response and pregnancy after GnRH agonist and GnRH antagonist controlled ovarian hyperstimulation protocols, most of them used single or combinations of a few predictive factors, and none included the stimulation protocol in the multivariable analysis. The present study was thus primarily designed to investigate the predictive value of the stimulation protocol and to analyze the possible relationships between stimulation protocols and treatment outcomes after adjusting for a large set of variables that potentially affect reproductive outcomes. Factors related to pregnancy achievement and predictive of the number of oocytes retrieved and high quality of the embryos obtained were also analyzed. METHODS To analyze the impact of GnRH ovarian stimulation protocols on the independent predictors of ovarian response, high quality embryos and clinical pregnancy, two groups out of 278 ICSI treatment cycles were compared prospectively, 123 with a GnRH agonist and 155 with a GnRH antagonist, with multivariable analysis assessing outcomes after adjusting for a large set of variables. RESULTS Antagonists were significantly associated with lower length and total dose of GnRH, lower length of rFSH, and higher numbers of oocytes and high quality embryos, whereas the agonist presented a higher fertilization rate and probability of pregnancy. Significant predictors of retrieved oocytes and high quality embryos were the antagonist protocol, lower female age, lower serum levels of basal FSH and higher total number of antral follicles. Significant predictors of clinical pregnancy were the agonist protocol, reduced number of attempts, increased endometrial thickness and lower female age. The probability of pregnancy increased until 30 years-old, with a decline after that age and with a sharp decline after 40 years-old. CONCLUSION The models found suggest that not only the protocol but also factors as female age, basal FSH, antral follicles, number of attempts and endometrial thickness should be analyzed for counselling patients undergoing an ICSI treatment.
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Affiliation(s)
- Fátima Pinto
- Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Margarida F Cardoso
- Department of Population Studies, ICBAS-Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | | | - Joaquina Silva
- Centre for Reproductive Genetics A. Barros, Porto, Portugal
| | - Mário Sousa
- Centre for Reproductive Genetics A. Barros, Porto, Portugal
- Lab Cell Biology, ICBAS-Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Barros
- Centre for Reproductive Genetics A. Barros, Porto, Portugal
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
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Roberts CP, Taylor RN. Applications of estradiol and testosterone assays in the management of the infertile female patient. Steroids 2008; 73:1328-32. [PMID: 18725241 DOI: 10.1016/j.steroids.2008.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 06/19/2008] [Indexed: 11/28/2022]
Abstract
A collaborative effort to improve steroid hormone measurements in patient care was convened by the Centers for Disease Control in March 2008 to discuss the need for enhanced performance and standardization of clinical estradiol and testosterone assays. This article discusses the current status of estradiol and testosterone assays in the treatment of infertile women to include the assessment of ovarian reserve, ovulation induction and follicle tracking, ovarian hyperstimulation syndrome, and the role of testosterone in fertility management.
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Affiliation(s)
- Carla P Roberts
- Emory University School of Medicine, Gynecology and Obstetrics, Reproductive Endocrinology and Infertility Division, 69 Jesse Hill Jr Drive SE, 4th Floor, Atlanta, GA 30303, United States.
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de Carvalho BR, Rosa e Silva ACJDS, Rosa e Silva JC, dos Reis RM, Ferriani RA, Silva de Sá MF. Ovarian reserve evaluation: state of the art. J Assist Reprod Genet 2008; 25:311-22. [PMID: 18679790 DOI: 10.1007/s10815-008-9241-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 07/08/2008] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Revise role of hormonal basal and dynamic tests, as well as ultrasonographic measures as ovarian reserve markers, in order to provide better counseling to subfertile couples. METHODS Review of publications on the topic, with an emphasis on recent well designed articles. RESULTS Currently available ovarian reserve tests do not provide sufficient evidence to be solely considered ideal, even for premature ovarian senescence patients who do not present subfertility complaints. However, these markers occupy important place in initial approach to treatment of subfertile couples, predicting unsatisfactory results that could be improved by differentiated induction schemes and reducing excessive psychological and financial burdens, and adverse effects. CONCLUSIONS In order to remedy the limitations due to the scarcity of strong evidence about this topic, future studies should try to clarify predictive value of markers in groups of specific diseases-related subfertility and pay special attention to propaedeutic multivariate models including anti-Müllerian hormone and antral follicle count.
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Affiliation(s)
- Bruno Ramalho de Carvalho
- Sector of Human Reproduction, Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
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Sun W, Stegmann BJ, Henne M, Catherino WH, Segars JH. A new approach to ovarian reserve testing. Fertil Steril 2008; 90:2196-202. [PMID: 18433750 DOI: 10.1016/j.fertnstert.2007.10.080] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 10/26/2007] [Accepted: 10/30/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To critically examine ovarian reserve testing before assisted reproduction. DESIGN A PUBMED computer search to identify relevant literature. SETTING Multiple sites. PATIENT(S) Patients undergoing assisted reproduction. INTERVENTION(S) Testing for ovarian reserve. MAIN OUTCOME MEASURE(S) Assisted reproductive technology (ART) and pregnancy outcomes. RESULT(S) The prevalence of ovarian insufficiency varies significantly for women aged 30-45 years. Generalization or averaging of threshold values across different aged women leads to very poor sensitivity, specificity, and positive predictive value for all tests of ovarian reserve. Because of the changing prevalence of ovarian insufficiency, there is no single, suitable threshold value for any screening test of ovarian reserve. Our analysis supports dividing impaired ovarian reserve into two groups: age-dependent ovarian aging (physiologic) and premature (nonphysiologic) reductions in the oocyte pool. Interpretation of any screening test used requires that age is considered as a variable. To guide clinical interpretation of test results, we suggest using a nomogram of FSH values versus expected delivery rate-per-cycle-start with ART for a given age. CONCLUSION(S) Proper interpretation of screening tests for ovarian insufficiency in couples considering ART is important as the presence of impaired ovarian reserve is associated with a low likelihood of pregnancy. The condition of premature (nonphysiologic) ovarian insufficiency warrants additional research.
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Affiliation(s)
- Wenjie Sun
- Department of Obstetrics and Gynecology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
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18
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Zhen XM, Qiao J, Li R, Wang LN, Liu P. The clinical analysis of poor ovarian response in in-vitro-fertilization embryo-transfer among Chinese couples. J Assist Reprod Genet 2008; 25:17-22. [PMID: 18202912 DOI: 10.1007/s10815-007-9187-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 11/14/2007] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To explore the prevalence, predictor of clinical pregnancy and possible aetiology of poor ovarian response (POR) in in vitro fertilization-embryo transfer (IVF-ET) in Chinese. METHODS A total of 4,600 retrieval oocyte cycles were finished between July 1, 2004 and April 30, 2006. Poor ovarian responses were observed in 426 patients of 472 cycles undergoing IVF, which were selected on the same retrieve oocyte day as the control group. The outcome of IVF-ET and the common markers of ovarian reserve were compared. RESULTS The patients had previous ovarian surgery in 64 cycles of 472 poor ovarian response cycles. The group with poor ovarian response has significant differences in comparison with the control group in age (36.6 +/- 4.2 vs 33.3 +/- 4.04), ovarian surgeries (13.6 vs 2.8%), dose of gonadotrophin (58.5 +/- 15.8 vs 40.6 +/- 17.0), fertilization rate (71.5 vs 86%) and pregnancy rate (14.8 vs 36.7%). In the group with poor ovarian responses, clinical pregnancy rate declined significantly in women aged >40 years than in those aged < or = 40 years (2.8 vs 18.5%, P < 0.001). The age, basal serum follicle stimulating hormone (FSH), basal serum luteinizing hormone (LH), basal oestradiol (E2) concentrations, FSH to LH ratio and the antral follicle count (AFC) are the common markers of ovarian reserve in our center. We found that there were significant differences in age, basal FSH, FSH-to-LH ratio and the antral follicle count. But no statistical significant differences were observed in basal oestradiol concentration and basal serum LH when comparing the two groups. Binary logistic regression analysis was used to study the relation among age, FSH, LH, E2, AFC and clinical pregnancy, and the age (odds ratio, 0.863; 95% confidence interval, 0.805-0.925; p = 0.000) was the only variable selected. CONCLUSION Our data show that the prevalence of poor ovarian response in Chinese is 11.9%. Previous ovarian surgery is associated with poor ovarian responses. The pregnancy rate of women with poor ovarian response is low in IVF-ET, especially the decline in clinical pregnancy rate of women aged >40 years became accelerated. Correct identification of those who are at risk for POR prior to stimulation is helpful in tailoring the best stimulation protocol to individual patients. Chronological age significantly improved the prediction of clinical pregnancy of poor ovarian responders.
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Affiliation(s)
- X M Zhen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100083, China
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Frattarelli JL. A prospective analysis of the changes in ovarian morphology during hormonal pituitary suppression before in vitro fertilization. Fertil Steril 2006; 86:577-82. [PMID: 16828478 DOI: 10.1016/j.fertnstert.2006.01.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2005] [Revised: 01/31/2006] [Accepted: 01/31/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the change in ovarian morphology at three specific times integral to an IVF cycle, and to evaluate the factors associated with a change in ovarian morphology after pituitary desensitization. DESIGN Prospective cohort analysis. SETTING Academic IVF center. PATIENT(S) Infertile patients undergoing 85 IVF cycles. INTERVENTION(S) Eighty-five patients had a transvaginal ultrasound to assess ovarian morphology on unstimulated menstrual day 3, 21 days after starting oral contraceptives (OCs), and 14 days after starting GnRH agonist (GnRH-a). MAIN OUTCOME MEASURE(S) Ovarian morphology. RESULT(S) Compared with the basal total ovarian volume, ovarian volume was significantly decreased after 21 days of OCs and after 14 days of GnRH-a. A significant decrease was noted in the total number of antral follicles from the basal state to after 21 days of OCs and after 14 days of GnRH-a treatment. There was no significant effect on pregnancy outcome rates. Univariate analysis showed a significant correlation between ovarian morphology and IVF stimulation parameters. CONCLUSION(S) Hormonal suppression significantly alters ovarian morphology. If the use of ovarian morphology is to be used to counsel patients and predict IVF success as suggested by some studies, it should be standardized for the day the ovarian morphology is evaluated.
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Frattarelli JL, Gerber MD. Basal and cycle androgen levels correlate with in vitro fertilization stimulation parameters but do not predict pregnancy outcome. Fertil Steril 2006; 86:51-7. [PMID: 16716312 DOI: 10.1016/j.fertnstert.2005.12.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 12/12/2005] [Accepted: 12/12/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate androgen levels before and during IVF. To assess for an association between androgen levels and IVF stimulation parameters or IVF pregnancy outcome. DESIGN Prospective cohort study. SETTING Residency-based IVF program. PATIENT(S) One hundred seventeen infertility patients. INTERVENTION(S) Androgen levels were evaluated on basal day 3 and during the IVF stimulation cycle. MAIN OUTCOME MEASURE(S) Pregnancy outcome rates and IVF stimulation parameters. RESULT(S) Mean serum androgen levels did not differ among different pregnancy outcomes. Multiple linear regression analysis revealed that body mass index (BMI) and oocyte number had a significant positive association with basal testosterone levels. Mean ovarian volume correlated negatively and follicle number correlated positively with testosterone levels on day 6 of stimulation. Peak E(2) and BMI correlated positively with testosterone on day of hCG administration. The interval change in androgen levels throughout the IVF cycle was not associated with outcome rates. Likewise, threshold analysis did not reveal any significant androgen level that affected pregnancy outcome. CONCLUSION(S) Serum androgen levels during IVF correlate with IVF stimulation parameters. However, these data do not support an influence of serum androgen levels on IVF pregnancy outcome rates.
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Affiliation(s)
- John L Frattarelli
- Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii, USA.
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22
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Prakash A, Li TC, Laird S, Nargund G, Ledger WL. Absence of follicular phase defect in women with recurrent miscarriage. Fertil Steril 2006; 85:1784-90. [PMID: 16643909 DOI: 10.1016/j.fertnstert.2005.11.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 11/08/2005] [Accepted: 11/08/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The study was designed to compare the follicular phase of women with recurrent pregnancy loss and a healthy control group. It is possible that a defective or aberrant follicular phase may be associated with poor oocyte quality leading to a production of an embryo with compromised quality and hence early pregnancy loss. DESIGN Prospective case-control study. SETTING A tertiary care hospital of Sheffield, UK. PATIENT(S) Thirty-four women with recurrent miscarriage and 10 women with no previous history of miscarriage and regular menstrual cycles (control group) were recruited. INTERVENTION(S) The characteristics studied included Doppler assessment of blood flow to the follicle and the endometrium. Simultaneously, serum concentrations of biochemical markers such as anti-Müllerian hormone, inhibin B, FSH, LH, and P were compared in the two groups. MAIN OUTCOME MEASURE(S) Differences in the two groups. RESULT(S) We were unable to detect significant differences in various biochemical and ultrasound measurements in the follicular phase between women with recurrent miscarriage and a control group; however, the expected correlation between ovarian and pituitary hormones, which was observed in the control group, was absent in women with recurrent miscarriage. CONCLUSION(S) There may be subtle derangements of the feedback mechanism responsible for regulation of follicle development in this group of women. However, there were no obvious differences in the follicular phase of women with recurrent miscarriage and a healthy control group.
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Affiliation(s)
- Alka Prakash
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, United Kingdom.
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Abstract
The use of assisted reproductive technology (ART) for treating the infertile couple is increasing in the United States. The purpose of this paper is to review the short-term outcomes after ART. Pregnancy rates after ART have shown nearly continuous improvement in the years since its inception. A number of factors affect the pregnancy rate, with the most important being a woman's age. Certain clinical diagnoses are associated with a poorer outcome from ART, including the presence of hydrosalpinges, uterine leiomyomata that distort the endometrial cavity, and decreased ovarian reserve. Multiple gestations are the major complication after ART. New laboratory techniques, including extended embryo culture, may allow the transfer of fewer embryos to maintain pregnancy rates while reducing the risk of multiple gestations. Although much of the morbidity in children born after ART is the result of multiples, recent analysis suggests that even singletons are at higher risk for perinatal morbidity, including preterm delivery and small for gestational age infants. In vitro fertilization may be associated with a slight increased risk for birth defects. The major short-term complication of ART in women is the development of ovarian hyperstimulation syndrome. This syndrome is difficult to predict, but new treatments are being developed that may limit its frequency. Because of its high pregnancy rate, couples are moving to ART more quickly in the management of their infertility. All outcomes of ART, including pregnancy rates and adverse complications, need to be compared with standard non-ART therapy when deciding the appropriate course of treatment for a given couple.
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Affiliation(s)
- Bradley J Van Voorhis
- Department of Obstetrics and Gynecology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242-1080, USA.
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Lutchman Singh K, Davies M, Chatterjee R. Fertility in female cancer survivors: pathophysiology, preservation and the role of ovarian reserve testing. Hum Reprod Update 2005; 11:69-89. [PMID: 15569700 DOI: 10.1093/humupd/dmh052] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The improved long-term survival of adolescents and young women treated for cancer has resulted in an increased focus on the effects of chemotherapy on ovarian function and its preservation. These women may seek advice and treatment regarding their reproductive status, including ways of preserving their fertility and preventing a premature menopause--factors that can have a profound impact on their quality of life. This article comprehensively reviews ovarian reserve testing (ORT) in general. Special emphasis is placed on patients with cancer, including the pathophysiology of gonadal damage following chemotherapy, fertility preservation and the potential role of ORT. Baseline parameters of ovarian reserve [FSH LH, estradiol, inhibin B and anti-Mullerian hormone (AMH)] have not yet performed sufficiently well in predicting poor outcome in assisted reproduction, but biochemical markers of ovarian reserve appear to be better than chronological age. Inhibin B and AMH show potential for future use. Dynamic testing appears to show much promise, especially stimulated levels of inhibin B and estradiol. The most promising tests of ovarian reserve are the biophysical markers, where total antral follicle count was found to be most discriminatory followed by ovarian volume. Combination of biochemical, biophysical and clinical markers of ovarian reserve may also improve predictive capacity. However, there is a lack of data pertinent to ORT in cancer. As yet there is no single clinically useful test to predict ovarian reserve accurately. Patients with cancer represent a distinct cohort who have particular concerns about their future fertility and the possibility of a premature menopause, they can benefit greatly from knowledge of their functional ovarian reserve. Large, prospective, randomized, adequately controlled studies specific to different geographical areas are required in a control population of comparable reproductive age to determine the potential role of ORT in clinical practice.
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Affiliation(s)
- Kerryn Lutchman Singh
- Department of Obstetrics and Gynaecology, Reproductive Medicine Unit, Elizabeth Garrett Anderson and Obstetric Hospital, University College London Hospital, Huntley Street, London WC1E 6DH, UK.
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Frazier LM, Grainger DA, Schieve LA, Toner JP. Follicle-stimulating hormone and estradiol levels independently predict the success of assisted reproductive technology treatment. Fertil Steril 2004; 82:834-40. [PMID: 15482756 DOI: 10.1016/j.fertnstert.2004.02.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 02/23/2004] [Accepted: 02/23/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the relationship between early follicular phase levels of FSH and E(2) and outcomes of therapy with assisted reproductive technologies (ART). DESIGN Retrospective cohort study. SETTING ART centers in the United States. PATIENT(S) Women receiving 19,682 ART procedures performed in 135 clinics. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Rates of clinical pregnancy, live birth delivery, and high ovarian response (>/=10 oocytes retrieved after stimulation). RESULT(S) The ratio of each FSH or E(2) value to the respective upper limit of normal value for the clinic was computed. Within each age group, rates of pregnancy, live birth, and high ovarian response decreased linearly as FSH levels increased. For example, among women 35 years of age and younger, pregnancy rates (PR) ranged from 41.1% (FSH ratio 0-0.5) to 18.5% (FSH ratio >2.0). The three outcomes exhibited a similar downward trend as E(2) ratios increased. When both hormone ratios were elevated, outcomes were least favorable. These relationships remained statistically significant after we adjusted for diagnosis, number of embryos transferred, previous births, previous ART therapy, and use of GIFT, zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), or assisted hatching. CONCLUSION(S) The FSH and E(2) ratios predict ART success independent of age and other clinical prognostic factors.
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Affiliation(s)
- Linda M Frazier
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, 67214, USA.
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27
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Frattarelli JL, Levi AJ, Miller BT, Segars JH. Prognostic use of mean ovarian volume in in vitro fertilization cycles: A prospective assessment. Fertil Steril 2004; 82:811-5. [PMID: 15482752 DOI: 10.1016/j.fertnstert.2004.02.143] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 02/26/2004] [Accepted: 02/26/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the predictive value and to define prognostic threshold measurements for mean ovarian volume (MOV) in patients undergoing IVF. DESIGN Prospective cohort analysis. SETTING Tertiary care center. PATIENT(S) Two hundred sixty-seven patients. INTERVENTION(S) Transvaginal ultrasound before starting gonadotropins. MAIN OUTCOME MEASURE(S) Number of oocytes retrieved, basal hormone levels, and cycle outcomes. RESULT(S) The MOV for the population was 4.78 +/- 2.6 cm(3) (range 0.9-21.1 cm(3)). The MOV significantly correlated with the majority of prestimulation and poststimulation IVF parameters. Threshold analysis demonstrated a lower pregnancy rate associated with a MOV of <2 cm(3) (31.6% vs. 55.6%). Threshold analysis revealed a trend toward higher cancellation rate associated with a MOV of <2 cm(3) (21.1% vs. 7.3%). CONCLUSION(S) Although MOV correlated with IVF stimulation parameters, its use as an adjunct in counseling patients during IVF appears to be of limited value. A MOV <2 cm(3) was associated clinically with a higher cancellation rate (21.1%) and a lower pregnancy rate (31.6%) in those cycles not cancelled. However, these values do not deviate far from the mean national IVF outcome rates. There was no absolute MOV that was predictive of pregnancy outcome or cycle cancellation.
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Frattarelli JL, Peterson EH. Effect of androgen levels on in vitro fertilization cycles. Fertil Steril 2004; 81:1713-4. [PMID: 15193506 DOI: 10.1016/j.fertnstert.2003.11.032] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2003] [Revised: 11/04/2003] [Accepted: 11/04/2003] [Indexed: 11/16/2022]
Abstract
Serum androgens have a negative correlation with some IVF stimulation parameters. Day 3 T levels <or=20 ng/dL are associated with poor IVF success rates.
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Levi R, Kupelioglu L, Ozçakýr HT, Cebi Z, Adakan S, Göker ENT, Tavmergen E. Complete down-regulation is not mandatory for good assisted reproductive treatment cycle outcomes. Eur J Obstet Gynecol Reprod Biol 2003; 111:55-8. [PMID: 14557012 DOI: 10.1016/s0301-2115(03)00281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the implications and predictive value of estradiol concentrations following pituitary down-regulation with gonadotrophin releasing hormone agonists in women undergoing controlled ovarian hyperstimulation for assisted reproductive technology. STUDY DESIGN A total of 277 patients undergoing ovarian hyperstimulation for intracytoplasmic sperm injection (ICSI) were enrolled into the study and the patients were divided into four groups according to estradiol levels on the initial day of stimulation of which group-A consisted of the patients who had < or =25 pg/ml (n=90), group-B with levels between 26 and 50 pg/ml (n=104), group-C with levels between 51 and 75 pg/ml (n=67) and group-D with levels > or =76-90 pg/ml (n=16) and the results were compared. The primary outcome measures included ovarian response and the clinical pregnancy rates. RESULTS The clinical pregnancy rates in groups-A, B, C and D were 33.3% (30/90), 26.0% (27/104), 35.8% (24/67), and 25.0% (4/16), respectively, and there was no statistically significant difference (P=0.482). The mean number of oocytes retrieved in groups were (9.7+/-5.8, 10.3+/-6.5, 11.0+/-6.8, and 12.1+/-6.6), respectively (P=0.453) and the fertilization rates in groups-A, B, C and D were found to be similar (75, 80, 73 and 79%, respectively; P=0.658). CONCLUSION Complete and deep desensitization obviously seems not to be mandatory for successful stimulation in assisted reproductive technology cycles.
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Affiliation(s)
- R Levi
- Family Planning Infertility Research and Treatment Center, Ege University, 35100 Bornova, Izmir, Turkey
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Abstract
A progressive decline in fecundity with advancing age is a reality, attributed primarily to the detrimental impact of various aging processes on female gametes. Despite medical advances that have dramatically prolonged the female life span, declining numbers and deteriorating quality of oocytes, and an increasing incidence of meiotic errors and aneuploidy of gametes and embryos, reduce clinical pregnancy rates and escalate pregnancy wastage. Increased fetal aneuploidies in ongoing pregnancies and an increased predisposition to obstetric morbidities further contribute to the diminishing reproductive successes associated with advancing age. The age of male partners, despite the decline in semen parameters and sexual performance with aging, does not appear to have a major impact on the eventual fertility of the aging couple. The contributions of age-related impaired sexuality and ejaculatory problems, although slight albeit significant, to declining fertility in the aging should be appreciated in appropriate cases. With the realization of the age-related detriment on fertility potential and the limitations of available therapeutic interventions, management of subfecundity in women beyond their mid-30s should be approached aggressively. Success of ovulation induction with clomiphine citrate or gonadotropins is marginal in women aged older than 40 years; a case can be made to proceed directly with ART in women in this age group, especially when there is coexisting male factor or pelvic disease. Except for the use of donor oocytes, the outcome of various therapeutic interventions to optimize reproductive performance in women aged older than 44 years remains dismal. A broader application of PGD techniques may contribute to improved live birth rates in reproductively aging women. The greater likelihood of obstetric complications in pregnancies resulting from donor oocytes and an increased prevalence of age-related medical problems complicating pregnancy should prompt a thorough medical evaluation before proceeding with ART.
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Affiliation(s)
- Lubna Pal
- Reproductive Endocrinology and Infertility, Albert Einstein College of Medicine, Department of Obstetrics, Gynecology, and Women's Health, 1300 Morris Park Avenue, Mazer 325, Bronx, NY 10461, USA.
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Frattarelli JL, Levi AJ, Miller BT, Segars JH. A prospective assessment of the predictive value of basal antral follicles in in vitro fertilization cycles. Fertil Steril 2003; 80:350-5. [PMID: 12909498 DOI: 10.1016/s0015-0282(03)00664-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the predictive value and define threshold values for basal antral follicle count in patients undergoing IVF. DESIGN Prospective cohort analysis. Tertiary care center. Two hundred eighty-nine patients. Transvaginal ultrasonography before starting gonadotropin administration. MAIN OUTCOME MEASURES Number of oocytes retrieved, basal hormone levels, and cycle outcomes. RESULTS Pregnant patients had significantly more antral follicles (13.8 +/- 7.5 vs. 12.4 +/- 10.0). Patients in whom cycles were canceled had significantly fewer antral follicles (7.6 +/- 4.8 vs. 13.7 +/- 8.8). Antral follicle count significantly correlated with most prestimulation and poststimulation IVF variables. Threshold analysis demonstrated a lower pregnancy rate (23.5% vs. 57.6%) and a higher cancellation rate (41% vs. 6.4%) associated with having four or fewer antral follicles. CONCLUSION(S) The basal antral follicle count identified patients who responded poorly to IVF stimulation. Having four or fewer antral follicles was associated with a high cancellation rate (41%) and, in patients without a cancelled cycle, a low pregnancy rate (23%). However, no antral follicle count absolutely predicted pregnancy or cycle cancellation.
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Loverro G, Nappi L, Mei L, Giacomoantonio L, Carriero C, Tartagni M. Evaluation of functional ovarian reserve in 60 patients. Reprod Biomed Online 2003; 7:200-4. [PMID: 14567892 DOI: 10.1016/s1472-6483(10)61752-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diminished ovarian reserve is a condition occurring in women at any adult age, although it is more frequent in women in their 30s and in couples with unexplained subfertility. Different tests are employed to diagnose the problem. The most common are basal tests for FSH, LH, oestradiol and inhibin B, or dynamic endocrine tests such as the clomiphene citrate challenge test and gonadotrophin analogue stimulating test. In recent years, great attention has been devoted to direct tests such as the antral follicle count and ovarian biopsy results. The basal FSH concentration is the most common test utilized for ovarian screening. An abnormal value is correlated with a decrease in pregnancy rate and an increase in cycle cancellation rate. Among other basal endocrine tests, inhibin concentrations appear promising, although more data are necessary before this can be included in clinical practice. The clomiphene citrate challenge test can unmask patients who might have not been detected by basal FSH screening alone, and appears to be more sensitive than day 3 FSH alone. A prospective study was performed on the simultaneous application of various markers of ovarian reserve (FSH, LH, oestradiol, inhibin B, antral follicle count) in the natural cycle preceding assisted reproductive therapy, in 60 women. The present study suggests that counting ovarian follicles by ultrasound appears, at the moment, the most reliable test of ovarian reserve, although it is influenced by subjective factors and more studies are needed in order to confirm its predictive value.
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Affiliation(s)
- G Loverro
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
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Brugh VM, Nudell DM, Lipshultz LI. What the urologist should know about the female infertility evaluation. Urol Clin North Am 2002; 29:983-92. [PMID: 12516767 DOI: 10.1016/s0094-0143(02)00087-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As childbirth is delayed and divorce rates remain high, urologists will continue to see more and more infertile couples. It is imperative that urologists understand at least the basic aspects of the female evaluation. Fundamental information can be obtained from a simple, directed history. Risk factors for female infertility can be identified in a matter of minutes, and the reproductive endocrinologist can then carry out a complete female evaluation simultaneously with the male evaluation. Most female infertility problems can be classified as ovulatory, anatomic, or cervical. Signs of decreasing ovarian reserve with age can be ascertained easily with a history and perhaps the determination of a day-3 serum FSH level. Finally, a basic understanding of the female evaluation allows meaningful discourse between the urologist and the reproductive endocrinologist, leading to a more effective treatment plan for the infertile couple.
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Affiliation(s)
- Victor M Brugh
- Division of Male Reproductive Medicine and Surgery, Scott Department of Urology, Baylor College of Medicine, 6560 Fannin, Suite 2100, Houston, TX 77030, USA
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