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Ip PNP, Mak JSM, Law TSM, Ng K, Chung JPW. A reappraisal of ovarian stimulation strategies used in assisted reproductive technology. HUM FERTIL 2023; 26:824-844. [PMID: 37980170 DOI: 10.1080/14647273.2023.2261627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/10/2023] [Indexed: 11/20/2023]
Abstract
Ovarian stimulation is a fundamental step in assisted reproductive technology (ART) with the intention of inducing ovarian follicle development prior to timed intercourse or intra-uterine insemination and facilitating the retrieval of multiple oocytes during a single in vitro fertilization (IVF) cycle. The basis of ovarian stimulation includes the administration of exogenous gonadotropins, with or without pre-treatment with oral hormonal therapy. Gonadotropin-releasing hormone agonist or antagonist is given in addition to the gonadotropins to prevent a premature rise of endogenous luteinizing hormone that would in turn lead to premature ovulation. With the advancement in technology, various stimulation protocols have been devised to cater for different patient needs. However, ovarian hyperstimulation syndrome and its serious complications may occur following ovarian stimulation. It is also evident that suboptimal ovarian stimulation strategies may have a negative impact on oogenesis, embryo quality, endometrial receptivity, and reproductive outcomes over recent years. This review describes the various forms of pre-treatment for ovarian stimulation and stimulation protocols, and aims to provide clinicians with the latest available evidence.
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Affiliation(s)
- Patricia N P Ip
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jennifer S M Mak
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tracy S M Law
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Karen Ng
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline P W Chung
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Nanassy L, Schoepper B, Schultze-Mosgau A, Depenbusch M, Eggersmann TK, Hiller RAF, Griesinger G. Evaluation of live birth rates and perinatal outcomes following two sequential vitrification/warming events at the zygote and blastocyst stages. J Assist Reprod Genet 2023; 40:2357-2365. [PMID: 37582908 PMCID: PMC10504135 DOI: 10.1007/s10815-023-02909-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To study the outcome of sequential cryopreservation-thawing of zygotes followed by the cryopreservation-thawing of blastocysts in the course of an IVF treatment on live birth rate and neonatal parameters. METHODS Single center, retrospective chart review for the time period of 2015-2020. Clinical and perinatal outcomes were compared between frozen embryo transfer cycles utilizing twice-cryopreserved (n = 182) vs. once-cryopreserved (n = 282) embryos. Univariate and multivariable analyses were used to adjust for relevant confounders. RESULTS After adjustment for maternal age, gravidity, parity, body mass index (BMI), paternal age, fertilization method used, the number of oocytes retrieved in the fresh cycle, fertilization rate, and transfer medium, the transfer of twice-cryopreserved embryos resulted in a reduced probability of live birth (OR, 0.52; 95% CI 0.27-0.97; p=0.041) compared to once-cryopreserved embryos. No differences in the sex ratio, the mean gestational age, the mean length at birth, or the mean birth weight were found between the two groups. CONCLUSION The circumstantial use of sequential double vitrification-warming in course of treatment is associated with a reduced (but still reasonable) live birth rate compared to once-cryopreserved embryos. As the neonatal outcomes of twice-cryopreserved embryos are similar to once-cryopreserved embryos, this treatment option appears still valid as a rescue scenario in selected cases.
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Affiliation(s)
- Laszlo Nanassy
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany.
| | - Beate Schoepper
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Askan Schultze-Mosgau
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marion Depenbusch
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tanja K Eggersmann
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Roman A F Hiller
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Georg Griesinger
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Marques M, Rodrigues P, Aibar J, Carvalho MJ, Plancha CE. Time to live birth: towards a common agreement. J Assist Reprod Genet 2023; 40:997-1001. [PMID: 37071319 PMCID: PMC10239416 DOI: 10.1007/s10815-023-02790-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
The major purpose of a couple at the first infertility appointment is to get a healthy baby as soon as possible. From diagnosis and decision on which assisted reproduction technique (ART) and controlled ovarian stimulation, to the selection of which embryo to transfer, the dedicated team of physicians and embryologists puts all efforts to shorten the time to pregnancy and live birth. Time seems thus central in assisted reproduction, and we can conveniently use it as a measure of treatment efficiency. How can we measure time to live birth? What timelines do we need to consider to evaluate efficiency? In this paper, we will discuss the importance of "Time" as a fundamental parameter for measuring ART success.
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Affiliation(s)
- Mónica Marques
- Centro Médico de Assistência à Reprodução - CEMEARE, Lisbon, Portugal.
| | - Patrícia Rodrigues
- Centro Médico de Assistência à Reprodução - CEMEARE, Lisbon, Portugal
- Escola de Psicologia de Ciências da Vida, Universidade Lusófona de Humanidade E Tecnologia de Lisboa, Lisbon, Portugal
| | - Juan Aibar
- Centro Médico de Assistência à Reprodução - CEMEARE, Lisbon, Portugal
| | | | - Carlos E Plancha
- Centro Médico de Assistência à Reprodução - CEMEARE, Lisbon, Portugal
- Inst. Histologia e Biol, Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Proteome Mapping of Cervical Mucus and Its Potential as a Source of Biomarkers in Female Tract Disorders. Int J Mol Sci 2023; 24:ijms24021038. [PMID: 36674559 PMCID: PMC9863546 DOI: 10.3390/ijms24021038] [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: 12/10/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Cervical mucus (CM) is a viscous fluid that is produced by the cervical glands and functions as a uterine cervix plug. Its viscosity decreases during ovulation, providing a window for non-invasive sampling. This study focuses on proteomic characterization of CM to evaluate its potential as a non-invasively acquired source of biomarkers and in understanding of molecular (patho)physiology of the female genital tract. The first objective of this work was to optimize experimental workflow for CM processing and the second was to assess differences in the proteomic composition of CM during natural ovulatory cycles obtained from intrauterine insemination (IUI) cycles and in vitro fertilization (IVF) cycles with controlled ovarian hyperstimulation. Proteomic analysis of CM samples revealed 4370 proteins involved in processes including neutrophil degranulation, cellular stress responses, and hemostasis. Differential expression analysis revealed 199 proteins enriched in IUI samples and 422 enriched in IVF. The proteins enriched in IUI were involved in phosphatidic acid synthesis, responses to external stimulus, and neutrophil degranulation, while those enriched in IVF samples were linked to neutrophil degranulation, formation of a cornified envelope and hemostasis. Subsequent analyses clarified the protein composition of the CM and how it is altered by hormonal stimulation of the uterus.
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Martinez F, Clua E, Roca M, Garcia S, Polyzos NP. Comparison of blastocyst euploidy rates following luteal versus follicular phase stimulation in a GnRH antagonist protocol: a prospective study with repeated ovarian stimulation cycles. Hum Reprod 2022; 37:2777-2786. [PMID: 36269092 DOI: 10.1093/humrep/deac222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Is there any difference in the mean number of euploid embryos following luteal phase start (LS) and follicular phase start (FS) of ovarian stimulation? SUMMARY ANSWER The mean number of euploid blastocysts is equivalent independent of whether the inseminated oocytes are derived from FS or LS. WHAT IS KNOWN ALREADY Starting ovarian stimulation at any time of the cycle ('random-start') is commonly used for emergency fertility preservation in cancer patients. A few retrospective studies have been published evaluating LS in women undergoing ovarian stimulation in the context of IVF, but there is a lack of robust data on the comparative efficacy of LS versus FS.Although 'random start' is commonly used in cancer survivors, few retrospective and uncontrolled studies have been published evaluating luteal phase stimulation in women undergoing ovarian stimulation in the context of IVF. Owing to this evident lack of robust data on the efficacy of LS, guidelines typically recommend the LS approach only for medical reasons and not in the context of IVF. STUDY DESIGN, SIZE, DURATION This is a prospective, equivalence study, with repeated stimulation cycles, conducted between May 2018 and December 2021. Overall, 44 oocyte donors underwent two identical consecutive ovarian stimulation cycles, one initiated in the FS and the other in the LS. The primary outcome of the study was to evaluate whether FS and LS in the same patient would result in equivalent numbers of euploid embryos following fertilization of oocytes with the same sperm sample. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall, 44 oocyte donors underwent two consecutive ovarian stimulation protocols with 150 μg corifollitropin alpha followed by 200 IU recombinant FSH (rFSH) in a fixed GnRH antagonist protocol. The only difference between the two cycles was the day of initiation of ovarian stimulation, which was in the early follicular phase (FS) in one cycle, and in the luteal phase (LS) in the other. Forty-four oocyte recipients participated in the study receiving a mean of six metaphase II (MII) oocytes from each stimulation cycle (FS and LS). All MIIs were inseminated with the corresponding recipient's partner sperm (which had been previously frozen) or donor sperm, in order to safeguard the use of the same sample for either the FS or LS. Following fertilization and blastocyst culture, all generated embryos underwent genetic analysis for aneuploidy screening (preimplantation genetic testing for aneuploidy). MAIN RESULTS AND THE ROLE OF CHANCE FS resulted in a significantly shorter duration of ovarian stimulation (difference between means (DBM) -1.05 (95% CI -1.89; -0.20)) and a lower total additional dose of daily rFSH was needed (DBM -196.02 (95% CI -319.92; -72.12)) compared with LS. The donors' hormonal profile on the day of trigger was comparable between the two stimulation cycles, as well as the mean number of oocytes (23.70 ± 10.79 versus 23.70 ± 8.81) (DBM 0.00 (95% CI -3.03; 3.03)) and MII oocytes (20.27 ± 9.60 versus 20.73 ± 8.65) (DBM -0.45 (95% CI -2.82; 1.91)) between FS and LS cycles, respectively. Following fertilization, the overall blastocyst formation rate was 60.70% with a euploid rate of 57.1%. Comparisons between the two stimulation cycles did not reveal any significance differences in terms of fertilization rates (71.9% versus 71.4%), blastocyst formation rates (59.4% versus 62%) and embryo euploidy rates (56.9 versus 57.3%) for the comparison of FS versus LS, respectively. The mean number of euploid blastocysts was equivalent between the FS (1.59 ± 1.30) and the LS (1.61 ± 1.17), (DBM -0.02 (90%CI -0.48; 0.44)). LIMITATIONS, REASONS FOR CAUTION The study was performed in young, potentially fertile oocyte donors who are patients with high blastocyst euploidy rates. Although results may be extrapolated to young infertile women with good ovarian reserve, caution is needed prior to generalizing the results to infertile women of older age. WIDER IMPLICATIONS OF THE FINDINGS The current study provides evidence that initiation of ovarian stimulation in the luteal phase in young potentially fertile women may result in a comparable number of oocytes and comparable blastocyst euploidy rates compared with follicular phase stimulation. This may imply that in case of a freeze-all protocol in young patients with good ovarian reserve, clinicians may safely consider initiation of ovarian stimulation during the luteal phase. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by an unrestricted grant from MSD/Organon. N.P.P. has received Research grants and honoraria for lectures from: Merck Serono, MSD/Organon, Ferring Pharmaceuticals, Besins Intenational, Roche Diagnostics, IBSA, Theramex, Gedeon Richter. F.M., E.C., M.R. and S.G. declared no conflict of interests. TRIAL REGISTRATION NUMBER The study was registered at Clinical Trials Gov (NCT03555942).
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Affiliation(s)
- Francisca Martinez
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Elisabet Clua
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Marta Roca
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Sandra Garcia
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Nikolaos P Polyzos
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
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Kadoura S, Alhalabi M, Nattouf AH. Conventional GnRH antagonist protocols versus long GnRH agonist protocol in IVF/ICSI cycles of polycystic ovary syndrome women: a systematic review and meta-analysis. Sci Rep 2022; 12:4456. [PMID: 35292717 PMCID: PMC8924277 DOI: 10.1038/s41598-022-08400-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Gonadotropin-releasing hormone (GnRH) analogues are commonly used in clinical practice to prevent premature luteinizing hormone (LH) surge during In-Vitro Fertilization/ Intra-Cytoplasmic Sperm Injection (IVF/ICSI) cycles. This review aimed to summarize the available evidence comparing the effects of conventional GnRH antagonist protocols, the most commonly used GnRH antagonist protocols, and GnRH agonist protocols on IVF/ICSI outcomes in women with polycystic ovary syndrome (PCOS). A comprehensive electronic search was carried out in Pubmed, Cochrane CENTRAL, Scopus, Web of Science, CINAHL, TRIP, ClinicalTrials.gov and ISRCTN registry from inception until 24 November 2020 without any language or date restrictions. In addition, reference lists of eligible studies and previous meta-analyses were hand-searched to identify relevant studies. Eligible randomized controlled trials were those designed to compare the effects of conventional GnRH antagonist protocols and GnRH agonist protocols on IVF/ICSI outcomes in PCOS subjects. The Cochrane ROB 2.0 tool was used to assess the risk of bias of each study, and the GRADE assessment was used to evaluate the overall quality of evidence. Data synthesis and analyses were done using Review Manager 5.3 with the assistance of Revman Web. A random-effects model was used for all meta-analysis. Dichotomous outcomes were reported as Relative Risk (RR) and continuous outcomes as Weighted Mean Difference (WMD), both with 95% CIs. The primary outcomes were Live birth rate, Ongoing pregnancy rate, and Ovarian hyperstimulation syndrome (OHSS) rate. Other IVF outcomes were considered secondary outcomes. We included ten studies with 1214 randomized PCOS women. Using GnRH antagonist protocols led to a significantly lower OHSS rate (RR = 0.58; 95% CI: [0.44 to 0.77], P = 0.0002), shorter stimulation duration (WMD = - 0.91; 95% CI: [-1.45 to - 0.37] day, P = 0.0009), lower gonadotropin consumption (WMD = - 221.36; 95% CI: [- 332.28 to - 110.45] IU, P < 0.0001), lower E2 levels on hCG day (WMD = - 259.21; 95% CI: [- 485.81 to - 32.60] pg/ml, P = 0.02), thinner endometrial thickness on hCG day (WMD = - 0.73; 95% CI: [- 1.17 to - 0.29] mm, P = 0.001), and lower number of retrieved oocytes (WMD = - 1.82; 95% CI: [- 3.48 to - 0.15] oocytes, P = 0.03). However, no significant differences in live birth rate, ongoing pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, miscarriage rate and cycle cancellation rate were seen between the GnRH antagonist protocols and the long GnRH agonist one. Although more cycles were cancelled due to poor ovarian response in the GnRH antagonist protocol (RR = 4.63; 95% CI: [1.49 to 14.41], P = 0.008), similar rates of cancellation due to risk of OHSS were noticed in both groups. The differences in IVF/ICSI outcomes may arise from the different patterns of gonadotropins suppression that the GnRH analogues exhibit during the early follicular phase of IVF/ICSI cycles and the divergent direct impacts of these analogues on ovaries and endometrial receptivity. The main evidence limitation was Imprecision. Conventional GnRH antagonist protocols represent a safer and more cost-effective treatment choice for PCOS women undergoing IVF/ICSI cycles than the standard long GnRH agonist protocol without compromising the IVF/ICSI clinical outcomes. The study had no sources of financial support and was prospectively registered at PROSPERO (International Prospective Register of Systematic Reviews) under registration number (CRD42021242476).
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Affiliation(s)
- Sally Kadoura
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Damascus University, Damascus, Syrian Arab Republic.
| | - Marwan Alhalabi
- Department of Embryology and Reproductive Medicine, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.,Assisted Reproduction Unit, Orient Hospital, Damascus, Syrian Arab Republic
| | - Abdul Hakim Nattouf
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Damascus University, Damascus, Syrian Arab Republic
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Xu DF, Liu PP, Fan L, Xie Q, Zhang ZQ, Wang LQ, Wu QF, Tan J. GnRH antagonist weakens endometrial stromal cells growth ability by decreasing c-kit receptor expression. Reprod Biol Endocrinol 2022; 20:29. [PMID: 35120552 PMCID: PMC8815158 DOI: 10.1186/s12958-021-00886-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several surveys have reported that patients treated with gonadotropin-releasing hormone antagonist (GnRH-ant) protocol showed a significantly lower rate of implantation and clinical pregnancy compared to GnRH agonist (GnRH-a) protocol during in vitro fertilization-fresh embryo transfer. Subsequent studies imputed this poor outcome to the negative effects of GnRH-ant on endometrial receptive. However, the mechanisms were not fully understood. METHODS The clinical data of 2815 patients undergoing fresh embryo transfer in our center were analyzed. Human endometrial stromal cells (ESCs) from healthy women undergoing elective pregnancy termination of a normal pregnancy at 8-10 weeks gestation were treated with GnRH-analogs or imatinib (c-kit receptor inhibitor). CCK8 and Flow cytometry were used to investigated the growth ability of ESCs. Immunofluorescence staining and western blot was used to detected the target proteins. RESULTS The clinical data showed that the endometrial thickness on HCG Day were significantly lower in GnRH-ant group. Although no difference of embryo quality in these two groups, GnRH-ant group showed remarkably decreased rate of HCG positive, embryo implantation and pregnancy. Moreover, GnRH-ant significantly reduced the proliferation and induced the apoptosis of ESCs. Furthermore, the expression and activation of c-kit receptor, which played pivotal roles during embryo implantation, were observably decreased by GnRH-ant. Inhibiting the activation of c-kit by imatinib remarkably suppressed the proliferation and promoted the apoptosis of ESCs. Additionally, the phosphorylation of AKT and expression of Cyclin D1, which were closely related with cellular growth, were distinctly lessened after treating with imatinib. CONCLUSIONS In summary, our study showed that GnRH-ant weakened the activization of c-kit receptor by decreasing its expression, causing the impaired growth ability of ESCs. Our findings provided a new insight into the effects of GnRH-ant on endometrium.
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Affiliation(s)
- Ding-Fei Xu
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, P. R. China
- Reproductive Medicine Center, Maternal and Child Health Hospital Affiliated to Nanchang University, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, P. R. China
| | - Pei-Pei Liu
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, P. R. China
- Reproductive Medicine Center, Maternal and Child Health Hospital Affiliated to Nanchang University, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, P. R. China
| | - Lu Fan
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, P. R. China
- Reproductive Medicine Center, Maternal and Child Health Hospital Affiliated to Nanchang University, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, P. R. China
| | - Qi Xie
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, P. R. China
| | - Zhi-Qin Zhang
- Reproductive Medicine Center, Maternal and Child Health Hospital Affiliated to Nanchang University, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, P. R. China
| | - Li-Qun Wang
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, P. R. China.
- Department of Reproductive Health, Maternal and Child Health Hospital of Nanchang University, Jiangxi maternal and child health hospital, Nanchang, Jiangxi, 330006, P. R. China.
| | - Qiong-Fang Wu
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, P. R. China.
- Reproductive Medicine Center, Maternal and Child Health Hospital Affiliated to Nanchang University, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, P. R. China.
| | - Jun Tan
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, P. R. China.
- Reproductive Medicine Center, Maternal and Child Health Hospital Affiliated to Nanchang University, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, P. R. China.
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Al-Obaidi M. Effect of early GnRH antagonist administration on assisted reproductive technique outcomes in normal responders. J Med Life 2022; 15:258-263. [PMID: 35419110 PMCID: PMC8999099 DOI: 10.25122/jml-2021-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
One of the main questions in assisted reproductive techniques is how to prevent premature LH surge using a variety of protocols depending on either pituitary down-regulation, in GnRH agonist protocols, or by receptors blockage, in GnRH protocols. It is possible to say that GnRH protocols are most popular nowadays. The study aimed to assess the effectiveness of early antagonist administration during days ≤6 and later antagonist administration on days >6 on assisted reproductive outcomes. Women admitted to the ART Department at the High Institute for Infertility Diagnosis and ART, Al-Nahrain University, Baghdad, Iraq were included in the study. Reproductive outcomes were evaluated in early ≤6 and late >6 antagonist administration in a total of 44 normal responders, as follows. Sandwich protocols in 14 patients that received antagonists in the first 3 days of the follicular phase and conventional flexible antagonist protocol in 30 patients. We compared the outcomes between the two groups. There were no differences between early antagonist administration ≤6 and late >6 days in the number of MII oocytes, 2PN, the number of transferred embryos, grades of the embryos, and pregnancy rates. However, there were statistically significant differences between the duration of stimulation and the total Gonadotropin dose required. There was no effect of antagonist administration on days ≤6 and >6 on controlled ovarian stimulation on assisted reproductive outcomes.
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Affiliation(s)
- Manal Al-Obaidi
- Reproductive Physiology, High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq,Corresponding Author: Manal Al-Obaidi, Reproductive Physiology, High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq. E-mail:
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9
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Wu HM, Chang HM, Leung PCK. Gonadotropin-releasing hormone analogs: Mechanisms of action and clinical applications in female reproduction. Front Neuroendocrinol 2021; 60:100876. [PMID: 33045257 DOI: 10.1016/j.yfrne.2020.100876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Extra-hypothalamic GnRH and extra-pituitary GnRH receptors exist in multiple human reproductive tissues, including the ovary, endometrium and myometrium. Recently, new analogs (agonists and antagonists) and modes of GnRH have been developed for clinical application during controlled ovarian hyperstimulation for assisted reproductive technology (ART). Additionally, the analogs and upstream regulators of GnRH suppress gonadotropin secretion and regulate the functions of the reproductive axis. GnRH signaling is primarily involved in the direct control of female reproduction. The cellular mechanisms and action of the GnRH/GnRH receptor system have been clinically applied for the treatment of reproductive disorders and have widely been introduced in ART. New GnRH analogs, such as long-acting GnRH analogs and oral nonpeptide GnRH antagonists, are being continuously developed for clinical application. The identification of the upstream regulators of GnRH, such as kisspeptin and neurokinin B, provides promising potential to develop these upstream regulator-related analogs to control the hypothalamus-pituitary-ovarian axis.
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Affiliation(s)
- Hsien-Ming Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University School of Medicine, Taoyuan 333, Taiwan, ROC
| | - Hsun-Ming Chang
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia V6H 3V5, Canada
| | - Peter C K Leung
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia V6H 3V5, Canada.
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Šprem Goldštajn M, Dumančić S, Mikuš M. Retrospective analysis of the use of two recombinant follitropin alfa injections in patients undergoing in vitro fertilization treatment with the gonadotropin-releasing hormone antagonist protocol. J Obstet Gynaecol Res 2020; 47:992-1001. [PMID: 33372397 DOI: 10.1111/jog.14626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/16/2020] [Accepted: 12/12/2020] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the clinical efficacy of biosimilar (Ovaleap) compared with the referenced follitropin alfa (Gonal-f), within the context of antagonistic multiple doses protocol of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) techniques. METHODS A retrospective, monocentric study included 229 infertile women aged 22 to 43 years who underwent their first cycle of COH for the purpose of the IVF or ICSI during the period of 2017. Eligible patients underwent ovarian stimulation with either Ovaleap (n = 152) or Gonal-f (n = 77) starting at Cycle Day 2 and were receiving gonadotropin-releasing hormone (GnRH) antagonist in either fixed or flexible antagonist protocol manner. RESULTS Ovaleap-treatment resulted in fewer number of oocytes retrieved in regard to Gonal-f-treatment, with the median of seven oocytes retrieved in the Ovaleap group versus nine in the Gonal-f group (U = 5369.5, P = 0.3079). Clinical pregnancy rate was 24.3% in the overall study sample and 31.9% in women with embryo transfer, in the Ovaleap group. Similarly, in the Gonal-f group these rates were 25.0% and 34.5%, respectively. Only four patients experienced ovarian hyperstimulation syndrome, with one case in Ovaleap-treatment group and three cases in Gonal-f-treatment group. CONCLUSION While the clinical efficacy profile favored using Gonal-f formulation of follitropin alfa, this analysis showed that there is no significant difference in the number of oocytes retrieved between Ovaleap and Gonal-f follitropin alfa formulations, used within GnRH antagonist protocols of COH.
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Affiliation(s)
- Marina Šprem Goldštajn
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Stipe Dumančić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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11
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Montoya-Botero P, Martinez F, Rodríguez-Purata J, Rodríguez I, Coroleu B, Polyzos NP. The effect of type of oral contraceptive pill and duration of use on fresh and cumulative live birth rates in IVF/ICSI cycles. Hum Reprod 2020; 35:826-836. [DOI: 10.1093/humrep/dez299] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/24/2019] [Indexed: 11/15/2022] Open
Abstract
Abstract
STUDY QUESTION
Are there any differences in the fresh (LB) and cumulative live birth rates (CLBR) of women undergoing controlled ovarian stimulation (COS) for IVF/ICSI following pretreatment with different types of oral contraceptive pills (OCP) for different durations as compared to no-OCP?
SUMMARY ANSWER
OCP administration for an interval of 12- to 30-day treatment period and with a 5-day washout period does not affect clinical pregnancy, LB nor cumulative LB in patients undergoing COS for an IVF cycle.
WHAT IS KNOWN ALREADY
The use of OCP is an effective way of treatment planning in IVF/ICSI cycles, but published evidence about its effect on pregnancy and LBR is inconsistent, some studies finding decreased rates but others no difference.
STUDY DESIGN, SIZE, DURATION
This is a retrospective analysis carried out in a University-affiliated tertiary centre between January 2009 and December 2017. Overall, 4116 infertile women between 18 and 45 years, who underwent their first ovarian stimulation cycle in our centre, were included.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Patients were categorised into two groups as receiving OCP (n = 3517) or not (no OCP, n = 599). All patients with OCP pretreatment initiated controlled ovarian stimulation (COS) 5 days post-pill. Overall, two types of OCP were used at the study’s centre: ethinylestradiol (EE) 30 μg/desogestrel 150 μg, a third-generation progesterone; or EE 30 μg/drospirenone 3 mg, a fourth-generation progestin with mild antiandrogenic activity.
MAIN RESULTS AND THE ROLE OF CHANCE
A total of n = 4116 patients were analysed, (OCP n = 3517 and non-OCP n = 599). The use of OCP was independently associated with a small increase in the number of oocytes retrieved after adjusting for age, BMI, use of OCP, cause of infertility, initial dose (IU), type of gonadotropin, stimulation days, total stimulation units (total IU) (β 0.22, 95% CI 0.12–0.31). Cumulative LBRs were comparable between groups OCP versus non-OCP (32.4 versus 31.6%, P = 0.712). Following adjustment for age, BMI, infertility diagnosis, starting and total dose, type of gonadotropin, total days of stimulation, type of insemination, number of oocytes retrieved, day of transfer and number of embryos transferred in a multiple logistic analysis, patients using OCPs had a similar probability of achieving a LB as compared with patients not-using OCPs following fresh embryo transfer (ORadj 0.89, 95% CI 0.69–1.15) and a similar probability for CLBR after the use of fresh and frozen embryos (ORadj 0.94, 95% CI 0.73–1.21). No differences were observed in ovarian stimulation and clinical outcomes between drospirenone and desogestrel OCP groups.
LIMITATIONS, REASONS FOR CAUTION
Limitations are related to the retrospective nature of the study; despite the sample size, the adjustments and the multivariable regression analysis conducted, we cannot exclude the presence of confounding bias. OCP administration was not randomly assigned, not allowing to exclude the presence of selection bias. Lastly, we only used two types of OCP with durations and washout periods as per institution protocol. Therefore, we cannot exclude that longer duration of administration, a different type of OCP or different pill-free interval might have had an alternative effect on LBR or CLBR; thus, the generalizability of this study’s results should be considered with caution.
WIDER IMPLICATIONS OF THE FINDINGS
Our study provides reassuring evidence that the use of 12–30 days OCP for cycle programming, prior to IVF, does not decrease the chance of live birth and cumulative live birth rates.
STUDY FUNDING/COMPETING INTEREST(S)
No external funding was used for this study. This research was performed under the auspices of ‘Càtedra d’Investigació en Obstetrícia I Ginecologia’ of the Department of Obstetrics, Gynaecology and Reproductive Medicine, Hospital Universitario Dexeus, Universitat Autònoma de Barcelona. The authors report no conflict of interest associated with the current study.
TRIAL REGISTRATION NUMBER
NA
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Affiliation(s)
- Pedro Montoya-Botero
- Department of Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71-75, Barcelona 08022, Spain
- Department of Reproductive Medicine, Conceptum – Unidad de Fertilidad del Country Conceptum, Bogotá 110221, Colombia
| | - Francisca Martinez
- Department of Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71-75, Barcelona 08022, Spain
| | - Jorge Rodríguez-Purata
- Department of Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71-75, Barcelona 08022, Spain
| | - Ignacio Rodríguez
- Department of Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71-75, Barcelona 08022, Spain
| | - Buenaventura Coroleu
- Department of Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71-75, Barcelona 08022, Spain
| | - Nikolaos P Polyzos
- Department of Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71-75, Barcelona 08022, Spain
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Chen Q, Yu F, Li Y, Zhang AJ, Zhu XB. Comparative proteomics reveal negative effects of gonadotropin-releasing hormone agonist and antagonist on human endometrium. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:1855-1863. [PMID: 31239640 PMCID: PMC6554521 DOI: 10.2147/dddt.s201871] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/04/2019] [Indexed: 12/11/2022]
Abstract
Purpose: The two major ovarian-stimulation protocols for in vitro fertilization are gonadotropin-releasing hormone agonist (GnRH-a) protocol or GnRH antagonist (GnRH-ant) protocol; however, comparisons of their relative efficacy remain controversial. Additionally, conflicting data exist regarding their effects on endometrial receptivity. Thus, this study investigated how GnRH-a and GnRH-ant treatments alter the endometrium during the mid-secretory phase. Patients and methods: We compared proteomic profiles across human endometrium tissues of mid-secretory phase from normal control humans (n=5), patients treated with GnRH-a (n=5), and patients treated with GnRH-ant (n=5). Results: We identified 2088 proteins, with 362 that exhibited significantly different expression. Fuzzy c-means clustering (FCM) using the M Fuzz algorithm analysis showed that the same 87 proteins changed significantly in both the GnRH-a and GnRH-ant groups compared with those in the control. Moreover, Gene Ontology (GO) analysis showed that, of these 87, downregulated proteins were associated with energy metabolism and upregulated proteins were linked to cytoskeleton maintenance. Upregulated proteins involved in complement-mediated immunity were present in 151 proteins that exhibited significantly different expression in the GnRH-ant group only. Conclusion: We demonstrated that comparative proteomic analysis is useful for accessing endometrial receptivity, which seemed more strongly impaired by GnRH-ant than GnRH-a treatments. Our findings also revealed that energy metabolism and immunity response may be the key biological mechanisms underlying human endometrial receptivity.
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Affiliation(s)
- Qian Chen
- Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Feng Yu
- Interdisciplinary Science Research Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yan Li
- Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ai-Jun Zhang
- Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiao-Bin Zhu
- Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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13
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Stoev S, Getov I, Timeva T, Naseva EK, Lebanova H, Petkova B. Study of clinical experience with different approaches to controlled ovarian hyperstimulation: a focus on safety and efficacy. Eur J Hosp Pharm 2019; 28:33-37. [PMID: 33355281 DOI: 10.1136/ejhpharm-2019-001870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Current retrospective cohort study analyses clinical database records of 4792 assisted reproduction procedures to assess the significance of target effectiveness endpoints from a safety perspective. METHODS Stimulation protocols with urinary, recombinant or combination of both types gonadotrophin preparations are compared according to the following primary endpoints: incidence of ovarian hyperstimulation syndrome (OHSS), cycle cancellation, follicle count, induced estradiol values, clinical pregnancy achieved and cycles reached embryo transfer/freezing. We have investigated the incidence of cases evaluated as 'risky for OHSS' by secondary efficacy endpoints (exogenous gonadotrophin exposure, luteinising hormone and progesterone values, oocyte yield, eggs with normal maturation). The following statistical methods were applied: descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, Pearson chi-square test, Fisher's exact test, binary logistic regression. RESULTS Only 16 cases (0.42%) of moderate and delayed OHSS were established. Three hundred and seven (8.6%) stimulation cycles have been cancelled, principally among urinary protocols. Although the clinical pregnancy rate does not differ significantly in compared groups, punctured follicle count, oocyte yield and progesterone level were higher for recombinant preparations, followed by combined and urinary protocols. Follicle count, mean estradiol and luteinising hormone levels are within the 'safe window' for all investigated groups, associated with minimised risk of stimulation cancellation. The mean follicle-stimulating hormone (FSH) dose was highest in urinary protocols at the same duration of stimulation compared with recombinant products. The younger age, bigger follicle count, oocytes yield, mature oocytes count, percentage of fertilised oocytes, more embryos transferred and the later day of embryo transfer are critical for both assisted reproduction techniques (ART) success rate and the safety profile of sterility treatment. CONCLUSIONS Safety surveillance of ART exceeds the incidence of OHSS. Suboptimal effectiveness of stimulation protocols may also jeopardise the well-being of ART patients. Gonadotrophin exposure, induced values of sex hormones, and quantity and quality of extracted oocytes should be considered to minimise any unintended suffering of treated couples.
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Affiliation(s)
| | - Ilko Getov
- Social Pharmacy, Faculty of Pharmacy, Sofia, Bulgaria
| | - Tanya Timeva
- Rusenski Universitet Angel Kunchev, Ruse, Bulgaria
| | - Emilia K Naseva
- Faculty of Public Health, Medical University Sofia, Sofia, Bulgaria
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14
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Bou Nemer L, Shi H, Carr BR, Word RA, Bukulmez O. Effect of single-dose ibuprofen on follicular fluid levels of interleukins in poor responders undergoing in vitro fertilization. Syst Biol Reprod Med 2018; 65:48-53. [DOI: 10.1080/19396368.2018.1557761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Laurice Bou Nemer
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility and the Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Haolin Shi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility and the Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce Richard Carr
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility and the Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ruth Ann Word
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility and the Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Orhan Bukulmez
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility and the Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Bosch E, Bulletti C, Copperman AB, Fanchin R, Yarali H, Petta CA, Polyzos NP, Shapiro D, Ubaldi FM, Garcia Velasco JA, Longobardi S, D'Hooghe T, Humaidan P. How time to healthy singleton delivery could affect decision-making during infertility treatment: a Delphi consensus. Reprod Biomed Online 2018; 38:118-130. [PMID: 30477755 DOI: 10.1016/j.rbmo.2018.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 11/18/2022]
Abstract
RESEARCH QUESTION How might time to healthy singleton delivery affect decision-making during infertility treatment? DESIGN This was a Delphi consensus investigating expert opinion that comprised three steps. In Step 1, 12 experts developed statements. In Step 2, 27 experts (including 12 from Step 1) voted (online survey) on their agreement/disagreement with each statement (providing reasons). Consensus was reached if ≥66% of participants agreed/disagreed. Statements not reaching consensus were revised and the process repeated until consensus was achieved. In Step 3 details of the final agreed statements were communicated. RESULTS Twelve statements were developed, and consensus (agreement) was reached on all after one round of voting. CONCLUSIONS Time to healthy singleton delivery should be taken into consideration when making decisions related to infertility treatment, and it is important that fertility treatment is provided in a timely manner, avoiding over- or under-treatment. In all subfertile women <40 years old, IVF outcomes could be optimized by performing up to six single-embryo transfers and certain procedures might reduce time to healthy singleton delivery. These procedures include preimplantation genetic testing for aneuploidies, frozen replacement cycles immediately after failed fresh cycles and use of gonadotrophin-releasing hormone antagonists. Finally, the number of oocytes retrieved should be maximized to increase cumulative live birth rate.
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Affiliation(s)
- Ernesto Bosch
- Instituto Valenciano de Infertilidad, Valencia, Spain.
| | - Carlo Bulletti
- Extra Omnes Medicina e Salute Riproduttiva, Cattolica, Italy
| | - Alan B Copperman
- Icahn School of Medicine at Mount Sinai and Reproductive Medicine Associates of New York, New York NY, USA; Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Renato Fanchin
- Centre of Reproductive Medicine, Hôpital Foch, University Paris-Ouest, Suresnes, France
| | - Hakan Yarali
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey; Anatolia IVF and Women's Health Centre, Ankara, Turkey
| | - Carlos A Petta
- Departamento de Ginecologia, Clinica Fertilidade e Vida, Campinas and Hospital Sirio Libanês, Sao Paulo, Brazil
| | - Nikolaos P Polyzos
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona Spain; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | | | | | | | - Thomas D'Hooghe
- Department of Development and Regeneration, University of Leuven (KU Leuven), Leuven, Belgium; The Fertility Clinic, Skive Regional Hospital, and Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark; The Fertility Clinic, Skive Regional Hospital, and Faculty of Health, Aarhus University, Aarhus, Denmark
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16
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Eftekhar M, Bagheri RB, Neghab N, Hosseinisadat R. Evaluation of pretreatment with Cetrotide in an antagonist protocol for patients with PCOS undergoing IVF/ICSI cycles: a randomized clinical trial. JBRA Assist Reprod 2018; 22:238-243. [PMID: 29969209 PMCID: PMC6106631 DOI: 10.5935/1518-0557.20180039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 06/11/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of three days of GnRH antagonist pretreatment on the pregnancy outcomes of women with polycystic ovarian syndrome (PCOS) on GnRH antagonist protocols for IVF/ICSI. METHODS Fifty women with PCOS in the control group received conventional antagonist protocols, starting on day 2 of the cycle. In the pretreatment group (n=38), a GnRH antagonist was administered from day 2 of the menstrual cycle for three days. RESULTS Controlled ovarian stimulation (COS) duration and gonadotropin dosages were similar in both groups. The number of metaphase II (MII) oocytes, 2PN oocytes, embryos, along with implantation and clinical pregnancy rates, were higher in the pretreatment group when compared with controls, although the increment was not significant (P value ≥0.05). The chemical pregnancy rate was significantly higher in the pretreatment group. The rate of OHSS was significantly lower in the pretreatment than in the control group. CONCLUSION Women with PCOS offered early follicular phase GnRH antagonist pretreatment for three consecutive days had significantly fewer cases of OHSS and higher chemical pregnancy rates. There were trends toward greater numbers of MII oocytes, 2PN oocytes, and embryos, and higher clinical pregnancy rates in the pretreatment group.
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Affiliation(s)
- Maryam Eftekhar
- Reasearch and Clinical Center for Infertility, Yazd
Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences,
Yazd, Iran
- Recurrent Abortion Research Center, Yazd Reproductive
Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran
| | - Ramesh Baradaran Bagheri
- Reasearch and Clinical Center for Infertility, Yazd
Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences,
Yazd, Iran
- Recurrent Abortion Research Center, Yazd Reproductive
Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran
| | - Nosrat Neghab
- Reasearch and Clinical Center for Infertility, Yazd
Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences,
Yazd, Iran
- Recurrent Abortion Research Center, Yazd Reproductive
Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran
| | - Robabe Hosseinisadat
- Department of Obstetrics and Gynecology, School of
Medicine, Kerman University of Medical Sciences, Kerman, Iran
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17
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Namavar Jahromi B, Parsanezhad ME, Shomali Z, Bakhshai P, Alborzi M, Moin Vaziri N, Anvar Z. Ovarian Hyperstimulation Syndrome: A Narrative Review of Its Pathophysiology, Risk Factors, Prevention, Classification, and Management. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:248-260. [PMID: 29892142 PMCID: PMC5993897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction that usually occurs after gonadotropin stimulation, followed by human chorionic gonadotropin administration, for infertility treatment. The existing knowledge about the pathophysiology, risk factors, and primary and secondary methods for the prevention of OHSS is reviewed in this manuscript. The clinical manifestations and characteristics of mild, moderate, severe, and critical forms of the syndrome are defined. The methods of handling affected cases as outpatient or in-hospital management methods as well as indications for hospitalization are summarized in this review. The clinical and biochemical routes of assessing and monitoring hospitalized patients with OHSS, various drugs and medical treatment strategies including indications for aspiration of the ascitic fluid and pleural effusion, and also rare indications for surgery are briefly explained in this article. Severe OHSS, which two decades ago was considered an iatrogenic life-threatening condition, can now be effectively prevented or managed during the early stages. An OHSS-free clinic can be established nowadays by carefully considering the endocrinology of ovulation and using appropriate and dose-adjusted pharmaceutical agents, which are summarized and discussed in this review.
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Affiliation(s)
- Bahia Namavar Jahromi
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
,Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ebrahim Parsanezhad
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
,Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shomali
- Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran;,Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pardis Bakhshai
- Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran;,Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Alborzi
- Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran;,Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Moin Vaziri
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Zahra Anvar
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;
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18
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March WA, Whitrow MJ, Davies MJ, Fernandez RC, Moore VM. Postnatal depression in a community-based study of women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2018; 97:838-844. [DOI: 10.1111/aogs.13332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/12/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Wendy A. March
- Adelaide Medical School; The University of Adelaide; Adelaide Australia
- Robinson Research Institute; The University of Adelaide; Adelaide Australia
| | - Melissa J. Whitrow
- Robinson Research Institute; The University of Adelaide; Adelaide Australia
- School of Public Health; The University of Adelaide; Adelaide Australia
| | - Michael J. Davies
- Adelaide Medical School; The University of Adelaide; Adelaide Australia
- Robinson Research Institute; The University of Adelaide; Adelaide Australia
| | - Renae C. Fernandez
- Adelaide Medical School; The University of Adelaide; Adelaide Australia
- Robinson Research Institute; The University of Adelaide; Adelaide Australia
- School of Public Health; The University of Adelaide; Adelaide Australia
| | - Vivienne M. Moore
- Robinson Research Institute; The University of Adelaide; Adelaide Australia
- School of Public Health; The University of Adelaide; Adelaide Australia
- Fay Gale Center for Research on Gender; The University of Adelaide; Adelaide Australia
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Li S, Zhou D, Yin T, Xu W, Xie Q, Cheng D, Yang J. Dual trigger of triptorelin and HCG optimizes clinical outcome for high ovarian responder in GnRH-antagonist protocols. Oncotarget 2018; 9:5337-5343. [PMID: 29435182 PMCID: PMC5797053 DOI: 10.18632/oncotarget.23916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022] Open
Abstract
In this paper, a retrospective cohort study was conducted to the high ovarian responders in GnRH-antagonist protocols of IVF/ICSI cycles. The purpose of the study is to investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG) can improve the clinical outcome compared with traditional dose (10000IU) HCG trigger and low-dose (8000IU) HCG trigger for high ovarian responders in GnRH-antagonist in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles. Our study included 226 couples with high ovarian responders in GnRH-antagonist protocols of IVF/ICSI cycles. Standard dosage of HCG trigger (10000 IU of recombinant HCG) versus dual trigger (0.2 mg of triptorelin and 2000 IU of recombinant HCG) and low-dose HCG trigger (8000IU of recombinant HCG) were used for final oocyte maturation. Our main outcome measures were high quality embryo rate, the number of usable embryos, the risk of OHSS, duration of hospitalization and incidence rate of complications. Our evidence demonstrated that dual trigger is capable of preventing severe OHSS while still maintaining excellent high quality embryo rate in in high ovarian responders of GnRH-antagonist protocols.
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Affiliation(s)
- Saijiao Li
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei 430060, P.R. China
| | - Danni Zhou
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei 430060, P.R. China
| | - Tailang Yin
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei 430060, P.R. China
| | - Wangming Xu
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei 430060, P.R. China
| | - Qingzhen Xie
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei 430060, P.R. China
| | - Dan Cheng
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei 430060, P.R. China
| | - Jing Yang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, Hubei 430060, P.R. China
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Elective frozen-thawed embryo transfer (FET) in women at risk for ovarian hyperstimulation syndrome. Reprod Biol 2017; 18:46-52. [PMID: 29279182 DOI: 10.1016/j.repbio.2017.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
Elective cryopreservation of cultured embryos has become a treatment option for women at risk for ovarian hyperstimulation syndrome (OHSS). The aim of our study was to investigate the outcome of elective cryopreservation and consecutive frozen-thawed embryo transfer (FET) in a large IVF clinic in Austria. A total of 6104 controlled ovarian hyperstimulation cycles (COH) were performed on 2998 patients including 200 patients (6.7%) who were undergoing elective cryopreservation and FET due to high risk of OHSS. We estimated the cumulative live birth rate using the Kaplan-Meier method and evaluated independent predictors for successful live births with a Cox model. A total of 270 frozen-thawed embryo transfers were performed on 200 patients with up to 4 transfers per patient. The first embryo transfer showed a live birth rate of 42.0%, the second transfer showed a cumulative rate of 58.5%. After a total of 4 FETs from the same COH cycle, a cumulative live birth rate of 61.0% per COH cycle could be achieved. Four cases of OHSS occurred amongst these patients (2.0%), all of them of moderate severity. Multivariate analysis identified maternal age, the use of assisted hatching and the number of embryos transferred at the blastocyst stage as independent predictors for cumulative live birth. Our study clearly suggests that elective FET is safe and shows excellent cumulative live birth rates. This concept can, therefore, be used to avoid the severe adverse events caused by COH and the inefficient use of cultured embryos.
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Wang AC, Wang Y, Wu FX, Zhu DY. Assessing predictors for the success of GnRH antagonist protocol in reproductive women in IVF/ICSI - in fresh cycles. Biomed Rep 2017; 7:482-486. [PMID: 29181162 DOI: 10.3892/br.2017.984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/06/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the factors that affect the success rate of gonadotropin-releasing hormone antagonist on in vitro fertilization/intracytoplasmic sperm injection cycles. Multivariate analysis was performed to assess the factors that influence the outcomes, such as oocytes retrieved, and the success of pregnancy. The results showed that E2, P on human chorionic gonadotropin (HCG) day and body mass index (BMI) were positively correlated with the number of oocytes retrieved (P=0.001, P=0.024, P=0.017, respectively). The duration of infertility as well as the luteinizing hormone on HCG day were negatively correlated with the number of oocytes (P=0.048, P=0.002, respectively). The age of the women and P on HCG day were negatively correlated with successful pregnancy (P<0.001, P=0.022). In conclusion, some parameters, such as E2, P, and LH on the HCG day, as well as age and BMI, may affect treatment outcomes.
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Affiliation(s)
- An-Cong Wang
- Department of Reproductive Medicine, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China.,Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Ying Wang
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Feng-Xia Wu
- Department of Anatomy, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Dong-Yi Zhu
- Department of Reproductive Medicine, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China.,Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
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Benbassat B, Mitov K, Savova A, Tachkov K, Petrova G. Cost-effectiveness of different types of COH protocols for in vitro fertilization at national level. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1261636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Boriana Benbassat
- Department of Social Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Mitov
- Department of Social Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Alexandra Savova
- Department of Social Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Department of Social Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Social Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
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Islam Y, Aboulghar MM, AlEbrashy AED, Abdel-Aziz O. The value of different ovarian reserve tests in the prediction of ovarian response in patients with unexplained infertility. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Affiliation(s)
- Michel De Vos
- Clinical Professor of Reproductive Medicine, Centre for Reproductive Medicine, UZ Brussel, Belgium
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Decleer W, Verschueren K, Vandeginste S, Osmanagaoglu K, Devroey P. Corifollitropin stimulation in combination with GnRH-antagonists after estradiol valerate pre-treatment. A pilot study on patientfriendly IVF. Facts Views Vis Obgyn 2015; 7:223-230. [PMID: 27729967 PMCID: PMC5058411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To demonstrate the feasibility of scheduling an IVF cycle, without disadvantages, in the new patient friendly stimulation protocol using the long acting Corifollitropin Alfa, in combination with GnRH-antagonist protection and GnRH-agonist triggering. STUDY DESIGN Two groups of ten patients were admitted in the study. Both received the same stimulation protocol with Corifollitropin Alfa in combination with GnRH-antagonist protection. After ultrasound evaluation on day 7 individually dosed Menopur was added. For triggering final oocyte maturation GnRH-agonists were used. The only difference between the two groups was that in the study group, estradiol valerate 4 mg/day was given from day 25 of the preceding cycle for a period of 10 days, thus postponing the start of follicular growth. RESULTS Scheduling the IVF stimulation by the administration of estradiol valerate 4 mg/day did not influence the hormonal curves, nor the embryological results in comparison to patients with the same stimulation, starting their stimulation at the beginning of menstruation. In this pilot study four out of ten patients turned out to be pregnant, demonstrating an acceptable pregnancy rate. CONCLUSION The combination of estradiol valerate 4 mg/day pre-treatment with the novel combination of Corifollitropin Alfa stimulation with GnRH-antagonist protection, individually topped off with Menopur, and triggered with GnRH-agonist proved to be a safe, patient-friendly (limited number of injections in comparison to classical IVF) (Patil, 2014) and efficient alternative to classical IVF stimulation protocols, allowing patients - and doctors - to schedule the treatment cycle to their convenience.
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Affiliation(s)
- W Decleer
- Fertility center, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium
| | - K Verschueren
- Living Statistics, Kunstenaarstraat 35, 9040 Sint-Amandsberg, Belgium
| | | | - K Osmanagaoglu
- Fertility center, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium
| | - P Devroey
- Fertility center, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium
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Is the GnRH Antagonist Protocol Effective at Preventing OHSS for Potentially High Responders Undergoing IVF/ICSI? PLoS One 2015; 10:e0140286. [PMID: 26468951 PMCID: PMC4607293 DOI: 10.1371/journal.pone.0140286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/23/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To determine if the GnRH antagonist protocol is effective in preventing ovarian hyperstimulation syndrome (OHSS) in potentially high responders. Methods A total of 660 IVF-ET/ICSI cycles were retrospectively identified. The inclusion criterion was age ≤ 30 years. Cycles were divided into two groups: a GnRHa group and a GnRHant group. In the GnRHa group, the patients received one single injection of 1.0mg-1.3mg Triptorelin in previous mid-luteal phase. In the GnRHant group, a daily dose of 0.25 mg Cetrotide was initiated when a lead follicle obtained a mean diameter of 14 mm, continued up until the day of hCG administration. The duration of stimulation, total dose of Gn, implantation rate, pregnancy rate, and OHSS rate were compared. Results The duration of stimulation, E2 level on hCG day, numbers of oocytes retrieved, MII oocytes, and high-quality embryos in the GnRHa group were all significantly more than those in the GnRHant group. In the GnRHa group, 83.53% of cancelled fresh-transferred cycles were cancelled because of high risk of OHSS, which was significantly higher than that in the GnRHant group (43.55%, P<0.05). The incidence of OHSS in the GnRHa group was slightly higher than that in the GnRHant group. The implantation and clinical pregnancy rates in the GnRHa group were significantly higher than those in the GnRHant group (37.36% VS 19.25%, 62.78% VS 31.06%; P<0.05). Conclusions Our study demonstrated that for potentially high responders, the GnRHant protocol can, to some extent, lower the cancellation and incidence rates of OHSS. The GnRHa protocol was superior to the GnRHant protocol in terms of implantation and clinical pregnancy rates.
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Gizzo S, Andrisani A, Noventa M, Gangemi M, Nardelli GB, Ambrosini G. Pretreatment with oral contraceptive pills to identify poor responders that may benefit from rLH supplementation during GnRH-antagonist treatment for IVF: A pilot perspective study proposal. Exp Ther Med 2015; 10:1692-1696. [PMID: 26640538 PMCID: PMC4665651 DOI: 10.3892/etm.2015.2734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 07/09/2015] [Indexed: 11/25/2022] Open
Abstract
Controlled ovarian stimulation, using a gonadotrophin-releasing hormone (GnRH) antagonist protocol, is a potential treatment option for women with a low response to other fertility treatments as it appears to be at least as effective as GnRH agonists (long protocol). However, previous studies have indicated that the administration of GnRH antagonist may cause an excessive reduction in endogenous luteinizing hormone (LH) levels. The use of recombinant LH (rLH) supplementation during ovarian stimulation is controversial. The present article proposes a future study focused on women aged ≥40 years old, with the aim of identifying patients who are poor responders to GnRH-antagonist treatment that may benefit from rLH supplementation. We hypothesize that patients with suppressed hypothalamic-pituitary-axis activity may benefit from rLH supplementation, as GnRH-antagonist administration has the potential to induce a marked reduction in LH levels in such patients compared with that in patients that exhibit a regular recovery following the administration of oral contraceptive pills (OCPs). Furthermore, patients with hyper-responsive hypothalamic-pituitary-axis activity may be affected by ‘low-gonadotropin-responsiveness’, similar to that observed in patients with any mutation in the follicle-stimulating hormone (FSH) receptor, who are known to benefit from rLH supplementation. The proposed pilot study would include 120 women who are predicted to be poor responders to GnRH-antagonist treatment. All subjects will be allocated at random (using 2:1 computerized randomization) into two study groups: Group A (OCP-treated) and group B (control). For all patients, the serum values of FSH, LH and 17β estradiol (E2) will be detected on day 3 of the menstrual cycle preceding OCP treatment (baseline) and at day 4 following OCP treatment. The Δ-variation from baseline levels for all markers, the FSH/LH ratio and the E2/FSH ratio will be determined. Δ-variation from the baseline of the FSH and LH values will be used to further categorize group A patients into subgroups A1–4, based on respective quartile numbers (Q1–4). Patients admitted to each of the four subgroups A1–4, based on their FSH quartile, will be selected at random to receive rLH supplementation (ratio, 1:1) during ovarian stimulation. If the resulting data are able to identify women that may benefit from rLH supplementation during ovarian stimulation, a large part of inconclusive evidence regarding rLH supplementation will be clarified. If patients supplemented with rLH (according to abnormal recovery of hypothalamic-pituitary-axis activity after OCP treatment) exhibit an improved ovarian response during in vitro fertilization (IVF) and subsequent pregnancy rate, the pre-IVF OCP test could be adopted as a useful tool for improving the success rate of assisted reproductive technologies in poorly-responding patients.
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Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, Clinic of Gynecology and Obstetrics, University of Padua, Padua I-35128, Italy
| | - Alessandra Andrisani
- Department of Woman and Child Health, Clinic of Gynecology and Obstetrics, University of Padua, Padua I-35128, Italy
| | - Marco Noventa
- Department of Woman and Child Health, Clinic of Gynecology and Obstetrics, University of Padua, Padua I-35128, Italy
| | - Michele Gangemi
- Department of Woman and Child Health, Clinic of Gynecology and Obstetrics, University of Padua, Padua I-35128, Italy
| | - Giovanni Battista Nardelli
- Department of Woman and Child Health, Clinic of Gynecology and Obstetrics, University of Padua, Padua I-35128, Italy
| | - Guido Ambrosini
- Department of Woman and Child Health, Clinic of Gynecology and Obstetrics, University of Padua, Padua I-35128, Italy
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Aslan K, Avci B, Uncu G, Saribal S, Ata B. Scheduling GnRH antagonist cycles by a short course of oral estradiol administration during early follicular phase: a comparative study with non-scheduled cycles. Gynecol Endocrinol 2015; 31:465-8. [PMID: 25982362 DOI: 10.3109/09513590.2015.1006189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This hypothesis generating study investigated whether GnRH antagonist cycles can be scheduled by a short course of oral estradiol administration during the follicular phase without impairing treatment outcome. Thirty-five women who underwent follicular phase estrogen scheduling (ES) of GnRH antagonist cycles were retrospectively matched for age and number of prior failed cycles with 35 women who underwent unscheduled GnRH antagonist cycles. ES group was given 6 mg/day estradiol orally from cycle day 2 until (including) one day before the scheduled start of stimulation. Gonadotropins were started on cycle days 2-3 in the control group. Flexible GnRH antagonist protocol was employed in both groups. ES group received estradiol for a median of 5 days. Total gonadotropin consumption was similar but one more GnRH antagonist injection was required in the ES group. Endometrial thickness on the day of hCG injection was increased in the ES group (12 versus 10 mm, p < 0.01). Number of oocytes, metaphase II oocytes and transferred embryos were similar. Embryo implantation rates were 44.8% versus 34.4% (p = 0.3), and clinical pregnancy rates were 48.6% versus 37.1%, (p = 0.33) in the ES and control groups, respectively. All women in the ES group had oocyte retrieval and embryo transfer within the desired period.
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Viardot-Foucault V, Nadarajah S, Lye WK, Tan HH. GnRH antagonist pre-treatment: one centre's experience for IVF–ICSI cycle scheduling. Reprod Biomed Online 2015; 30:366-72. [DOI: 10.1016/j.rbmo.2014.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 11/26/2022]
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Garcia-Velasco JA, Fatemi HM. To pill or not to pill in GnRH antagonist cycles: that is the question! Reprod Biomed Online 2015; 30:39-42. [DOI: 10.1016/j.rbmo.2014.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/14/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
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Bayoglu Tekin Y, Ceyhan ST, Kilic S, Korkmaz C. The impact of the time interval on in-vitro fertilisation success after failure of the first attempt. J OBSTET GYNAECOL 2014; 35:403-6. [PMID: 25264732 DOI: 10.3109/01443615.2014.960830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to identify the optimal time interval for in-vitro fertilisation that would increase treatment success after failure of the first attempt. This retrospective study evaluated 454 consecutive cycles of 227 infertile women who had two consecutive attempts within a 6-month period at an IVF centre. Data were collected on duration of stimulation, consumption of gonadotropin, numbers of retrieved oocytes, mature oocytes, fertilised eggs, good quality embryos on day 3/5 following oocyte retrieval and clinical and ongoing pregnancy. There were significant increases in clinical pregnancy rates at 2-, 3- and 4-month intervals. The maximum increase was after two menstrual cycles (p = 0.001). The highest rate of ongoing pregnancy was in women that had the second attempt after the next menstrual cycle following failure of IVF (27.2%). After IVF failure, initiating the next attempt within 2-4 months increases the clinical pregnancy rates.
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Affiliation(s)
- Y Bayoglu Tekin
- Department of Obstetrics and Gynecology, Recep Tayyip Erdoğan University, School of Medicine , Rize
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Mahajan N. Should mild stimulation be the order of the day? J Hum Reprod Sci 2014; 6:220-6. [PMID: 24672159 PMCID: PMC3963303 DOI: 10.4103/0974-1208.126282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/14/2013] [Accepted: 09/22/2013] [Indexed: 11/04/2022] Open
Abstract
Mild stimulation protocols aim to reduce the physical, financial and emotional burden associated with the conventional IVF protocol without compromising the pregnancy rate. Such protocols help to decrease the complications and the discomfort related to the prolonged administration of agonist and large doses of gonadotrophins, by limiting the number of oocytes recruited to no more than eight. The per cycle pregnancy rates are lower though the cumulative pregnancy rate in a year is equivalent. This CPR comes by going through earlier repeat cycles. Whether this reduces the physical, emotional or financial burden remains a matter of debate. There is need to standardize these protocol and do more trials to compare the two effectively. Till such time there is a clear benefit above the conventional protocol it will not be the protocol of choice with most physicians.
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Affiliation(s)
- Nalini Mahajan
- Department of Reproductive Medicine, NOVA IVI Fertility, New Delhi, India
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Bermejo A, Iglesias C, Ruiz-Alonso M, Blesa D, Simón C, Pellicer A, García-Velasco J. The impact of using the combined oral contraceptive pill for cycle scheduling on gene expression related to endometrial receptivity. Hum Reprod 2014; 29:1271-8. [PMID: 24706003 DOI: 10.1093/humrep/deu065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Alfonso Bermejo
- Instituto Valenciano de Infertilidad, Av. Del Talgo 68 (28023), Madrid, Spain
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Abstract
Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro. This chapter provides a brief overview of ART, including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support. This chapter also discusses potential complications of ART, namely ovarian hyperstimulation syndrome (OHSS) and multiple gestations, and the perinatal outcomes of ART.
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Hauzman EE, Zapata A, Bermejo A, Iglesias C, Pellicer A, Garcia-Velasco JA. Cycle scheduling for in vitro fertilization with oral contraceptive pills versus oral estradiol valerate: a randomized, controlled trial. Reprod Biol Endocrinol 2013; 11:96. [PMID: 24074027 PMCID: PMC3849807 DOI: 10.1186/1477-7827-11-96] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 09/24/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Both oral contraceptive pills (OCPs) and estradiol (E2) valerate have been used to schedule gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles and, consequently, laboratory activities. However, there are no studies comparing treatment outcomes directly between these two pretreatment methods. This randomized controlled trial was aimed at finding differences in ongoing pregnancy rates between GnRH antagonist IVF cycles scheduled with OCPs or E2 valerate. METHODS Between January and May 2012, one hundred consecutive patients (nonobese, regularly cycling women 18-38 years with normal day 3 hormone levels and <3 previous IVF/ICSI attempts) undergoing IVF with the GnRH antagonist protocol were randomized to either the OCP or E2 pretreatment arms, with no restrictions such as blocking or stratification. Authors involved in data collection and analysis were blinded to group assignment. Fifty patients received OCP (30 μg ethinyl E2/150 μg levonorgestrel) for 12-16 days from day 1 or 2, and stimulation was started 5 days after stopping OCP. Similarly, 50 patients received 4 mg/day oral E2 valerate from day 20 for 5-12 days, until the day before starting stimulation. RESULTS Pretreatment with OCP (mean±SD, 14.5±1.7 days) was significantly longer than with E2 (7.8±1.9 days). Stimulation and embryological characteristics were similar. Ongoing pregnancy rates (46.0% vs. 44.0%; risk difference, -2.0% [95% CI -21.2% to 17.3%]), as well as implantation (43.5% vs. 47.4%), clinical pregnancy (50.0% vs. 48.0%), clinical miscarriage (7.1% vs. 7.7%), and live birth (42.0% vs. 40.0%) rates were comparable between groups. CONCLUSIONS This is the first study to directly compare these two methods of cycle scheduling in GnRH antagonist cycles. Our results fail to show statistically significant differences in ongoing pregnancy rates between pretreatment with OCP and E2 for IVF with the GnRH antagonist protocol. Although the study is limited by its sample size, our results may contribute to a future meta-analysis. An interesting future direction would be to extend our study to women with decreased ovarian reserve, as these are the patients in whom an increase in oocyte yield-due to the hypothetical beneficial effect of steroid pretreatment on follicular synchronization-could more easily be demonstrated. TRIAL REGISTRATION ClinicalTrials.gov http://NCT01501448.
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Affiliation(s)
| | | | | | | | - Antonio Pellicer
- IVI Valencia, Plaza de la Policía Local, 3, 46015 Valencia, Spain
- Universidad de Valencia, Avda de Blasco Ibáñez, 13, 46010 Valencia, Spain
| | - Juan A Garcia-Velasco
- IVI Madrid, Avda del Talgo, 68-70, 28023 Madrid, Spain
- Rey Juan Carlos University, Avda del Talgo 68-70, 28023 Madrid, Spain
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Maldonado LGL, Franco JG, Setti AS, Iaconelli A, Borges E. Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments. Fertil Steril 2013; 99:1615-22. [DOI: 10.1016/j.fertnstert.2013.01.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/07/2013] [Accepted: 01/09/2013] [Indexed: 11/30/2022]
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Copperman AB, Benadiva C. Optimal usage of the GnRH antagonists: a review of the literature. Reprod Biol Endocrinol 2013; 11:20. [PMID: 23496864 PMCID: PMC3618003 DOI: 10.1186/1477-7827-11-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/27/2013] [Indexed: 11/25/2022] Open
Abstract
Gonadotropin-releasing hormone (GnRH) antagonists, which became commercially available from 1999, have been used for the prevention of premature luteinizing hormone (LH) surges in controlled ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection. This review focuses on the recent literature on the use of GnRH antagonists and provides guidelines for optimal use in light of increasing evidence showing that GnRH antagonists are safe and effective, allowing flexibility of treatment in a wide range of patient populations. This includes patients undergoing first-line controlled ovarian stimulation, poor responders, and women diagnosed with polycystic ovary syndrome. The GnRH antagonist offers a viable alternative to the long agonists, providing a shorter duration of treatment with fewer injections and with no adverse effects on assisted reproductive technology outcome. This results in a significantly lower amount of gonadotropins required, which is likely to lead to improved patient compliance.
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Affiliation(s)
- Alan B Copperman
- Mount Sinai Medical Center, New York, NY, USA
- Reproductive Medicine Associates of New York, New York, NY, USA
| | - Claudio Benadiva
- The Center for Advanced Reproductive Services, Department of Ob/Gyn, University of Connecticut, Farmington, CT, USA
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Huang JYJ, Rosenwaks Z. In vitro fertilisation treatment and factors affecting success. Best Pract Res Clin Obstet Gynaecol 2012; 26:777-88. [PMID: 23059403 DOI: 10.1016/j.bpobgyn.2012.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/02/2012] [Accepted: 08/10/2012] [Indexed: 11/25/2022]
Abstract
The efficacy of assisted reproductive technologies has improved significantly over the past decades. The main indications for in vitro fertilisation include tubal obstruction, severe male-factor infertility, severe endometriosis, ovulatory dysfunction, diminished ovarian reserve, and infertility of unexplained cause. In vitro fertilisation has also become an effective treatment option for couples wishing to undergo pre-implantation genetic diagnosis or screening, and for those wishing to cryopreserve their oocytes or embryos for preservation of fertility. The management of women in late reproductive age poses a major challenge; the optimum in vitro fertilisation treatment for poor responders remains elusive. The success of in vitro fertilisation treatment can be optimised by taking an individualised, patient-centered approach to controlled ovarian hyperstimulation. Key components involve selection of an appropriate controlled ovarian protocol, close-cycle monitoring, adjustment of gonadotropin dosage to avoid hyper-response, and individualised timing of human chorionic gonadotropin injection. Future directions of assisted reproductive technologies include development of non-invasive embryo selection methods, use of transcriptomics, proteomics, metabolomics, and time-lapse imaging technologies.
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Affiliation(s)
- Jack Yu Jen Huang
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College of Cornell University, 1305 York Avenue, 7th Floor, New York, NY, USA
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Qiao J, Lu G, Zhang HW, Chen H, Ma C, Olofsson JI, Witjes H, Heijnen E, Mannaerts B. A randomized controlled trial of the GnRH antagonist ganirelix in Chinese normal responders: high efficacy and pregnancy rates. Gynecol Endocrinol 2012; 28:800-4. [PMID: 22429192 DOI: 10.3109/09513590.2012.665103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Gonadotropin-releasing hormone (GnRH) antagonists for controlled ovarian stimulation (COS) were only recently introduced into China. The efficacy and safety of the GnRH antagonist ganirelix was assessed in a multicenter, controlled, open-label study, in which Chinese women were randomized to either ganirelix (n = 113) or a long GnRH agonist protocol of triptorelin (n = 120). The primary end point was the amount of recombinant follicle-stimulating hormone (rFSH) required to meet the human chorionic gonadotropin criterion (three follicles ≥17 mm). The amount of rFSH needed was significantly lower for ganirelix (1272 IU) vs. triptorelin (1416 IU; P< 0.001). Ongoing pregnancy rates per started cycle were 39.8% (ganirelix) and 39.2% (triptorelin). Although both treatments were well tolerated, cancellation due to risk of ovarian hyperstimulation syndrome (OHSS) was less frequent with ganirelix (1.8%) than triptorelin (7.5%) (P = 0.06). Less rFSH was needed in the ganirelix protocol than the long GnRH agonist protocol, with fewer reported cases of OHSS and similar pregnancy rates.
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Affiliation(s)
- Jie Qiao
- Reproductive Medical Center, Peking University Third Hospital, Beijing, China
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FSH receptor in vitro modulation by testosterone and hCG in human luteinized granulosa cells. Eur J Obstet Gynecol Reprod Biol 2012; 165:259-64. [PMID: 22964136 DOI: 10.1016/j.ejogrb.2012.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 07/24/2012] [Accepted: 08/14/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effect of testosterone and hCG on FSH receptor (FSHR) protein and mRNA expression in human granulosa cells (GC) in vitro. STUDY DESIGN Experimental in vitro cell culture obtained from healthy women undergoing IVF/ICSI due to male factor infertility. Human follicular fluid samples were obtained and after cumulus-oocyte complexes were identified, fluids were pipetted onto Ficoll gradients and centrifuged for 15 min at 400 × g at room temperature. Cells at the interface were removed and plated in 24-well plates for 3 days in M-199 with 10% FBS. Cells were treated with different concentrations of testosterone and hCG. After purification, cells were labeled with specific antibodies and the protein expression of the FSHR was evaluated by flow cytometry in the GC population. Also, total RNA was extracted from confluent GC and the FSHR gene expression was evaluated by RT-PCR. RESULTS FSHR expression was modulated by treating GC in vitro at different testosterone/hCG concentrations. When compared with untreated GC, we observed a significant effect of testosterone and hCG on the expression of the FSHR at the protein level. Time course experiments confirmed that the gene expression of the FSHR peaked at 12-24h when testosterone or hCG was used as a stimulus. CONCLUSIONS Both testosterone and hCG are able to positively modulate FSHR expression at gene and protein level in human GC in vitro.
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Jayaprakasan K, Chan Y, Islam R, Haoula Z, Hopkisson J, Coomarasamy A, Raine-Fenning N. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril 2012; 98:657-63. [DOI: 10.1016/j.fertnstert.2012.05.042] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 05/15/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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Morley L, Tang T, Yasmin E, Hamzeh R, Rutherford AJ, Balen AH. Timing of human chorionic gonadotrophin (hCG) hormone administration in IVF protocols using GnRH antagonists: a randomized controlled trial. HUM FERTIL 2012; 15:134-9. [DOI: 10.3109/14647273.2012.712739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Guivarc'h-Leveque A. Estradiol programming of antagonist IVF cycles. Reprod Biomed Online 2012; 25:331-2. [PMID: 22795765 DOI: 10.1016/j.rbmo.2012.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022]
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Schmitz C, Bocca S, Beydoun H, Stadtmauer L, Oehninger S. Does the degree of hypothalamic-pituitary-ovarian recovery after oral contraceptive pills affect outcomes of IVF/ICSI cycles receiving GnRH-antagonist adjuvant therapy in women over 35 years of age? J Assist Reprod Genet 2012; 29:877-82. [PMID: 22729431 DOI: 10.1007/s10815-012-9812-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 05/28/2012] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate if the degree of recovery of serum gonadotropins after oral contraceptive pills (OCP) pretreatment has an impact on ovarian response in GnRH-antagonist IVF cycles in women of advanced maternal age. METHODS In this retrospective cohort study, we included 98 women 35-42 years undergoing their first IVF cycle receiving gonadotropins and a fixed GnRH-antagonist adjuvant protocol. Data analysis was carried out according to changes in serum FSH, LH and estradiol (E(2)) levels (basal and post-OCP) divided in quartiles, and also according to absolute levels. The main outcomes were peak serum E(2), number of mature oocytes retrieved, length of stimulation, and amount of gonadotropins used. RESULTS By quartile analysis, patients with the highest levels of serum gonadotropins suppression and also patients with gonadotropin rebound needed larger amounts of LH during the treatment. On the other hand, women with absolute suppression of FSH/LH had increased length of stimulation. CONCLUSIONS The results of this study provide data that assist in clinical management. Gonadotropin serum levels after OCP treatment provide information for optimization of supplementation with LH in GnRH-antagonist cycles in women over age 35.
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Affiliation(s)
- Carla Schmitz
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, The Jones Institute for Reproductive Medicine, 601 Colley Ave, Norfolk, VA, USA
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Cédrin-Durnerin I, Guivarc'h-Levêque A, Hugues JN. Pretreatment with estrogen does not affect IVF-ICSI cycle outcome compared with no pretreatment in GnRH antagonist protocol: a prospective randomized trial. Fertil Steril 2012; 97:1359-64.e1. [DOI: 10.1016/j.fertnstert.2012.02.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/17/2012] [Accepted: 02/21/2012] [Indexed: 11/26/2022]
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Howles CM, Ezcurra D, Homburg R. Ovarian stimulation protocols in assisted reproductive technology: an update. Expert Rev Endocrinol Metab 2012; 7:319-330. [PMID: 30780844 DOI: 10.1586/eem.12.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Controlled ovarian stimulation (COS) with gonadotropins to produce multiple follicular development and high-quality oocytes is the cornerstone of assisted reproductive technology. Today, recombinant human follicle-stimulating hormone (r-hFSH) is widely used for COS. A long-acting r-hFSH and a combination of r-hFSH and recombinant human luteinizing hormone have recently become available. Formulations of purified urinary FSH with or without luteinizing hormone activity (provided by human chorionic gonadotropin) are also available. COS protocols can now be individualized to optimize efficacy and safety - defined as singleton pregnancies with a low incidence of ovarian hyperstimulation syndrome. This is facilitated by an estimation of ovarian response using the antral follicle count and/or serum anti-Müllerian hormone levels; anti-Müllerian hormone is viewed as the most reliable single marker. However, an efficient management strategy for poor responders to COS is still required. Developments in biomarkers and other techniques for accurate identification of viable oocytes and embryos and optimal uterine receptivity are expected.
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Affiliation(s)
- Colin M Howles
- a Merck Serono S.A. - Geneva , Geneva, Switzerland
- c Merck Serono S.A. - Geneva , Geneva, Switzerland.
| | | | - Roy Homburg
- b Barzilai Medical Centre, Ashkelon, Israel and Homerton University Hospital, Hackney, London, UK
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Kato K, Takehara Y, Segawa T, Kawachiya S, Okuno T, Kobayashi T, Bodri D, Kato O. Minimal ovarian stimulation combined with elective single embryo transfer policy: age-specific results of a large, single-centre, Japanese cohort. Reprod Biol Endocrinol 2012; 10:35. [PMID: 22541043 PMCID: PMC3407520 DOI: 10.1186/1477-7827-10-35] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 04/27/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The two main complications associated with the use of assisted reproduction techniques, ovarian hyperstimulation syndrome and multiple pregnancies, could be eliminated by milder ovarian stimulation protocols and the increased use of a single embryo transfer (SET) policy. A retrospective, cohort study was performed in private infertility centre to evaluate the embryological and clinical results of a large exclusively SET program according to patient age (lower or equal 29, 30-34, 35-39, 40-44 and equal or higher 45 years). MATERIALS A total of 7,244 infertile patients have undergone 20,244 cycles with a clomiphene-based minimal stimulation or natural cycle IVF protocol during 2008. Following oocyte retrieval, fertilization and embryo culture a total of 10,401 fresh or frozen single embryo transfer procedures were performed involving cleavage-stage embryos or blastocysts. RESULTS Successful oocyte retrieval rate (78.0 %) showed no age-dependent decrease until 45 years. Fertilization (80.3 %) and cleavage (91.1 %) rates were not significantly different between age groups. Blastocyst formation (70.1 % to 22.8 %) and overall live birth rates (35.9 % to 2 %) showed an age-dependent decrease. Frozen-thawed blastocyst transfer cycles gave the highest chance of live birth per embryo transfer (41.3 % to 6.1 %). CONCLUSIONS High fertilization and cleavage rates were obtained regardless of age whereas blastocyst formation and live birth rates showed an age-dependent decrease. An elective single embryo transfer program based on a minimal ovarian stimulation protocol yields acceptable live birth rates per embryo transfer in infertile patients up until their mid-forties. However in very advanced age patients (equal or higher 45 years old) success rates fall below 1 %.
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Affiliation(s)
- Keiichi Kato
- Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Yuji Takehara
- Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | | | - Satoshi Kawachiya
- Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Takashi Okuno
- Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Tamotsu Kobayashi
- Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Daniel Bodri
- Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Osamu Kato
- Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
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Oestradiol valerate pretreatment in GnRH-antagonist cycles: a randomized controlled trial. Reprod Biomed Online 2012; 24:272-80. [DOI: 10.1016/j.rbmo.2011.11.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/10/2011] [Accepted: 11/15/2011] [Indexed: 11/20/2022]
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Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2012:CD008605. [PMID: 22336848 DOI: 10.1002/14651858.cd008605.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a complication resulting from administration of human chorionic gonadotrophin (hCG) in assisted reproduction technology (ART) treatment. Most case are mild, but forms of moderate or severe OHSS appear in 3% to 8% of in vitro fertilisation (IVF) cycles. Recently, the dopamine agonist cabergoline has been introduced as a secondary prevention intervention for OHSS in women at high risk of OHSS who are undergoing ART treatment. OBJECTIVES To assess the effectiveness and safety of cabergoline in preventing ovarian hyperstimulation syndrome (OHSS) in high-risk women undergoing ART treatment. SEARCH METHODS Major medical databases (Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials, CENTRAL (The Cochrane Library), MEDLINE, EMBASE and PsycINFO) were systematically searched for randomised controlled trials (RCTs) assessing the effect of cabergoline in preventing OHSS. Databases were searched up to September 2011. Registers of clinical trials, abstracts of scientific meetings and reference lists of included studies were searched. No language restrictions were applied. SELECTION CRITERIA RCTs which compared cabergoline with placebo, no treatment or another intervention for preventing OHSS in high-risk women were considered for inclusion. Primary outcome measures included incidence of moderate or severe OHSS and live birth rate. Secondary endpoints were clinical pregnancy rate, multiple pregnancy rate, miscarriage rate and any other adverse effects of the treatment. DATA COLLECTION AND ANALYSIS Two authors independently screened titles, abstracts and the full text of publications; extracted data; and assessed risk of bias. Any disagreements were resolved by consensus. Pooled results were reported as odds ratio (OR) and 95% confidence interval (95% CI) by the Mantel-Haenszel method. MAIN RESULTS Only two trials involving 230 women met the inclusion criteria. Both studies had a moderate risk of bias. Oral cabergoline, 0.5 mg daily, was given as an intervention and compared with a matched placebo. A statistically significant reduction in OHSS was observed in the cabergoline treated group (OR 0.40, 95% CI 0.20 to 0.77; 2 RCTs, 230 women) with a number needed to treat (NTT) of 7. There was a statistically significant difference in the incidence of moderate OHSS, favouring cabergoline (OR 0.38, 95% CI 0.19 to 0.78; 2 RCTs, 230 women) but not in severe OHSS (OR 0.77, 95% CI 0.24 to 2.45; 2 RCTs, 230 women). There was no significant difference in the clinical pregnancy rate (OR 0.94, 95% CI 0.56 to 1.59; 2 RCTs, 230 women), miscarriage rate (OR 0.31, 95% CI 0.03 to 3.07; 1 RCT, 163 women) or any other adverse effects of the treatment (OR 2.07, 95% CI 0.56 to 7.70; 1 RCT, 67 women). However, no data on multiple pregnancy rate or live birth rate were reported in either trial. AUTHORS' CONCLUSIONS Cabergoline appears to reduce the risk of OHSS in high-risk women, especially for moderate OHSS. The use of cabergoline does not affect the pregnancy outcome (clinical pregnancy rate, miscarriage rate), nor is there an increased risk of adverse events. Further research should consider the risk of administering cabergoline and the comparison between cabergoline and established treatments (such as intravenous albumin and coasting). Large, well-designed and well-executed RCTs that involve more clinical endpoints are necessary to further evaluate the role of cabergoline in OHSS prevention.
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Affiliation(s)
- Huilin Tang
- Department of Pharmacy, Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Peking UniversityThird Hospital, Beijing, China.
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Castillo J, Dolz M, Moreno J, Gijón L, Ferrer R, Ferrero E, Bonilla-Musoles F. Triggering with GnRH agonist in oocyte-donation cycles: oestradiol monitoring is not necessary during ovarian stimulation. Reprod Biomed Online 2012; 24:247-50. [DOI: 10.1016/j.rbmo.2011.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 11/04/2011] [Accepted: 11/09/2011] [Indexed: 10/15/2022]
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