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Fernández-Prada S, Martín-Cameán M, Armijo O, Diez-Sebastián J, Iniesta S, Lobo S, Silva P, Sanz C, Sánchez MJ, Hernández A. Use of steroid pre-treatments in IVF-ICSI cycles with GnRH antagonist protocol and their impact on gestational outcomes. J OBSTET GYNAECOL 2021; 42:478-484. [PMID: 34151671 DOI: 10.1080/01443615.2021.1916806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Different steroid pre-treatments have been used to schedule the start of the ovarian stimulation in IVF cycles. Currently, there is controversy about their effects on gestational outcomes. We designed a three-armed randomised controlled trial (RCT). Eighty-six normoresponder patients undergoing IVF treatment with antagonist GnRH protocol were allocated to three different groups. In the group 1, 34 patients received oral contraceptive pill (OCP) from the first day of the cycle to five days before starting ovarian stimulation, in the group 2, 25 patients received 2 mg/12 hours of oral E2 valerate from day 25 of the previous cycle until the day before starting stimulation, and finally, in the group 3, 27 patients did not receive any treatment. There are no statistically significant differences neither in clinical pregnancy rate (CPR) (40.9% OCP vs. 28.6% E2 vs. 53.3% no treatment group, p=.388) nor live birth rate (LBR) (31.8% OCP vs. 28.6% E2 vs. 46.7% no treatment group, p=.537) between groups in fresh embryo transfer. Likewise, no differences were found in the cumulative CPR, nor in cumulative LBR. However, there is a tendency to worst outcomes in the E2 group. In this E2 group, we observed better results with longer exposition, although no significant differences are reached (E2 mean days in the pregnant group 8.29 vs. 6.83 in the non-pregnant group, p=.08). Our study shows no significant differences in pregnancy rates between groups, but the E2 group is trending at worse gestational results. Trial registration number: Eudra-CT registration number is 2014-001809-40.Impact StatementWhat is already known on this subject? Nowadays, there is much controversy about how pregnancy rates could be affected by the selection of steroid pre-treatments used in order to schedule IVF cycles. However, these treatments are widely utilised in clinical practice.What the results of this study add? The results support the clinical findings of most of the studies previously published. No significant differences in gestational outcomes were found between the groups treated with steroid pre-treatments and the control group. Additionally, oestrogen pre-treatment seems to be related to better pregnancy outcomes when the exposition is longer. Thus, an earlier start of this treatment in the luteal phase could be the optimal approach.What the implications are of these findings for clinical practice and/or further research? This study pretends to provide clarity about the treatment guidelines of steroid pre-treatments to schedule the clinical work without impact on gestational outcomes.
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Affiliation(s)
- Sara Fernández-Prada
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - María Martín-Cameán
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Onica Armijo
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | | | - Silvia Iniesta
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Sonia Lobo
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Patricia Silva
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Clara Sanz
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Maria José Sánchez
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Alicia Hernández
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
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Fischer R, Nakano FY, Roque M, Bento FC, Baukloh V, Esteves SC. A quality management approach to controlled ovarian stimulation in assisted reproductive technology: the "Fischer protocol". Panminerva Med 2019; 61:11-23. [DOI: 10.23736/s0031-0808.18.03549-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- D H Barlow
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford
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Basile N, Garcia-Velasco JA. The state of "freeze-for-all" in human ARTs. J Assist Reprod Genet 2016; 33:1543-1550. [PMID: 27629122 DOI: 10.1007/s10815-016-0799-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/16/2016] [Indexed: 11/24/2022] Open
Abstract
The recent development of vitrification technologies and the good outcomes obtained in assisted reproduction technologies have supported new indications for freezing and segmentation of treatment. Beyond OHSS prevention and avoidance of embryo transfers in the setting of an adverse endocrinological profile or endometrial cavity, we have witnessed a trend to shift fresh embryo transfers to frozen embryo transfers in many programs. We critically review the available evidence and suggest that freeze-all is not "for all," but should be individualized.
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Affiliation(s)
- Natalia Basile
- IVI-Madrid, Rey Juan Carlos University, Av del Talgo 68, 28023, Madrid, Spain
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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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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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Cédrin-Durnerin I, Bständig B, Parneix I, Bied-Damon V, Avril C, Decanter C, Hugues JN. Effects of oral contraceptive, synthetic progestogen or natural estrogen pre-treatments on the hormonal profile and the antral follicle cohort before GnRH antagonist protocol. Hum Reprod 2006; 22:109-16. [PMID: 16936304 DOI: 10.1093/humrep/del340] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Steroid pre-treatments may be useful to program GnRH antagonist IVF/ICSI cycles. This prospective study assessed hormonal and ultrasound data collected during the free period after the discontinuation of three different pre-treatments to provide information on the optimal time interval required before starting stimulation. METHODS Women were randomized to receive oral contraceptive pill (OCP) [ethinyl estradiol (E(2)) 30 microg + desogestrel 150 microg] (n = 21) or norethisterone 10 mg/day (n = 23) or 17-betaE(2) 4 mg/day (n = 25) or no pre-treatment (n = 24) for one cycle before IVF. Assessments were performed on post-treatment day (PD) 1, 3 and 5, or on spontaneous cycle day (CD) 1 and 3. RESULTS After OCP and progestogen administration, FSH and LH concentrations shifted from strongly suppressed PD1 levels to PD5 values similar to those observed on CD1. Meanwhile, follicle sizes remained small up to PD5. In contrast, estrogen pre-treatment poorly reduced FSH levels on PD1 compared with OCP or progestogen. Consequently, follicle size was more heterogeneous. FSH rebound was maximal on PD3, whereas LH levels were slightly increased up to PD5. CONCLUSIONS A 5-day free interval after OCP or progestogen offers the advantages of gonadotrophin recovery and homogeneous follicular cohort, whereas early FSH rebound occurring after estrogen pre-treatment argues for a short free period.
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Affiliation(s)
- I Cédrin-Durnerin
- Service de Médecine de la Reproduction, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Université Paris XIII, Bondy.
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Nakagawa K, Yamano S, Senuma M, Myogo K, Yamazaki J, Aono T. Avoidance of oocyte retrieval on the weekend through the use of scheduled ovarian hyperstimulation for in vitro fertilization and embryo transfer. Fertil Steril 1997; 68:787-90. [PMID: 9389803 DOI: 10.1016/s0015-0282(97)00327-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To avoid oocyte retrieval for IVF-ET during the weekend, the scheduled method of ovarian hyperstimulation, in which oocyte retrieval is planned in advance for Monday through Wednesday, was evaluated. DESIGN A retrospective study. SETTING The IVF-ET unit of the Department of Obstetrics and Gynecology at Tokushima University Hospital. PATIENT(S) One hundred seventy-eight cycles in patients undergoing ovarian hyperstimulation for IVF-ET were stimulated according to the scheduled method of ovarian hyperstimulation (scheduled group). One hundred seventy-one cycles in patients of similar age and with comparable causes of infertility were stimulated according to the conventional method of ovarian hyperstimulation for IVF-ET (conventional group). INTERVENTION(S) In the scheduled method, under GnRH-a, the day of oocyte retrieval was determined in advance for IVF-ET. Ovarian stimulation with FSH and hMG was started 12 days before oocyte retrieval. MAIN OUTCOME MEASURE(S) The cancellation and clinical pregnancy rates (PRs), the days of oocyte retrieval, and other clinical parameters were evaluated in the two groups. RESULT(S) The cancellation rates in the scheduled and conventional groups were 9.6% and 4.7%, respectively. In about 75% of cycles in the scheduled group, oocyte retrieval was conducted on the scheduled day. When oocyte retrieval was scheduled for Monday through Wednesday, overtime work on the weekend could be avoided in 91% of the cycles without cancellation. The clinical PR was comparable between the two groups. CONCLUSION(S) The scheduled method of ovarian hyperstimulation for IVF-ET was useful for avoiding oocyte retrieval on the weekend.
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Affiliation(s)
- K Nakagawa
- Department of Obstetrics and Gynecology, School of Medicine, University of Tokushima, Japan
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9
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Ben-Chetrit A, Senoz S, Greenblatt EM. In vitro fertilization programmed for weekday-only oocyte harvest: analysis of outcome based on actual retrieval day. J Assist Reprod Genet 1997; 14:26-31. [PMID: 9013307 PMCID: PMC3454706 DOI: 10.1007/bf02765748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Our aim was to assess the effect of the day of ovum retrieval on outcome in an IVF program scheduled for weekday-only ovum retrievals. DESIGN This was a retrospective study of patients who underwent transvaginal ultrasound-guided ovum retrieval (TVUS-OR) in an IVF program from August 10, 1992, to April 30, 1993. SETTING A university-based tertiary referral hospital center was the setting. PARTICIPANTS AND METHODS All patients (n = 501) who underwent TVUS-OR were divided into three groups: (1) patients who underwent TVUS-OR on Monday; (2) patients who underwent retrieval on Tuesday, Wednesday, or Thursday; and (3) patients who underwent retrieval on Friday. All patients were induced by the same controlled ovarian hyperstimulation protocol, which consisted of a GnRH analogue "flare-up" followed by parenteral menotropins, after a scheduled oral contraceptive-induced menses. Patients and cycle characteristics in the three groups were compared and clinical outcome was evaluated. RESULTS The similarity of patients and cycle characteristics confirmed the uniformity of the three groups. No difference was found in any of the clinical outcomes. However, in the first half of the program, we revealed a trend in which patients at high risk for ovarian hyperstimulation syndrome, requiring freezing all embryos and not allowing transfer during the treatment cycle, occurred more commonly in women whose retrieval occurred on Monday. This trend disappeared in the second half of the analysis. CONCLUSIONS In an in vitro fertilization program in which ovum retrievals occurred only on weekdays, no significant difference in outcome was found in patients undergoing ovum retrieval on Monday or Friday versus midweek. In addition to significant savings by eliminating weekend retrievals, IVF outcome is not compromised.
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Affiliation(s)
- A Ben-Chetrit
- Department of Obstetrics and Gynecology, Toronto Hospital, Ontario, Canada
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10
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Gonzalez P, Maloul S, Ciuffardi I, Frederick JL, Balmaceda JP, Asch RH. The use of progestins for programming assisted reproductive cycles and gonadotropin-releasing hormone agonist flare-up protocols in older patients. Fertil Steril 1995; 63:249-51. [PMID: 7843425 DOI: 10.1016/s0015-0282(16)57349-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine if the use of norethisterone acetate (NET) in the previous cycle affects the ovarian response to GnRH agonist (GnRH-a) in flare-up protocols and controlled ovarian hyperstimulation in older patients. DESIGN Retrospective analysis of the outcome of the assisted reproductive technology (ART) cycle. PATIENTS Eighty women > 37 years old undergoing controlled ovarian hyperstimulation (COH) for a ART cycle (GIFT, IVF, zygote intrafallopian transfer). Forty received NET during the luteal phase of the previous cycle for programming the procedure and 40 did not receive NET (control group). Gonadotropin-releasing hormone agonist in follicular phase (flare-up) protocols were administered to all the patients. MAIN OUTCOME MEASURES Cycle outcome: amount of gonadotropins used, oocyte production and quality, fertilization, and pregnancy rates. Estradiol, FSH, and LH levels the first 3 days of COH in eight patients. RESULTS There were no differences between both groups in the cycle outcome. Estradiol levels during the first 3 days of COH were higher in the patients that did not receive NET in the previous cycle. Follicle-stimulating hormone and LH levels were similar in both groups. CONCLUSIONS The administration of NET in the previous cycle in patients > 37 years old does not affect the ovarian response to the combination of follicular phase GnRH-a and gonadotropins for COH.
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Affiliation(s)
- P Gonzalez
- Department of Obstetrics and Gynecology, University of California-Irvine Medical Center, Orange
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Cahill DJ, Prosser CJ, Wardle PG, Ford WC, Hull MG. Relative influence of serum follicle stimulating hormone, age and other factors on ovarian response to gonadotrophin stimulation. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1994; 101:999-1002. [PMID: 7999732 DOI: 10.1111/j.1471-0528.1994.tb13047.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the relative value of the woman's age, basal follicle stimulating hormone (FSH), basal luteinising hormone (LH) and menstrual cycle pattern (all defined prior to treatment) in predicting the ovarian response to gonadotrophin stimulation for in vitro fertilisation. DESIGN Open, descriptive cohort study. PATIENTS One hundred and seventy-one consecutive ovulatory women undergoing their first cycle of in vitro fertilisation with ovarian stimulation after pituitary desensitisation. INTERVENTIONS Measurement of basal (early follicular phase) and down-regulated concentrations of serum FSH and LH, and calculation of age at treatment and of median length of menstrual cycles and range of variation prior to treatment. MAIN OUTCOME MEASURES Duration and amount of gonadotrophin stimulation to achieve follicular maturity, number of mature follicles, peak serum oestradiol concentration and number of mature oocytes, were compared between banded values of variables studied. RESULTS Increasing basal FSH concentrations were significantly associated with reducing oestradiol levels, numbers of mature follicles and oocyte yield even when the FSH levels were still within the normal range though above average (6 to 8.9 i.u./l). There were similar but weaker associations with FSH levels after down-regulation. There were also significant differences between women over and under 40 years old in their oestradiol levels, numbers of follicles and of oocytes. Analysis of variance showed significant independent association of basal FSH with both oestradiol and numbers of oocytes, but not of age, menstrual pattern, or serum LH concentrations. CONCLUSION Serum FSH is more sensitive than the woman's age in determining her ovarian responsiveness to stimulation. LH concentrations and menstrual cycle patterns are unhelpful.
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Affiliation(s)
- D J Cahill
- University of Bristol Department of Obstetrics and Gynaecology, St Michael's Hospital, UK
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12
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Chang SY, Lee CL, Wang ML, Hu ML, Lai YM, Chang MY, Soong YK. No detrimental effects in delaying initiation of gonadotropin administration after pituitary desensitization with gonadotropin-releasing hormone agonist. Fertil Steril 1993; 59:183-6. [PMID: 8419205 DOI: 10.1016/s0015-0282(16)55636-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine if delaying initiation of exogenous gonadotropin administration after pituitary desensitization with gonadotropin-releasing hormone agonist (GnRH-a) is a realistic option to avoid scheduling clinical and laboratory work on weekends/holidays. DESIGN, PATIENTS A review of 57 in vitro fertilization (IVF) cycles in which, after pituitary desensitization with GnRH-a, initiation of gonadotropin administration were delayed in an attempt to avoid off-hour work. Thirty-eight IVF cohort cycles served as control. SETTING Tertiary medical center. RESULTS There were no statistically significant differences in ovarian response, dose of gonadotropin required, oocytes and embryos obtained, pregnancy rates, and abortion rates between groups. Eighty-three percent of the delayed cycles had clinical and laboratory work that fell within weekdays. CONCLUSION Delaying initiation of exogenous gonadotropin administration after pituitary desensitization had no detrimental effects on IVF outcomes. It may be used to avoid scheduling work on weekends/holidays.
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Affiliation(s)
- S Y Chang
- Department of Obstetrics and Gynecology, Chang Gung Medical Center, Taipei, Taiwan, Republic of China
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Acharya U, Irvine S, Hamilton M, Templeton A. Prospective study of short and ultrashort regimens of gonadotropin-releasing hormone agonist in an in vitro fertilization program. Fertil Steril 1992; 58:1169-73. [PMID: 1459268 DOI: 10.1016/s0015-0282(16)55564-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the usefulness of the ultrashort regimen of gonadotropin-releasing hormone agonist (GnRH-a) in ovulation induction in an in vitro fertilization (IVF) program. DESIGN A prospective randomized trial comparing short and ultrashort regimens of GnRH-a. SETTING Aberdeen Assisted Reproduction Unit. PATIENTS Forty-eight patients having IVF for the first time were randomized between the two protocols. MAIN OUTCOME MEASURES Response to ovarian stimulation and occurrence of spontaneous luteinizing hormone (LH) surges. RESULTS In ovulation induction, fertilization, and pregnancy rates the ultrashort regimen produces results that were no different to the short regimen but it did not always prevent an LH surge. CONCLUSION The ultrashort regimen can be a useful alternative for ovarian stimulation of patients undergoing IVF.
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Affiliation(s)
- U Acharya
- Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Scotland
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14
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Abstract
To examine possible mechanisms for the association between cigarette smoking and reduced fertility, we have measured the concentration of the nicotine metabolite cotinine in ovarian follicular fluid collected at the time of oocyte recovery during treatment for in-vitro fertilisation. In a group of women in whom follicular fluid cotinine could not be detected (limit of accurate measurement 20 ng/ml) 116 oocytes were collected, of which 84 became fertilised (72%), whereas among women with cotinine concentration greater than 20 ng/ml 20/45 (44%) oocytes did so (p < 0.01). The median fertilisation rates for individuals (range 1-8 eggs each) in the high and low cotinine groups were 57% and 75%, respectively (p < 0.05). These findings suggest that infertile women should be advised to stop or reduce smoking generally, and especially before treatment by in-vitro fertilisation.
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Affiliation(s)
- S K Rosevear
- University of Bristol Department of Obstetrics and Gynaecology, St Michael's Hospital, UK
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15
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Awadalla SG, Randall GW. Efficiency and cost effectiveness of three protocols for gamete transfer. JOURNAL OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER : IVF 1991; 8:344-8. [PMID: 1770276 DOI: 10.1007/bf01133026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S G Awadalla
- Department of Obstetrics and Gynecology, West Virginia University Medical Center, Charleston 25302
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16
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Dimitry ES, Bates SA, Oskarsson T, Margara R, Winston RM. Programming in vitro fertilization for a 5- or 3-day week. Fertil Steril 1991; 55:934-8. [PMID: 2022272 DOI: 10.1016/s0015-0282(16)54302-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To schedule oocyte retrievals on either 5 or 3 days per week in in vitro fertilization (IVF) cycles. DESIGN Human chorionic gonadotropin (hCG) administration was delayed by at least 24 hours in patients undergoing superovulation to avoid egg collections on weekends (group 1). Encouraged by the results, a further prospective study in which oocyte retrievals were programmed for only 3 days a week was undertaken (group 2). SETTING Hammersmith Hospital, a tertiary referral unit. PATIENTS All patients undergoing IVF treatment were included. MAIN OUTCOME MEASURES To schedule oocyte retrievals on either 5 or 3 days per week. RESULTS Only 4.0% of egg collections (12/303) occurred on weekends compared with 12.6% (22/175) before delaying hCG. In group 2 (n = 215), only four egg collections (2.1%) had to be performed out of schedule. Delaying administration of hCG had no detrimental effects. CONCLUSIONS Delayed administration of hCG allows scheduling oocyte retrievals on either 5 or 3 days per week, leading to a substantial decrease in out-of-hours oocyte retrievals, reducing cycle costs, and facilitating efficiency. The method is applicable to assisted reproduction specialized units as well as district general hospitals that use gonadotropin-releasing hormone analogs in their superovulation regimens before IVF, gamete intrafallopian transfer, or intrauterine insemination.
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Affiliation(s)
- E S Dimitry
- Institute of Obsetrics and Gynaecology, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
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17
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Frydman R. Programming ovulation. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1990; 4:535-40. [PMID: 2126492 DOI: 10.1016/s0950-3552(05)80309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Studd JW, Abdalla HI. Planned cycles for IVF and GIFT. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1988; 95:1217-9. [PMID: 3066397 DOI: 10.1111/j.1471-0528.1988.tb06808.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J W Studd
- Fertility and Endocrinology Centre, Lister Hospital, London
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Bromwich P, Walker A, Kennedy S, Wiley M, Little D, Ross C, Sargent I, Bellinger J, O'Reilly H, Lopez-Bernal A. In vitro fertilisation in a small unit in the NHS. BMJ : BRITISH MEDICAL JOURNAL 1988; 296:759-61. [PMID: 3126964 PMCID: PMC2545374 DOI: 10.1136/bmj.296.6624.759] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In vitro fertilisation is one of the most effective new treatments for infertility, but financial restrictions have made it impossible for it to be widely carried out in the National Health Service. We report on the establishment of a small, largely self funded, unit that was set up with the help of the local health service management. All cycles are programmed so that most work is carried out during the working week; oocyte recoveries are performed as outpatient procedures without general anaesthesia and guided by ultrasound. Roughly a tenth of treatment cycles and roughly a fifth of embryo transfers resulted in a clinical pregnancy.
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Affiliation(s)
- P Bromwich
- Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Headington, Oxford
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20
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Affiliation(s)
- D N Bateman
- Wolfson Unit of Clinical Pharmacology, University of Newcastle upon Tyne
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Michelow MC, Bernstein J, Jacobson MJ, McLoughlin JL, Rubenstein D, Hacking AI, Preddy S, Van der Wat IJ. Mother-daughter in vitro fertilization triplet surrogate pregnancy. JOURNAL OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER : IVF 1988; 5:31-4. [PMID: 3367072 DOI: 10.1007/bf01138867] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A successful triplet pregnancy has been established in a surrogate gestational mother following the transfer of five embryos fertilized in vitro. The oocytes were donated by her biological daughter, and the sperm obtained from the daughter's husband. The daughter's infertility followed a total abdominal hysterectomy performed for a postpartum hemorrhage as a result of a placenta accreta. Synchronization of both their menstrual cycles was obtained using oral contraceptive suppression for 2 months, followed by stimulation of both the surrogate gestational mother and her daughter such that embryo transfer would occur at least 48 hr after the surrogate gestational mother's own ovulation. This case raises a number of medical, social, psychological, and ethical issues.
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Affiliation(s)
- M C Michelow
- Vitalab, Parklane Clinic, Parktown, Republic of South Africa
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