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Bayefsky MJ, Cascante SD, McCulloh DH, Blakemore JK. Live birth rates in in vitro fertilization cycles with five or fewer follicles. J Assist Reprod Genet 2024; 41:223-229. [PMID: 37978117 PMCID: PMC10789701 DOI: 10.1007/s10815-023-02985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE To evaluate live birth rates (LBRs) for in vitro fertilization (IVF) cycles with ≤5 follicles at trigger, with the goal of helping patients with low follicle counts decide whether to proceed to retrieval. METHODS This is a retrospective cohort study from an urban, university-affiliated fertility center. All IVF cycles that yielded <10 oocytes between 2016 and 2020 were reviewed. Cycles were included if <5 follicles measuring >14 mm were verified on trigger day. The primary outcome was LBR per retrieval after fresh or frozen transfer. Secondary outcomes were number of oocytes, mature oocytes, 2-pronuclear zygotes (2-PNs), blastocysts for transfer/biopsy, and euploid blastocysts (if preimplantation genetic testing for aneuploidy (PGT-A) was used). RESULTS 1502 cycles (900 with PGT-A) from 972 patients were included. Mean number of oocytes, mature oocytes, 2-PNs, blastocysts for transfer/biopsy, and euploid blastocysts differed by follicle number (p < 0.001). Across all age groups, there were differences in LBR associated with follicle number (p < 0.001). However, within age groups, not all results were significant. For example, for patients <35 years, LBR did not differ by follicle number and among patients 35-37 years; LBR with two or three follicles was lower than with five (p < 0.02). LBR for patients 35-40 years was <20% with 1-3 follicles and 25-40% with 4-5 follicles. LBR for patients >41 years was <5% with 1-3 follicles and <15% with 4-5 follicles. CONCLUSION As expected, LBR is higher with more follicles. Providing patients with <5 follicles with specific data can help them weigh the emotional, physical, and financial costs of retrieval.
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Affiliation(s)
- Michelle J Bayefsky
- New York University Langone Health, Grossman School of Medicine, 462 First Avenue, Ninth Floor, New York, NY, 10016, USA.
| | - Sarah D Cascante
- New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10022, USA
| | - David H McCulloh
- New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10022, USA
- Gameto, Inc., 286 Madison Ave, New York, NY, 10017, USA
| | - Jennifer K Blakemore
- New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10022, USA
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Zeng X, Du L, Yang H, Wang F. Efficacy and safety of recombinant human granulocyte colony-stimulating factor in patients with poor ovarian response: protocol for a multicentre, randomised, controlled trial. BMJ Open 2023; 13:e074135. [PMID: 38159964 PMCID: PMC10759079 DOI: 10.1136/bmjopen-2023-074135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/25/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Approximately 17.5% of couples of reproductive age have experienced infertility. Women with a poor ovarian response (POR) must undergo in vitro fertilisation (IVF) and embryo transfer to achieve pregnancy. However, studies have reported a poor response to gonadotropin stimulation in women undergoing IVF-ET. Results from animal experiments suggest that granulocyte colony-stimulating factor (G-CSF) has a curative effect by protecting ovarian function, reducing follicle loss and delaying premature ovarian failure in rats caused by chemotherapy. Clinical studies on the therapeutic effect of G-CSF are deficient; therefore, this study will investigate its ability to improve ovum quality and maturity among women with POR undergoing IVF/intracytoplasmic sperm injection (ICSI). METHODS AND ANALYSIS This clinical, multicentre, triple-blind, placebo-controlled trial will employ balanced randomisation (1:1). The planned sample size is 312 participants (156 subjects in each group). A total of 312 patients with infertility undergoing IVF/ICSI will be recruited from four public hospitals in China. The participants will be randomly divided into an experimental group (G-CSF) and a placebo group (control). All patients will be treated by using the progestin-primed ovarian stimulation superovulation protocol. The primary outcome will be D3 embryo quality. The number of ova obtained, MII ova and transferable embryos will be inclusive in the secondary outcome. ETHICS AND DISSEMINATION To our knowledge, this is the first clinical trial to investigate the effect of G-CSF treatment timing and stimulation protocol in patients with POR in China. This study will provide new information about G-CSF efficacy among patients with POR undergoing IVF/ICSI and can help improve ovum quality and maturity. Clinical trials on this subject are deficient in China; therefore, a well-designed randomised trial is needed to determine the ability of G-CSF to improve ovum quality and maturity to facilitate conception among women with POR treated with IVF/ICSI. TRIAL REGISTRATION NUMBER ChiCTR2200062412.
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Affiliation(s)
- Xianghui Zeng
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
- Reproductive Center, Qinghai Province People's Hospital, Xining, China
| | - Lirong Du
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, China
| | | | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
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Duan X, Li Z, Li M, Ma X. Analysis of controlled ovarian hyperstimulation protocols in women over 35 years old with poor ovarian response: a real-world study. BMC Pregnancy Childbirth 2023; 23:813. [PMID: 37996795 PMCID: PMC10666416 DOI: 10.1186/s12884-023-06112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
The objective of this study was to investigate the optimal controlled ovarian hyperstimulation (COH) protocol for patients aged 35 and above with poor ovarian response (POR), utilizing real-world data. This retrospective cohort study examined clinical information from a total of 4256 patients between January 2017 and November 2022. The patients were categorized into three groups: modified GnRH agonist protocol (2116 patients), GnRH antagonist protocol (1628 patients), and Mild stimulation protocol (512 patients). Comparative analysis was conducted on clinical variables and pregnancy outcomes across the three groups. The GnRH agonist protocol was associated with a higher number of oocyte number (4.02 ± 2.25 vs. 3.15 ± 1.52 vs. 2.40 ± 1.26, p < 0.001), higher number of transferable embryos (1.73 ± 1.02 vs. 1.35 ± 1.22 vs. 1.10 ± 0.86, p = 0.016), higher cumulative live birth rate 28.50(603/2116) vs. 24.94(406/1628) vs. 20.51(105/512), p < 0.001) than GnRH antagonist protocol and Mild stimulation protocol, the Mild stimulation protocol was associated with a higher miscarriage rates 16.27(62/381) vs. 16.61(48/289) vs. 32.22(29/90), p = 0.001) than the other two groups. Therefore, it can be concluded that all three protocols can be used in patients over 35 years old with poor ovarian response. However, if patients require more frozen-thawed embryo transfers to achieve better cumulative live birth rates, the modified GnRH agonist protocol may be the preferable option.
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Affiliation(s)
- Xiaoyan Duan
- Department of Gynaecology and obstetrics, The First People's Hospital of Shangqiu, 292 Kaixuan South Road, Henan, Shangqiu, People's Republic of China.
| | - Zhan Li
- Department of Gynaecology and obstetrics, The First People's Hospital of Shangqiu, 292 Kaixuan South Road, Henan, Shangqiu, People's Republic of China
| | - Mingming Li
- Graduate School of Zhengzhou University, Henan, People's Republic of China
| | - Xing Ma
- Graduate School of Zhengzhou University, Henan, People's Republic of China
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Jamil M, Debbarh H, Kabit A, Ennaji M, Zarqaoui M, Senhaji WR, Hissane M, Saadani B, Louanjli N, Cadi R. Impact of the number of retrieved oocytes on IVF outcomes: oocyte maturation, fertilization, embryo quality and implantation rate. ZYGOTE 2023; 31:91-6. [PMID: 36533391 DOI: 10.1017/S096719942200065X] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The process of oocyte retrieval represents a key phase during the cycles of in vitro fertilization (IVF). It involves controlled ovarian stimulation to retrieve the highest number of oocytes possible. According to many previous studies, the higher the number of oocytes the higher the chances of obtaining embryos for multiple transfers. In this study, in total, 1987 patients were retrospectively reviewed to investigate the correlations between the number of retrieved oocytes and the subsequent IVF outcomes. Patients were divided into three groups according to the number of retrieved oocytes (Group 1: ≤5 oocytes; Group 2: 6-15 oocytes; Group 3: ≥15 oocytes). The results showed a significant negative correlation between oocyte number and maturation rate as well as fertilization rate. However, a significant positive correlation was found between oocyte number and the blastulation rate. The implantation rate after fresh embryo transfers was higher in group 2 (6-15 oocytes) compared with group 1 (≤5 oocytes). According to our findings, we conclude that oocyte numbers between 6 and 15 oocytes can result in the highest chances of positive IVF outcomes in terms of embryo quality and fresh embryo transfers with lower risks of ovarian hyperstimulation.
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Liu X, Shi S, Sun J, He Y, Zhang Z, Xing J, Chong T. The influence of male and female overweight/obesity on IVF outcomes: a cohort study based on registration in Western China. Reprod Health 2023; 20:3. [PMID: 36593463 PMCID: PMC9806889 DOI: 10.1186/s12978-022-01558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Overweight/obesity can affect fertility, increase the risk of pregnancy complications, and affect the outcome of assisted reproductive technology (ART). However, due to confounding factors, the accuracy and uniformity of published findings on IVF outcomes have been disputed. This study aimed to assess the effects of both male and female body mass index (BMI), individually and in combination, on IVF outcomes. METHODS This retrospective cohort study included 11,191 couples undergoing IVF. Per the Chinese BMI standard, the couples were divided into four groups: normal; female overweight/obesity; male overweight/obesity; and combined male and female overweight/obesity. The IVF outcomes of the four groups were compared and analysed. RESULTS Regarding the 6569 first fresh IVF-ET cycles, compared with the normal weight group, the female overweight/obesity and combined male/female overweight/obesity groups had much lower numbers of available embryos and high-quality embryos (p < 0.05); additionally, the fertilization (p < 0.001) and normal fertilization rates (p < 0.001) were significantly decreased in the female overweight/obesity group. The combined male/female overweight/obesity group had significant reductions in the available embryo (p = 0.002), high-quality embryo (p = 0.010), fertilization (p = 0.001) and normal fertilization rates (p < 0.001); however, neither male or female overweight/obesity nor their combination significantly affected the clinical pregnancy rate (CPR), live birth rate (LBR) or abortion rate (p > 0.05). CONCLUSION Our findings support the notion that overweight/obesity does not influence pregnancy success; however, we found that overweight/obesity affects the fertilization rate and embryo number and that there are sex differences.
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Affiliation(s)
- Xiang Liu
- grid.43169.390000 0001 0599 1243The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, 710004 Shaanxi China ,grid.440257.00000 0004 1758 3118Reproductive Center of Northwest Women’s and Children’s Hospital, Xi’an, 710061 Shaanxi China
| | - Shengjia Shi
- grid.440257.00000 0004 1758 3118Reproductive Center of Northwest Women’s and Children’s Hospital, Xi’an, 710061 Shaanxi China
| | - Jianhua Sun
- grid.440257.00000 0004 1758 3118Reproductive Center of Northwest Women’s and Children’s Hospital, Xi’an, 710061 Shaanxi China
| | - Yuan He
- grid.440257.00000 0004 1758 3118Reproductive Center of Northwest Women’s and Children’s Hospital, Xi’an, 710061 Shaanxi China
| | - Zhou Zhang
- grid.440257.00000 0004 1758 3118Reproductive Center of Northwest Women’s and Children’s Hospital, Xi’an, 710061 Shaanxi China
| | - Junping Xing
- grid.43169.390000 0001 0599 1243The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, 710061 Shaanxi China
| | - Tie Chong
- grid.43169.390000 0001 0599 1243The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, 710004 Shaanxi China
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Yang J, Gao J, Wang Y, Liu H, Lian X. Impact of follicular size categories on oocyte quality at trigger day in young and advanced-age patients undergoing GnRH-ant therapy. Front Endocrinol (Lausanne) 2023; 14:1167395. [PMID: 37124736 PMCID: PMC10140496 DOI: 10.3389/fendo.2023.1167395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Aim To study the effect of follicle sizes of different proportions on oocyte and embryo quality in young and advanced-age patients, and provide evidence for personalized protocol adjustment. Methods This was a retrospective real-world data study including a total of 11,462 patients who had started their first in vitro fertilization cycle with a gonadotropin-releasing hormone antagonist (GnRH-ant) protocol during 2018-2021. We classified patients into groups according to the size of the dominant proportion of follicles on the human chorionic gonadotropin (hCG) trigger day: Large, Medium, Small, and Equal (containing equivalent proportions of all three size categories). The Cochran-Mantel-Haenszel test by different Anti-Mullerian Hormone (AMH) and antral follicle count (AFC) was used to compare factors such as the metaphase II (MII) oocyte rate, normal fertilization rate, and two pronuclei (2PN) cleavage rate between groups. General linear model (GLM) analysis was performed for inter-group comparison of the oocyte and embryo quality. Results In patients aged < 35 years and with AMH ≥ 1.2μg/L, the MII oocyte percentages in the Large and Medium groups were significantly higher than in the Small group (P < 0.001). The germinal vesicle (GV) oocyte and unavailable oocyte percentages in the Large and Medium groups were lower than in the Small group (P < 0.001). Among patients aged ≥ 35 years with AFC < 5 and AMH ≥ 1.2μg/L, the GV oocyte percentage in the Large group was significantly lower than in the Medium group (2.54% vs. 4.46%, P < 0.001). In patients < 35 years, the GLM demonstrated that the Large and Medium groups had positively impacted on the development of MII oocyte and live birth rate(LBR) of first embryo transfer(ET)(β>0, all P value < 0.05);and had less likely to develop into unavailable oocyte, degenerated oocyte, GV oocyte and MI oocyte rates relative to the Small group(β<0, all P value < 0.05). And among patients ≥ 35 years, the Medium group had positively impacted on the development of MII oocyte and 2PN rates relative to the Small group(β>0, all P value < 0.05); and had less likely to develop into MI oocytes relative to the Small group(β<0, all P value < 0.05). The GLM indicated that AMH, along with Gn total dose, start dose, and Gn days, had significant impact on oocyte and embryo quality. For young patients, age was not a significant influencing factor, but for advanced-age patients, age influenced the outcomes. Conclusion Our analysis suggests that for young patients (< 35 years), triggering when there is a high proportion of large or medium follicles results in better quality oocytes, while for older patients (≥ 35 years), it is better to trigger when the proportion of medium follicles is no less than that of small follicles. Further research is required to confirm these findings.
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Affiliation(s)
- Jingwei Yang
- Chongqing Key Laboratory of Human Embryo Engineering, Center for Reproductive Medicine, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Jing Gao
- Department of Academic Affairs, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuting Wang
- Department of Medical Records and Statistics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongya Liu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xuemei Lian
- School of Public Health, Chongqing Medical University, Chongqing, China
- *Correspondence: Xuemei Lian,
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Wang RR, Su MH, Liu LY, Lai YY, Guo XL, Gan D, Zheng XY, Yang H, Yu SY, Liang FR, Wei W, Zhong Y, Yang J. Systematic review of acupuncture to improve ovarian function in women with poor ovarian response. Front Endocrinol (Lausanne) 2023; 14:1028853. [PMID: 36992800 PMCID: PMC10040749 DOI: 10.3389/fendo.2023.1028853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine the effect of acupuncture in treating poor ovarian response (POR). METHODS We searched MEDLINE (via PubMed), EMBASE, Allied and Complementary Medicine Database, CNKI, CBM, VIP database, Wanfang Database, and relevant registration databases from inception to January 30, 2023. In this review, both Chinese and English peer-reviewed literature were included. Only randomized controlled trials (RCTs) using acupuncture as an intervention for POR patients undergoing in vitro fertilization were considered. RESULTS Seven clinical randomized controlled trials (RCTs) were eventually included for comparison (516 women). The quality of included studies was generally low or very low. For the meta-analysis, seven studies showed that compared with controlled ovarian hyperstimulation (COH) therapy, acupuncture combined with COH therapy could significantly increase the implantation rate (RR=2.13, 95%CI [1.08, 4.21], p=0.03), the number of oocytes retrieved (MD=1.02, 95%CI [0.72, 1.32], p<0.00001), the thickness of endometrium (MD=0.54, 95%CI [0.13, 0.96], p=0.01), and the antral follicle count (MD=1.52, 95%CI [1.08, 1.95], p<0.00001), reduce follicle-stimulating hormone (FSH) levels (MD=-1.52, 95%CI [-2.41, -0.62], p=0.0009) and improve estradiol (E2) levels (MD=1667.80, 95%CI [1578.29, 1757.31], p<0.00001). Besides, there were significant differences in the duration of Gn (MD=0.47, 95%CI [-0.00, 0.94], p=0.05) between the two groups. However, no statistical variation was observed in improving clinical pregnancy rate (CPR), fertilization rate, high-quality embryo rate, luteinizing hormone (LH) value, anti-mullerian hormone (AMH) value, or reducing the dose of gonadotropin (Gn) values between the acupuncture plus COH therapy group and the COH therapy group. CONCLUSION Acupuncture combined with COH therapy is doubtful in improving the pregnancy outcome of POR patients. Secondly, acupuncture can also improve the sex hormone level of POR women, and improve ovarian function. Furthermore, more RCTs of acupuncture in POR are needed to be incorporated into future meta-analyses. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier CRD42020169560.
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Affiliation(s)
- Rong-Rong Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Meng-Hua Su
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li-Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuan-Yuan Lai
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiao-Li Guo
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
| | - Di Gan
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
| | - Xiao-Yan Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Han Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Si-Yi Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fan-Rong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Wei
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
| | - Ying Zhong
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
| | - Jie Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Traditional Chinese Medicine Department, Chengdu Xi'nan Gynecology Hospital, Chengdu, Sichuan, China
- Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu, Sichuan, China
- *Correspondence: Wei Wei, ; Ying Zhong, ; Jie Yang,
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Jirge PR, Patil MM, Gutgutia R, Shah J, Govindarajan M, Roy VS, Kaul-Mahajan N, Sharara FI. Ovarian Stimulation in Assisted Reproductive Technology Cycles for Varied Patient Profiles: An Indian Perspective. J Hum Reprod Sci 2022; 15:112-125. [PMID: 35928474 PMCID: PMC9345274 DOI: 10.4103/jhrs.jhrs_59_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Controlled ovarian stimulation has been an integral part of in vitro fertilisation (IVF) treatment cycles. Availability of different gonadotropins for ovarian stimulation and gonadotropin releasing hormone (GnRH) analogues for prevention of premature rise of leutinising hormone during follicular phase offer an opportunity to utilise them for a successful outcome in women with different subsets of ovarian response. Further, use of GnRH agonist as an alternative for human chorionic gonadotropin improves safety of ovarian stimulation in hyper-responders. Mild ovarian stimulation protocols have emerged as an alternative to conventional protocols in the recent years. Individualisation plays an important role in improving safety of IVF in hyper-responders while efforts continue to improve efficacy in poor responders. Some of the follicular and peri-ovulatory phase interventions may be associated with negative impact on the luteal phase and segmentalisation of the treatment with frozen embryo transfer may be an effective strategy in such a clinical scenario. This narrative review looks at the available evidence on various aspects of ovarian stimulation strategies and their consequences. In addition, it provides a concise summary of the evidence that has emerged from India on various aspects of ovarian stimulation.
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Affiliation(s)
- Padma Rekha Jirge
- Shreyas Hospital and Sushrut Assisted Conception Clinic, Kohlhapur, India
| | | | | | - Jatin Shah
- Mumbai Fertility Clinic & IVF Centre, Mumbai, India
| | | | | | | | - Faddy I Sharara
- Virginia Center for Reproductive Medicine, Reston; Department of O&G, George Washington University, Washington, DC, USA
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Bercovich O, Almog B, Fouks Y, Kalma Y, Hasson J, Azem F, Cohen Y. A decision tree analysis applied to women aged 43-45: who should be referred for ovum donation? Reprod Biomed Online 2021:S1472-6483(21)00485-5. [PMID: 34815156 DOI: 10.1016/j.rbmo.2021.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022]
Abstract
RESEARCH QUESTION In women at the advanced age of 43-45 years undergoing repeated IVF cycles with autologous oocytes, who has the highest chance for birth and who should be referred early to receive donor oocytes? DESIGN A retrospective cohort study was conducted at a university hospital reproductive centre. The computerized database of 394 women aged 43-45 years undergoing 1528 non-donor IVF or intracytoplasmic sperm injection cycles between 2010 and 2019 was analysed. A decision tree was developed, enabling a comprehensive study of a set of clinical parameters and the expected outcomes. RESULTS The cumulative clinical pregnancy rate was 15.0% (59/394) and the cumulative live birth rate was 8.4% (33/394). The decision tree developed to predict women who should be offered egg donation included age, poor ovarian response to stimulation, the number of top-quality embryos, dominant follicles, previous pregnancy or live birth, fertilized oocytes and body mass index. The model showed that a good ovarian response in the first cycle was the best predictor for live birth (13.3% gave birth). However, among women with poor responses, 7.1% of those who were younger than 43.5 years gave birth, and none of the women who were older than 43.5 years did. CONCLUSIONS Women over 43.5 years old with fewer than four oocytes collected in their first IVF cycle should be offered ovum donation, since their live birth rate in subsequent cycles is negligible.
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Shrem G, Salmon-Divon M, Mahfoudh AM, Balayla J, Volodarsky-Perel A, Henderson S, Zeadna A, Son WY, Steiner N, Dahan MH. Influence of Maternal Age and Ovarian Reserve on the Decision to Continue or to Cancel IVF Cycles in Patients with One or Two Large Follicles: a Dual Effect. Reprod Sci 2021; 29:291-300. [PMID: 34115367 DOI: 10.1007/s43032-021-00649-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to study whether IVF stimulation that results in one or two mature follicles should proceed to oocyte retrieval. This is a retrospective cohort study conducted at McGill University Health Center on 459 patients who underwent IVF treatment between 2011 and 2014, undergoing hormonal stimulation and monitoring of their ovarian response. The primary outcomes were pregnancy and live birth rates. Statistical modeling was used to determine individual roles of patient age and ovarian reserve on outcomes, while controlling for the other factors. Of the 459 cycles included in the study, 360 cycles (78.4%) ended in embryo transfer. Live birth rates per cycle were 15.6%, for the ≤ 34-year-olds; 6.5%, for the 35-39-year-olds; and 2.7%, for the ≥ 40-year-olds (p < 0.01). Twenty-five percent of the cycles in the ≥ 40-year-old group were canceled versus 17% and 15% in the 35-39-year-old and ≤ 34-year-old groups, respectively (p < 0.05). Testing likelihood of live birth as a function of age and antral follicular count (AFC) revealed that a 1-year increase in age reduces the likelihood of live birth by 11% (p < 0.05) and one-unit increase in AFC count leads to a 9% increase in the odds of a live birth (p < 0.05). For the youngest age group, the AFC had a most significant effect, and those with AFC > 11 had 56% live birth rate, while those with AFC ≤ 11 had only 6% of live birth rate. This study supports a shift in reasoning from age being the predictor of outcomes in women with a low response at IVF to both age and ovarian reserve needing to be taken into consideration.
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Affiliation(s)
- Guy Shrem
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 845 Rue Sherbrooke O, Montréal, H3A 0G4, Canada. .,MUHC Reproductive Center, McGill University, Montréal, QC, H2L 4S8, Canada. .,Department of Obstetrics and Gynecology, IVF Unit, Kaplan Medical Center, Rehovot, Israel.
| | - Mali Salmon-Divon
- Department of Molecular Biology, Ariel University, 40700, Ariel, Israel. .,Adelson School of Medicine, Ariel University, Ariel, Israel.
| | - Alina M Mahfoudh
- MUHC Reproductive Center, McGill University, Montréal, QC, H2L 4S8, Canada
| | - Jacques Balayla
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 845 Rue Sherbrooke O, Montréal, H3A 0G4, Canada
| | - Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 845 Rue Sherbrooke O, Montréal, H3A 0G4, Canada.,MUHC Reproductive Center, McGill University, Montréal, QC, H2L 4S8, Canada.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Sara Henderson
- MUHC Reproductive Center, McGill University, Montréal, QC, H2L 4S8, Canada
| | - Atif Zeadna
- Ben-Gurion University of the Negev, Medicine, Southern, Beer-Sheva, Israel
| | - Weon-Young Son
- MUHC Reproductive Center, McGill University, Montréal, QC, H2L 4S8, Canada
| | - Naama Steiner
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 845 Rue Sherbrooke O, Montréal, H3A 0G4, Canada.,MUHC Reproductive Center, McGill University, Montréal, QC, H2L 4S8, Canada.,Ben-Gurion University of the Negev, Medicine, Southern, Beer-Sheva, Israel
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 845 Rue Sherbrooke O, Montréal, H3A 0G4, Canada.,MUHC Reproductive Center, McGill University, Montréal, QC, H2L 4S8, Canada
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11
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Chinta P, Antonisamy B, Mangalaraj AM, Kunjummen AT, Kamath MS. POSEIDON classification and the proposed treatment options for groups 1 and 2: time to revisit? A retrospective analysis of 1425 ART cycles. Hum Reprod Open 2021; 2021:hoaa070. [PMID: 33614989 PMCID: PMC7882041 DOI: 10.1093/hropen/hoaa070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/20/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do live birth outcomes differ when Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number (POSEIDON) stratified groups are compared with women with good prognosis (non-POSEIDON group) undergoing ART? SUMMARY ANSWER The current study showed no significant difference in the live birth rates (LBRs) per embryo transfer between POSEIDON groups 1 and 2 when compared with women in the non-POSEIDON group undergoing ART. WHAT IS KNOWN ALREADY Recently, there has been a lot of focus on the POSEIDON classification for low prognosis women undergoing ART and various management options have been advocated. For POSEIDON groups 1 and 2, low starting dose and gonadotrophin receptor polymorphism have been suggested as possible reasons for a hyporesponse, and increasing the starting gonadotrophin dose, the addition of recombinant LH and dual stimulation have been suggested as treatment options. Most of these treatment options are hypothetical in nature and need validation. STUDY DESIGN SIZE DURATION In the current cohort study, a total of 1425 cycles were analyzed retrospectively following a single cycle fresh embryo transfer. The study period was from January 2013 to June 2018. PARTICIPANTS/MATERIALS SETTING METHODS Women undergoing ART at a tertiary level infertility clinic were included. Clinical and treatment-related details were obtained from the hospital's electronic medical records. The ART outcomes in a non-POSEIDON group (women with an adequate ovarian reserve and/or optimal ovarian response i.e. >9 oocytes retrieved in the previous ART cycle) and a low prognosis group stratified by POSEIDON criteria were compared. We also examined the effectiveness of the modifications made in the current ART treatment protocols among women with an adequate ovarian reserve who had a history of poor/suboptimal response (POSEIDON 1 and 2). MAIN RESULTS AND THE ROLE OF CHANCE There was no statistically significant difference in the LBR per embryo transfer in POSEIDON group 1 (32/109, 29%) and group 2 (17/58, 29%) when compared with the non-POSEIDON group (340/1041, 33%) (adjusted odds ratio (aOR) 0.69; 95% CI 0.37-1.27 and aOR 0.93, 95% CI 0.43-1.97, respectively), while significantly lower LBR were observed in POSEIDON groups 3 (17/97, 17.5%) and 4 (12/120, 10%) (aOR 0.49; 95% CI 0.28-0.89 and aOR 0.38, 95% CI 0.19-0.74, respectively). The gonadotrophin dose alone was increased in one-quarter of the cycles and in another 27% the dose was increased along with the protocol change among POSEIDON group 1. In POSEIDON group 2, a change in the dose alone and in combination with protocol change was performed in 5 and 41% of cycles, respectively. LIMITATIONS REASONS FOR CAUTION A limitation of our study is the retrospective nature of the study with an inherent risk of unknown confounders influencing the outcomes. Other limitations are the lack of cumulative live birth data and the relatively small sample within POSEIDON group 2, which could lead to a type II error. WIDER IMPLICATIONS OF THE FINDINGS The current study showed no significant difference in the LBR between the POSEIDON groups 1 and 2 when compared with the non-POSEIDON group of women, while groups 3 and 4 had significantly lower LBR. The simple gonadotrophin/protocol changes in groups 1 and 2 resulted in LBRs comparable to women with good prognosis. These findings call for revisiting the proposed treatment strategies for POSEIDON groups 1 and 2. STUDY FUNDING/COMPETING INTERESTS No funding was obtained. There are no competing interests to declare.
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Affiliation(s)
- Parimala Chinta
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | | | - Ann M Mangalaraj
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | | | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
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12
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Khojah M, Khayat S, Dahan MH. Comparison of in vitro fertilization cycles stimulated with 20 mg letrozole daily versus high-dose gonadotropins in Rotterdam Consensus ultra-poor responders: A proof of concept. Int J Gynaecol Obstet 2021; 156:102-106. [PMID: 33507538 DOI: 10.1002/ijgo.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate if high-dose letrozole can be used successfully to stimulate poor responders for in vitro fertilization (IVF). METHODS This was a retrospective study conducted at a university hospital reproductive center. The analysis included women who were up to 42 years of age and were Rotterdam Consensus poor responders. A total of 247 patients received gonadotropins (300-450 IU daily) and 62 patients were stimulated with letrozole (20 mg daily) as part of an antagonist IVF protocol. RESULTS The use of 20 mg of letrozole decreased the total dose of gonadotropins used (645 ± 175 IU vs. 5360 ± 1028 IU, P = 0.001) and resulted in lower costs of stimulation medications ($ 555.56 ± $ 150 vs. $ 4616 ± $ 885 Canadian Dollars; P = 0.001). Pregnancy per cycle (14.5%) and per transfer (16%) rates were legitimate for this low prognosis group and may have been better than or similar to those with high-dose gonadotropins. The rate of cycle cancellation may have been reduced in the letrozole versus gonadotropin group (11% vs. 38%; P = 0.001). CONCLUSION Letrozole (20 mg daily) may be used to reduce the cost of ovarian stimulation in ultra-poor responders, significantly reducing the cost of the IVF cycle with probably at least similar outcomes to high-dose gonadotropins.
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Affiliation(s)
- Mohammad Khojah
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.,Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, Montreal, QC, Canada
| | - Suhaib Khayat
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.,Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, Montreal, QC, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.,Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, Montreal, QC, Canada
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13
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Song JY, Gao DD, Cao XL, Xiang S, Chen YH, Teng YL, Li XF, Liu HP, Wang FX, Zhang B, Xu LH, Zhou L, Huang XH, Sun ZG. The Role of Traditional Chinese Formula Ding-Kun Pill (DKP) in Expected Poor Ovarian Response Women (POSEIDON Group 4) Undergoing In Vitro Fertilization-Embryo Transfer: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Front Endocrinol (Lausanne) 2021; 12:675997. [PMID: 34220712 PMCID: PMC8247913 DOI: 10.3389/fendo.2021.675997] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The primary objective of the study was to assess traditional Chinese formula DKP supplementation in terms of efficacy and safety on reproductive outcomes of expected poor ovarian responder (POR, POSEIDON Group 4) undergoing in vitro fertilization-embryo transfer (IVF-ET). DESIGN SETTING AND PARTICIPANTS Women eligible for IVF-ET were invited to participate in this randomized, double-blind, placebo-controlled, superiority trial at academic fertility centers of ten public hospitals in Chinese Mainland. A total of 462 patients (35-44 years) equally divided between DKP and placebo groups with antral follicle count (AFC) <5 or anti-müllerian hormone (AMH) <1.2 ng/ml were randomized. INTERVENTIONS All participants were given DKP or 7 g placebo twice daily on the previous menstrual cycle day 5 until oocyte retrieval, which took approximately 5 to 6 weeks. MAIN OUTCOME MEASURE The primary outcome was the ongoing pregnancy defined as more than 20 gestational weeks of an intrauterine living fetus confirmed by pelvic ultrasonography. RESULTS Demographic characteristics were equally distributed between the study populations. Intention-to-treat (ITT) analysis revealed that ongoing pregnancy rate (OPR) was not significantly different between DKP and placebo groups [26.4% (61/231) versus 24.2% (56/231); relative risk (RR) 1.09, 95% confidence interval (CI) 0.80 to 1.49, P = 0.593]. No significant differences between groups were observed for the secondary outcomes. The additional per protocol (PP) analysis was in line with ITT results: OPR in DKP group was 27.2% (61/224) versus 24.1% (55/228) in placebo group [RR 1.13, 95%CI (0.82 to 1.55), P = 0.449]. After subgroup analysis the findings concluded that POR population of 35-37 years had a significantly higher OPR after 5-6 weeks of oral DKP (41.8%, 33/79) versus placebo (25.4%, 18/71) [RR 1.65, 95% CI (1.02 to 2.65), P = 0.034, P for interaction = 0.028]. CONCLUSION This well-designed randomized controlled trial (RCT) offers new high-quality evidence to supplement existing retrospective literature concerning DKP performance in expected PORs. DKP could be recommended as a safe and natural remedy for expected PORs (aged 35-37 years) who fulfill the POSEIDON group 4 criteria. However, additional interventional clinical studies are undoubtedly required to be conducted in the future to validate this hypothesis. CLINICAL TRIAL REGISTRATION www.chictr.org.cn, identifier ChiCTR1900026614.
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Affiliation(s)
- Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dan-Dan Gao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xian-Ling Cao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shan Xiang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yan-Hua Chen
- Reproductive Medicine Center, Shanxi Maternal and Child Health Care Hospital, Taiyuan, China
| | - Yi-Li Teng
- Reproductive Medicine Center, The Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiu-Fang Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
| | - Hai-Ping Liu
- Department of Reproductive Medicine, The 960th Hospital of the PLA Joint Logistics Support Force Jinan, Jinan, China
| | - Fu-Xin Wang
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Bin Zhang
- Department of Reproductive Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Li-Hua Xu
- Reproductive Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Li Zhou
- Department of Reproductive Medicine, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiang-Hong Huang
- Reproduction & Genetics Center, Xiangtan Central Hospital, Xiangtan, China
| | - Zhen-Gao Sun
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- *Correspondence: Zhen-Gao Sun,
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14
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Law YJ, Zhang N, Kolibianakis EM, Costello MF, Keller E, Chambers GM, Venetis CA. Is there an optimal number of oocytes retrieved at which live birth rates or cumulative live birth rates per aspiration are maximized after ART? A systematic review. Reprod Biomed Online 2020; 42:83-104. [PMID: 33390313 DOI: 10.1016/j.rbmo.2020.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Abstract
The association between the number of oocytes retrieved and fresh live birth rate (LBR) or cumulative LBR (CLBR), and whether an optimal number of oocytes are retrieved when LBR or CLBR are maximized, are highly relevant clinical questions; however published results are conflicting. A systematic review of all eligible studies (n = 16) published until January 2020 on MEDLINE, Embase, Scopus, CINAHL and Web of Science was conducted. Five studies evaluated only LBR from fresh cycles, five studies evaluated only CLBR from stimulated cycles and six evaluated both. A marked difference was observed between the oocyte yields at which LBR and CLBR were reportedly maximized in the individual studies. On the basis of nine studies, the optimal number of oocytes at which fresh LBR seems to be maximized is proposed to be between 12 and 18 oocytes (15 oocytes was the most common suggestion). On the other hand, CLBR continues to increase with the number of oocytes retrieved. This is the first systematic review on the topic, and it suggests that the retrieval of 12-18 oocytes is associated with maximal fresh LBR, whereas a continuing positive association is present between the number of oocytes retrieved and CLBR.
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Affiliation(s)
- Yin Jun Law
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia
| | - Ning Zhang
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia
| | | | - Michael F Costello
- School of Women's and Children's Health, UNSW Medicine, Sydney NSW, Australia; IVFAustralia, Sydney NSW, Australia
| | - Elena Keller
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia
| | - Christos A Venetis
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney NSW, Australia; IVFAustralia, Sydney NSW, Australia.
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15
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Liu FT, Hu KL, Li R. Effects of Growth Hormone Supplementation on Poor Ovarian Responders in Assisted Reproductive Technology: a Systematic Review and Meta-analysis. Reprod Sci 2021; 28:936-48. [PMID: 33078329 DOI: 10.1007/s43032-020-00298-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
To investigate whether additional growth hormone (GH) treatment can improve pregnancy outcomes in poor ovarian responders (POR), this systematic review and meta-analysis is prospectively designed and has been registered in PROSPERO (Registration number: CRD42019137866). Literature search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library from January 2010 to June 2019, and studies before 2010 were included based on a Cochrane review published in 2010. Only English articles and randomized clinical trial studies were included. A total of 12 studies were included for analysis. GH treatment in poor ovarian responders significantly increased the clinical pregnancy rate (odds ratio (OR) = 1.75 (1.23, 2.50)), and the live birth rate also tended to increase after GH treatment (OR = 1.51 (0.97, 2.35)). Other outcomes including the gonadotropin requirement, oocyte retrieval number, endometrium thickness, and the number of patients with available embryos for transfer were also improved by growth hormone treatment (weighted mean differences (WMD) = - 0.78 (- 1.23, - 0.33), 1.41 (0.72, 2.09), 0.36 (0.18, 0.53), OR = 2.67 (1.47, 4.68), respectively). Based on the current study, GH treatment in POR can increase clinical pregnancy rate and show a higher but not statistically significant likelihood of live birth rate. The effect is likely to be mediated by improving ovarian response and endometrium thickness. The effect of GH treatment on live birth rate should be tested by further studies with a larger sample size.
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16
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Song J, Ma T, Liang Y, Cao X, Sun Z. Efficacy and safety of Dingkun pill for female infertility patients with low prognosis undergoing in vitro fertilization-embryo transfer: study protocol for a multicenter, double-blind, randomized, placebo-controlled trial. Trials 2020; 21:550. [PMID: 32560734 PMCID: PMC7304132 DOI: 10.1186/s13063-020-04502-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/11/2020] [Indexed: 01/28/2023] Open
Abstract
Background Approximately 15% of couples in the reproductive age are affected by infertility. Women with diminished ovarian reserves (DOR) or with a poor ovarian response (POR) are required to undergo in vitro fertilization and embryo transfer (IVF-ET) to achieve pregnancy. However, studies indicate that poor response to gonadotropin stimulation has been reported in women undergoing IVF-ET. Results from two recent clinical studies in China suggest that traditional Chinese medicine (TCM) formula Dingkun pill (DKP) showed a curative effect by improving the clinical pregnancy rate in women with DOR and POR. However, the heterogeneity of the studies does not allow one to draw a definitive conclusion on the therapeutic effect of DKP. Therefore, the purpose of this study was to investigate the effect of DKP on improving the clinical outcome of pregnancy of IVF-ET in women with low prognosis. Methods A multicenter, double-blinded, randomized placebo-controlled trial was conducted. A total of 460 infertile patients undergoing IVF or intracytoplasmic sperm injection (ICSI) were recruited from 12 public hospitals in China. Participants were randomly divided into the experimental group (DKP formula) or the placebo group (control) at a ratio of 1:1. All patients were treated with GnRH antagonist protocol and ovarian stimulation performed for 5 weeks (from the 5th day of the previous menstrual cycle to the day of oocyte retrieval). The patients were followed up for 6 months to record their conception outcome. The primary outcome is to compare the pregnancy outcome to those under placebo treatment. Secondary outcomes included the total count of the retrieved oocyte, embryo quality, endometrial thickness on ET day, implantation rate, and early miscarriage rate. Discussion Currently, no multicenter, double-blind, randomized, placebo-controlled trials have been performed on the use of the DKP formula to improve on the clinical outcome of the conception of IVF-ET in women with low prognosis. DKP might provide a good clinical solution for females with low prognosis and undergoing IVF. There is no contemporary Western medicine to improve on the clinical outcome of conception in IVF-ET in women with low prognosis. Therefore, it is important to undertake a well-designed randomized trial to determine the effect of DKP in improving the clinical outcome of the conception of IVF-ET in women with low prognosis. Trial registration Chinese Clinical Trial Registry (ChiCTR). Trial registration number: ChiCTR1900026614. Registered on 16 October 2019.
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Affiliation(s)
- Jingyan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, China.,Reproductive and Genetic Center of Integrated Traditional and Western Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, 250011, Shandong Province, China
| | - Ting Ma
- Science and Technology Department, Shandong University of Traditional Chinese Medicine, Jinan, 250300, China
| | - Yanlin Liang
- Medical Marketing Department, Shanxi Guangyuyuan Medicine Co., Ltd., Xian, 710003, China
| | - Xianling Cao
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Zhengao Sun
- Reproductive and Genetic Center of Integrated Traditional and Western Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, 250011, Shandong Province, China.
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17
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Vaitsopoulou CI, Kolibianakis EM, Bosdou JK, Neofytou E, Lymperi S, Makedos A, Savvaidou D, Chatzimeletiou K, Grimbizis GF, Lambropoulos A, Tarlatzis BC. Expression of genes that regulate follicle development and maturation during ovarian stimulation in poor responders. Reprod Biomed Online 2020; 42:248-259. [PMID: 33214084 DOI: 10.1016/j.rbmo.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/12/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022]
Abstract
RESEARCH QUESTION Sex hormone-binding globulin (SHBG), androgen receptor (AR), LH beta polypeptide (LHB), progesterone receptor membrane component 1 (PGRMC1) and progesterone receptor membrane component 2 (PGRMC2) regulate follicle development and maturation. Their mRNA expression was assessed in peripheral blood mononuclear cells (PBMC) of normal and poor responders, during ovarian stimulation. DESIGN Fifty-two normal responders and 15 poor responders according to the Bologna criteria were enrolled for IVF and intracytoplasmic sperm injection and stimulated with 200 IU of follitrophin alpha and gonadotrophin-releasing hormone antagonist. HCG was administered for final oocyte maturation. On days 1, 6 and 10 of stimulation, blood samples were obtained, serum hormone levels were measured, RNA was extracted from PBMC and real-time polymerase chain reaction was carried out to identify the mRNA levels. Relative mRNA expression of each gene was calculated by the comparative 2-DDCt method. RESULTS Differences between mRNA levels of each gene on the same time point between the two groups were not significant. PGRMC1 and PGRMC2 mRNA levels were downregulated, adjusted for ovarian response and age. Positive correlations between PGRMC1 and AR (standardized beta = 0.890, P < 0.001) from day 1 to 6 and PGRMC1 and LHB (standardized beta = 0.806, P < 0.001) from day 1 to 10 were found in poor responders. PGRMC1 and PGRMC2 were positively correlated on days 6 and 10 in normal responders. CONCLUSIONS PGRMC1 and PGRMC2 mRNA are significantly decreased during ovarian stimulation, with some potential differences between normal and poor responders.
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Affiliation(s)
- Christine I Vaitsopoulou
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece.
| | - Efstratios M Kolibianakis
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Julia K Bosdou
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Eirini Neofytou
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Stefania Lymperi
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Anastasios Makedos
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Despina Savvaidou
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Katerina Chatzimeletiou
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Grigoris F Grimbizis
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Alexandros Lambropoulos
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
| | - Basil C Tarlatzis
- Unit for Human Reproduction, Laboratory of Genetics, 1st Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia Thessaloniki 56403, Greece
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Jang S, Kim KH, Jun JH, You S. Acupuncture for in vitro fertilization in women with poor ovarian response: a systematic review. Integr Med Res 2020; 9:100395. [PMID: 32322482 PMCID: PMC7160570 DOI: 10.1016/j.imr.2020.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/04/2022] Open
Abstract
Background Poor ovarian response (POR) is one reason for infertility. In vitro fertilization (IVF) is frequently used to help achieve pregnancy, and performing acupuncture before IVF may promote ovulation and reduce egg retrieval pain. The purpose of this systematic review was to evaluate the effectiveness of acupuncture on clinical pregnancy rates (CPR) after IVF in women with POR. Methods Eight electronic databases were searched in January 2020, and reference lists of retrieved articles and previous review articles were hand-searched. Randomized controlled trials (RCTs) using any type of acupuncture for women with POR undergoing IVF were considered. Risk of bias was assessed using the Cochrane risk of bias standards. Results Three RCTs were included in this review. CPR and the number of retrieved oocytes were measured in two studies, while the values of anti-Mullerian hormone (AMH) and antral follicle count (AFC) were only reported in one study. In two studies, CPR was higher in the intervention group than the control group [37.8 % vs 24.3 %]. We did not conduct a meta-analysis, as there was a high level of heterogeneity in interventions among the included trials. Conclusions This study suggests that acupuncture may improve CPR, AMH, AFC and the number of retrieved oocytes in women with POR undergoing IVF. However it is difficult to conclude that acupuncture is more effective than conventional treatment. Additionally, more clinical trials are needed to evaluate the effectiveness of acupuncture on CPR and other outcomes of POR. Study registration PROSPERO CRD42018087813; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018087813
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Affiliation(s)
- Soobin Jang
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kyeong Han Kim
- Department of Preventive Medicine, College of Korean Medicine, Woosuk University, Jeonju, Republic of Korea
| | - Ji Hee Jun
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sooseong You
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Corresponding author at: Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea.
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Esteves SC, Roque M, Bedoschi GM, Conforti A, Humaidan P, Alviggi C. Defining Low Prognosis Patients Undergoing Assisted Reproductive Technology: POSEIDON Criteria-The Why. Front Endocrinol (Lausanne) 2018; 9:461. [PMID: 30174650 PMCID: PMC6107695 DOI: 10.3389/fendo.2018.00461] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/26/2018] [Indexed: 01/12/2023] Open
Abstract
Women with impaired ovarian reserve or poor ovarian response (POR) to exogenous gonadotropin stimulation present a challenge for reproductive specialists. The primary reasons relate to the still limited knowledge about the POR pathophysiology and the lack of practical solutions for the management of these conditions. Indeed, clinical trials using the current standards to define POR failed to show evidence in favor of a particular treatment modality. Furthermore, critical factors for reproductive success, such as the age-dependent embryo aneuploidy rates and the intrinsic ovarian resistance to gonadotropin stimulation, are not taken into consideration by the current POR criteria. As a result, the accepted definitions for POR have been criticized for their inadequacy concerning the proper patient characterization and for not providing clinicians a guide for therapeutic management. A novel system to classify infertility patients with "expected" or "unexpected" inappropriate ovarian response to exogenous gonadotropins-the POSEIDON criteria-was developed to provide a more nuanced picture of POR and to guide physicians in the management of such patients. The new standards are provoking as they challenge the current terminology of POR in favor of the newly defined concept of "low prognosis." This article provides readers a critical appraisal of the existing criteria that standardize the definition of POR and explains the primary reasons for the development of the POSEIDON criteria.
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Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
- *Correspondence: Sandro C. Esteves
| | - Matheus Roque
- ORIGEN, Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - Giuliano M. Bedoschi
- Division of Reproductive Medicine, Department of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto, Brazil
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark
- Fertility Clinic Skive Regional Hospital, Skive, Denmark
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
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