1
|
Guo W, Xu Y, Tian T, Yang S, Li R, Qiao J, Zheng X. Outcomes of the Next In Vitro Fertilization Cycle in Women with Polycystic Ovary Syndrome after a Failed In Vitro Maturation Attempt. J Clin Med 2023; 12:5761. [PMID: 37685828 PMCID: PMC10488624 DOI: 10.3390/jcm12175761] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/05/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND In vitro maturation (IVM) is indicated in women with polycystic ovary syndrome (PCOS) who have a very good ovarian response during in vitro fertilization (IVF) and are therefore at high risk of ovarian hyperstimulation syndrome (OHSS). According to the latest practice committee document, IVM could be a major advance in assisted reproductive technology (ART) procedures (reduced cost and simplified treatment); nevertheless, retrospective studies of IVM versus IVF still demonstrate lower chances of a live birth with IVM. Could IVM prove to be an optimal first-line treatment approach? And limited information is available concerning the success of the subsequent IVF cycle after the failure of an IVM cycle. Does IVM treatment adversely affect the subsequent IVF cycle, and is this worth considering before performing the IVF cycle for women with PCOS? METHODS This prospective nested case-control study at the Peking University Reproductive Medicine center in China was performed between March 2018 and September 2020. Women aged 20-38 years with PCOS and infertility and who were scheduled for their first IVF attempt were eligible. A total of 351 women were randomly allocated to receive one cycle of unstimulated natural IVM (n = 175) or one cycle of standard IVF with a flexible GnRH antagonist protocol followed by hCG as an ovulation trigger (n = 176). This study involved 234 women (58 women with no blastocysts in the first IVM cycle and 158 women who underwent the first IVF cycle). Cumulative live birth rate at 12 months after oocyte retrieval and OHSS of a standard controlled ovarian stimulation (COS) IVF cycle were compared between 58 women in an IVF cycle following a failed IVM cycle and 158 women who underwent the first IVF cycle. RESULTS No significant differences were found in the cumulative live birth rate (CLBR), ongoing pregnancy rate, or clinical pregnancy rate at 12 months after oocyte retrieval between the two groups (56.9% vs. 58.9%, p = 0.795; 58.6% vs. 60.8%, p = 0.776; and 84.5% vs. 76.0%, p = 0.178). The incidence of moderate-to-severe OHSS was not significantly different between the groups (6.9% vs. 5.7%, p = 0.742). Additionally, there were no significant differences in the total gonadotropin dose, stimulation duration, number of retrieved oocytes, number of retrieved mature oocytes, or fertilization rates. CONCLUSIONS Even if the first IVM attempt failed in subfertile women with PCOS, comparable cumulative live birth rates were observed in the subsequent IVF cycle. IVM treatment does not adversely affect the subsequent IVF cycle.
Collapse
Affiliation(s)
- Wei Guo
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing 100191, China; (W.G.); (Y.X.); (T.T.); (S.Y.); (R.L.)
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Yalan Xu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing 100191, China; (W.G.); (Y.X.); (T.T.); (S.Y.); (R.L.)
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Tian Tian
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing 100191, China; (W.G.); (Y.X.); (T.T.); (S.Y.); (R.L.)
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Shuo Yang
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing 100191, China; (W.G.); (Y.X.); (T.T.); (S.Y.); (R.L.)
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Rong Li
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing 100191, China; (W.G.); (Y.X.); (T.T.); (S.Y.); (R.L.)
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest, Chinese Academy of Medical Sciences, Beijing 100006, China
| | - Jie Qiao
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing 100191, China; (W.G.); (Y.X.); (T.T.); (S.Y.); (R.L.)
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest, Chinese Academy of Medical Sciences, Beijing 100006, China
| | - Xiaoying Zheng
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing 100191, China; (W.G.); (Y.X.); (T.T.); (S.Y.); (R.L.)
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest, Chinese Academy of Medical Sciences, Beijing 100006, China
| |
Collapse
|
2
|
Hatırnaz Ş, Tan SL, Hatırnaz E, Çelik Ö, Kanat-Pektaş M, Dahan MH. Vaginal ultrasound-guided ovarian needle puncture compared to laparoscopic ovarian drilling in women with polycystic ovary syndrome. Arch Gynecol Obstet 2019; 299:1475-1480. [PMID: 30729291 DOI: 10.1007/s00404-019-05067-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/14/2018] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To compare pregnancy outcomes in PCOS women undergoing transvaginal ovarian injury (TVOI) and laparoscopic ovarian drilling (LOD) DESIGN: 126 infertile patients with PCOS were included in this prospective cohort study CANADIAN TASK FORCE CLASSIFICATION OF LEVEL OF EVIDENCE: IIA. SETTING University-affiliated fertility center. PATIENTS Sixty-seven infertile patients with the history of failed in vitro maturation underwent follow-up as the TVOI group. Fifty-nine infertile women who underwent LOD acted as controls. All subjects had PCOS with menstrual irregularity and were anovulatory by repetitive serum progesterone levels. INTERVENTIONS The LOD group underwent six cauterizations of a single ovary with 30W for 4-6 s. Failed IVM subjects with 20-30 needle punctures per ovary acted as the TVOI group. Subjects were followed for six months. MEASUREMENTS AND MAIN RESULTS There was not a significant difference between the groups when the cases were evaluated in terms of spontaneous pregnancy or miscarriage rates. BMI levels decreased in both the TVOI and the LOD groups in a similar fashion. However, serum AMH and AFC decreased greater after LOD than they did with TVOI over the six-month duration of the study (p < 0.001 in both cases). CONCLUSIONS Preliminary data suggest that TVOI likely represents a safer, less costly and equally effective manner of surgical ovulation induction in anovulatory PCOS women when compared to LOD.
Collapse
Affiliation(s)
- Şafak Hatırnaz
- Medicana International Hospital, Yeni mahalle, Şehit Mesut Birinci Cad., No 85 Canik, Samsun, 55080, Turkey.
| | - Seang Lin Tan
- Mc Gill Fertility Center, Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| | - Ebru Hatırnaz
- Medicana International Hospital, Yeni mahalle, Şehit Mesut Birinci Cad., No 85 Canik, Samsun, 55080, Turkey
| | - Önder Çelik
- Obstetrics and Gynecology, Private Office, Uşak, Turkey
| | - Mine Kanat-Pektaş
- Department of Obstetrics and Gynecology, School of Medicine, Kocatepe University, Afyon, Turkey
| | - Michael H Dahan
- Mc Gill Fertility Center, Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| |
Collapse
|
3
|
Braam SC, Consten D, Smeenk JM, Cohlen BJ, Curfs MH, Hamilton CJ, Repping S, Mol BW, de Bruin JP. In Vitro Maturation of Oocytes in Women at Risk of Ovarian Hyperstimulation Syndrome-A Prospective Multicenter Cohort Study. Int J Fertil Steril 2019; 13:38-44. [PMID: 30644243 PMCID: PMC6334011 DOI: 10.22074/ijfs.2019.5452] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 07/25/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND In vitro maturation (IVM) is an artificial reproductive technology in which immature oocytes are harvested from the ovaries and subsequently will be matured in vitro. IVM does not require ovarian hyperstimulation (OH) and thus the risk of ovarian hyperstimulation syndrome (OHSS) is avoided. In this study, we assessed the live birth rate per initiated IVM cycle in women eligible for in vitro fertilization/intracytoplasmic sperm injection (IVF/ ICSI) and at risk for OHSS. Furthermore, we followed women who were not pregnant after IVM and committed to a conventional IVF/ICSI procedure. MATERIALS AND METHODS In this multicenter prospective cohort study, we started 76 IVM cycles using recombinant follicle stimulating hormone (rFSH) priming in 68 patients. There were 66 oocyte retrievals, in which a total of 628 oocytes were collected. We incubated the immature oocytes for 24-48 hours and fertilized those that reached metaphase II by ICSI. RESULTS Three hundred eighty six (61% oocytes) achieved metaphase II. The fertilization rate was 55%. We performed 59 embryo transfers (1.9 embryos per transfer) in 56 women, including 3 frozen embryo transfers. There were four ongoing pregnancies (5.3% per initiated cycle) leading to the birth of a healthy child at term. None of the patients developed OHSS. The ongoing pregnancy rate of the first conventional IVF/ICSI cycle after an unsuccessful IVM cycle was 44%, which was unexpectedly high. CONCLUSION We concluded that IVM led to live births but with low effectiveness in our study. Earlier reported IVM success rates are higher which can be caused by a more extended experience in these centers with the intricate laboratory process. However, a possible selection bias in these studies cannot be ruled out. Furthermore, IVM might have a beneficial effect on further IVF/ICSI treatments due to its "ovarian drilling" effect.
Collapse
Affiliation(s)
- Sanne C. Braam
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands,Department of Obstetrics and GynaecologyAcademic Medical CenterMeibergdreef 91105 AZAmsterdamThe Netherlands
| | - Dimitri Consten
- Department of Obstetrics and Gynaecology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Jesper M.J. Smeenk
- Department of Obstetrics and Gynaecology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Ben J. Cohlen
- Department of Obstetrics and Gynaecology, Isala Clinics, Zwolle, The Netherlands
| | - Max H.J.M. Curfs
- Department of Obstetrics and Gynaecology, Isala Clinics, Zwolle, The Netherlands
| | - Carl J.C.M. Hamilton
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Sjoerd Repping
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ben W.J. Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Jan Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| |
Collapse
|
4
|
Abstract
Purpose Following the analytical phase, the current practice of many hospital laboratories involves the manual verification of all test results followed by the production of the report. However, manual verification is a time-consuming and tedious process. In this paper, we provide a detailed description of how to design autoverification rules for thyroid function test profiles and sex hormones. Materials and methods We used DM2 (Data manager 2) to construct the algorithm and build the database for autoverification of thyroid function test profiles and sex hormones, with reference to Boolean logic, Auto 10-A and CLSI'88. The rules consist of checking quality control, instrument error flags, critical values, the analytical measurement range (AMR), the limit range, consistency check and delta check. Firstly, we established the rules in the DM2, collected clinical specimens for validation, then tested the rules in a 'live' environment. Results Agreement was achieved between manual verification by two senior laboratory personnel and verification using the autoverification rules in 99.78% of the cases. The total autoverification rate for all tests was 77.06%. Following implementation of the rules, the laboratory turnaround time (TAT) was reduced by 54.55% and staffing numbers fell from three to two whole time equivalents (WTE). Statistical analysis resulted in a kappa statistic of 0.99 ( P < 0.001). Moreover, after implementing the autoverification rules, the error rate fell to 0.04%, indicating that errors were almost completely eliminated. Conclusion Implementing autoverification rules can reduce TAT, minimize the number of samples that require manual verification and allow for a reduction in staffing numbers. It also allows laboratory staff to devote more time and effort to the handling of problematic test results and contributing to improved patient care.
Collapse
Affiliation(s)
- Jiancheng Li
- 1 Department of Clinical Laboratory, Central Hospital of Hengyang, Hunan, People's Republic of China
| | - Bizhen Cheng
- 2 Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, People's Republic of China
| | - Huizhen Ouyang
- 2 Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, People's Republic of China
| | - Tongtong Xiao
- 2 Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, People's Republic of China
| | - Jing Hu
- 2 Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, People's Republic of China
| | - Yingmu Cai
- 2 Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, People's Republic of China
| |
Collapse
|
6
|
Abstract
Purpose of review To provide an update on the latest clinical applications of serum antimüllerian hormone (AMH) testing with practical approaches to mitigate the impact of significant variability in AMH results. Recent findings Recent studies continue to demonstrate that AMH is the best single serum test for ovarian response management with, at most, a weak-to-moderate age-independent association with live-birth rate and time to conception. Data confirm serum AMH levels improve menopause prediction, monitoring of ovarian damage, and identification of women at risk for several ovary-related disorders such as polycystic ovary syndrome and premature or primary ovarian insufficiency. However, it is now recognized that serum AMH results can have dramatic variability due to common, biologic fluctuations within some individuals, use of hormonal contraceptives or other medications, certain surgical procedures, specimen treatment, assay changes, and laboratory calibration differences. Practical guidelines are provided to minimize the impact of variability in AMH results and maximize the accuracy of clinical decision-making. Summary AMH is an ovarian biomarker of central importance which improves the clinical management of women's health. However, with the simultaneous rapid expansion of AMH clinical applications and recognition of variability in AMH results, consensus regarding the clinical cutpoints is increasingly difficult. Therefore, a careful approach to AMH measurement and interpretation in clinical care is essential.
Collapse
|