1
|
Demir M, Ince O, Yilmaz B, Decleer W, Osmanagaoglu K. The effect of human papilloma virus vaccination on embryo yield and clinical in vitro fertilisation outcomes: a matched retrospective cohort study. J OBSTET GYNAECOL 2020; 41:421-427. [PMID: 32662316 DOI: 10.1080/01443615.2020.1739008] [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] [Indexed: 10/23/2022]
Abstract
The effects of HPV vaccination on embryo yield and pregnancy outcomes in IVF cycles with fresh embryo transfer (ET) were investigated. First, embryo yielding rates (EYR) in 2795 cycles with and without HPV vaccination were compared by retrospective cohort study design. EYR of HPV vaccinated and non-vaccinated patients were not significantly different (OR, 1.66; 95% CI, 0.76-3.63). Second, ET outcomes were compared for 155 HPV vaccine + cycles and 465 HPV vaccine - cycles after matching for ages and cycle attempt number. The differences in the number of retrieved oocytes (10.2 ± 6.1, 11.2 ± 6.7; p = .161), mature (MII) oocytes (8.7 ± 5.7, 9.8 ± 6.3; p = .088), two pronuclear zygotes (2PN) (5.4 ± 4.1, 6.1 ± 4.6; p = .110) and fertilisation rates (0.62 ± 0.23, 0.62 ± 0.23; p = .539) were insignificant between the two groups. Moreover, positive (OR, 0.74; 95% CI, 0.47-1.16), clinical (0.60; 0.36-1.01) and the ongoing pregnancy (0.55; 0.30-1.01) rates were lower in the HPV vaccinated group but the difference was not statistically significant.IMPACT STATEMENTWhat is already known on this subject? There are recent case studies that report premature ovarian insufficiency (POI) following a post-vaccination autoimmune response against the HPV vaccine. These studies suggest that the possible trigger for the immune reaction might be the immunogen content of the vaccine. However, the number of clinical studies investigating the effects of the HPV vaccine on reproductive function and in vitro fertilisation outcomes is limited.What do the results of this study add? In contrast to the case reports suggesting impaired reproductive and ovarian functions in HPV vaccinated patients, this study finds that in IVF patients HPV vaccinated and non-vaccinated women have similar EYR, MII, 2PN, oocyte counts, fertilisation rates, positive, clinical and ongoing pregnancy rates.What are the implications of these findings for clinical practice and/or further research? The results suggest the HPV vaccine does not have a negative impact on embryo yielding rates oocyte counts and fertilisation rates, positive, clinical and ongoing pregnancy rates in IVF treatments. Hence, they can be safely used for primary prevention against cervical cancer.
Collapse
Affiliation(s)
- Mustafa Demir
- Department of Obstetrics and Gynecology, Anka Hospital, Gaziantep, Turkey.,IVF Centrum, AZ Jan Palfijn Hospital, Gent, Belgium
| | - Onur Ince
- Department of Obstetrics and Gynecology, Kutahya Health Sciences University, Kutahya, Turkey
| | - Bulent Yilmaz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Wim Decleer
- IVF Centrum, AZ Jan Palfijn Hospital, Gent, Belgium
| | | |
Collapse
|
2
|
Decleer W, Comhaire F, De Clerck K, Vanden Berghe W, Devriendt G, Osmanagaoglu K. Preconception nutraceutical food supplementation can prevent oxidative and epigenetic DNA alterations induced by ovarian stimulation for IVF and increases pregnancy rates. Facts Views Vis Obgyn 2020; 12:23-30. [PMID: 32696021 PMCID: PMC7363242] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It is hypothesized that oxidative and epigenetic alterations to DNA induced by ovarian stimulation for in vitro fertilization (IVF) may be associated with an increased risk of diseases and cancer in the offspring and could possibly be attenuated by preconception food supplementation. METHODS In a prospective randomised open-label trial, 62 patients were randomly assigned to either 30 days of preconception treatment with the nutraceutical Fertility woman ® duo (Nutriphyt, Beernem, Belgium) (group 1), this nutraceutical complemented with selenomethionine (group 2), or folic acid only (group 3). Biochemical and epigenetic effects and pregnancy rates were assessed. RESULTS In all 3 groups the level of DNA oxidative damage, estimated by the concentration of 8-hydroxy- 2-deoxyguanosine over creatinine in early morning urine, and the concentration of homocysteine in the blood decreased after treatment. In group 2, the degree of methylation of the cancer-associated CpG2 dinucleotide of the human Telomerase Reverse Transcriptase (hTERT) promoter region, assessed by pyrosequence in follicular cells obtained at oocyte pick-up, was 18% lower than that of group 3. The pregnancy rate, including the transfer of fresh and frozen embryos, was significantly higher in group 2 (50%) than in group 3 (6%) with the result in group 1 being intermediate (30%). CONCLUSION The results suggest that preconception food supplementation using a specific nutraceutical significantly reduces oxidative and epigenetic DNA changes to follicular cells of women treated by IVF, and may optimize gene expression in the oocytes, thus increasing the pregnancy rate per cycle of ovarian stimulation.
Collapse
Affiliation(s)
- W Decleer
- Fertility-Belgium Clinic, Weststraat, 16-18, B-9880 Aalter, Belgium;,Centre for Fertility, AZ Jan Palfijn Gent, Watersportlaan 5, B-9000 Gent, Belgium
| | - F Comhaire
- Fertility-Belgium Clinic, Weststraat, 16-18, B-9880 Aalter, Belgium
| | - K De Clerck
- Lab Protein Science, Proteomics and Epigenetic Signaling, Department of Biomedical Sciences, University Antwerp, Campus Drie Eiken, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - W Vanden Berghe
- Lab Protein Science, Proteomics and Epigenetic Signaling, Department of Biomedical Sciences, University Antwerp, Campus Drie Eiken, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - G Devriendt
- Pures Ltd., Kasteelhoek 12, B-8730 Beernem, Belgium
| | - K Osmanagaoglu
- Centre for Fertility, AZ Jan Palfijn Gent, Watersportlaan 5, B-9000 Gent, Belgium
| |
Collapse
|
3
|
Decleer W, Comhaire F, Balduyck J, Ameye A, Osmanagaoglu K, Devroey P. Replacing HMG/FSH by low-dose HCG to complete corifollitropin alfa stimulation reduces cost per clinical pregnancy: a randomized pragmatic trial. Reprod Biomed Online 2020; 40:468-474. [PMID: 32057673 DOI: 10.1016/j.rbmo.2019.10.008] [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: 07/18/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION The cost of IVF treatment remains high, among other factors because of the medication needed for ovarian stimulation. This study investigated the effect of using low-dose human chorionic gonadotrophin (HCG) for the second phase of follicular maturation after corifollitropin alfa induction, to replace the more expensive, either recombinant or human menopausal gonadotrophin (HMG), on the cost of ovarian stimulation. DESIGN One hundred and five patients were randomly divided into two groups: patients in the HCG group (n = 50) received low-dose HCG from Day 7 until the diameter of at least three follicles reached 17 mm or more, while patients in the FSH group (n = 55) received conventional ovarian stimulation with highly purified HMG injections. RESULTS The clinical pregnancy rate in the HCG group was 38% higher than in the FSH group (number needed to treat, NNT = 13). The cost per pregnancy needed for ovarian stimulation was reduced from €4902 in the FSH group to €2684 in the HCG group. Hence, the cost of ovarian stimulation medication to obtain 10 pregnancies using the conventional FSH protocol is sufficient to attain 18 pregnancies when applying the low-dose HCG protocol. CONCLUSION This study provides evidence that using HCG instead of HMG/FSH for ovarian stimulation results in a significant reduction in the cost of IVF with, at least, an equivalent pregnancy rate.
Collapse
Affiliation(s)
- Wim Decleer
- Fertility Clinic, Weststraat 16-18, Aalter 9880, Belgium; IVF Center, AZ Jan Palfijn Gent, Watersportlaan 5, Gent 9000, Belgium.
| | - Frank Comhaire
- Fertility Clinic, Weststraat 16-18, Aalter 9880, Belgium
| | | | - Alice Ameye
- KU Leuven, Oude Markt 13, Leuven 3000, Belgium
| | - Kaan Osmanagaoglu
- IVF Center, AZ Jan Palfijn Gent, Watersportlaan 5, Gent 9000, Belgium
| | - Paul Devroey
- Fertility Clinic, Weststraat 16-18, Aalter 9880, Belgium; Center for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, Jette 1090, Belgium
| |
Collapse
|
4
|
Mahieu F, Decleer W, Osmanagaoglu K, Provoost V. Anonymous sperm donors' attitude towards donation and the release of identifying information. J Assist Reprod Genet 2019; 36:2007-2016. [PMID: 31463872 DOI: 10.1007/s10815-019-01569-9] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/15/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Belgian legislation allows only strictly anonymous gamete donation and known donation (donation to a recipient known by the donor). Recently, an amendment of the legislation was proposed to grant donor offspring, as of 18 years old, the right to claim identifying information about their donor. PURPOSE The aim is to explore the attitude of actual sperm donors towards donation and the release of identifying information and to investigate which donors would be willing to donate when anonymity would be prohibited by law. METHODS All men who were accepted as sperm donors (n = 242) by AZ Jan Palfijn Hospital (Ghent, Belgium) were invited to complete an anonymous online survey. The response rate was 65.5%. RESULTS One in five (20.1%; n = 30) would continue sperm donation upon a legislation change towards identifiable donation. Three in four donors (75.2%) would agree to provide basic non-identifiable information about themselves and one in three (32.9%) would provide extra non-identifiable information such as a baby photo or a personal letter. Almost half of the donors (45.6%) would agree to donate in a system where the hospital can trace the donor at the child's request and contact the donor, leaving it to the donor to decide whether or not to have contact with the requesting donor child. CONCLUSION These findings show that only one in five current donors would continue to donate when identifiable. The study also demonstrates that current donors think more positive about alternative options and that nearly half of them are willing to be contacted by the hospital at the donor child's request, providing the donor can decide at that time whether or not to release his identity.
Collapse
Affiliation(s)
- F Mahieu
- Department of Reproductive Medicine, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000, Ghent, Belgium.
| | - W Decleer
- Department of Reproductive Medicine, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000, Ghent, Belgium
| | - K Osmanagaoglu
- Department of Reproductive Medicine, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000, Ghent, Belgium
| | - V Provoost
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, 9000, Ghent, Belgium
| |
Collapse
|
5
|
Decleer W, Osmanagaoglu K, Verschueren K, Comhaire F, Devroey P. RCT to evaluate the influence of adjuvant medical treatment of peritoneal endometriosis on the outcome of IVF. Hum Reprod 2016; 31:2017-23. [PMID: 27370359 DOI: 10.1093/humrep/dew148] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 09/17/2015] [Accepted: 05/27/2016] [Indexed: 01/20/2023] Open
Abstract
STUDY QUESTION Does a 3-month adjuvant hormonal treatment of mild peritoneal endometriosis after laparoscopic surgery influence the outcome of IVF stimulation in terms of number of mature oocytes obtained per cycle? SUMMARY ANSWER Complementary medical treatment of mild peritoneal endometriosis does not influence the number of oocytes per treatment cycle. WHAT IS KNOWN ALREADY Endometriosis is a disease known to be related to infertility. However, the influence of superficial endometriosis-and its treatment-is still a matter of debate. STUDY DESIGN, SIZE, DURATION A prospective controlled, randomized, open label trial was performed between February 2012 and March 2014 and embryological and clinical outcomes were measured. Patients with laparoscopically diagnosed peritoneal endometriosis (n= 120) were treated by laser surgery after which they were sequentially randomized by computer-generated allocation to one of the two groups. The primary outcome of the trial was the number of Metaphase II (MII) oocytes. Sample size was chosen to detect a difference of two MII oocytes with a power of 80%. The control group (Group B) received the classical long protocol IVF stimulation, whereas the research group (Group A) had an additional pituitary suppression, of 3 months using a long-acting GnRH agonist, prior to IVF. PARTICIPANTS/ MATERIALS, SETTING, METHODS A total of 120 patients were included in the study, 61 of them in the study group and 59 patients in the control group. One patient of the control group was lost to follow up leading to 58 evaluable patients. MAIN RESULTS AND THE ROLE OF CHANCE There was no difference in terms of the number of MII oocytes obtained per cycle: 8.2 in both groups (difference in MII between A and B: 0.07 [-1.89; 2.04] 95% confidence interval (CI)). Pregnancy rate did not differ, being 39.3% for Group A (24 out of 61 patients) versus 39.7% for Group B (23 out of 58 patients) (95% CI around difference in pregnancy rate between A and B: -0.31% [-17.96%; 17.86%]). However, a significantly (P = 0.025) lower dose of FSH (2561 IU for Group A and 2303 IU for Group B, 95% CI around difference in FSH between B and A: -258.6 IU [-483.4 IU; -33.8 IU]) and a significantly (P = 0.004) shorter stimulation period (Group A 12.3 days and Group B 11.3 days, 95% CI around difference in stimulation period between B and A: -1.03 days [-1.73 days; -0.33 days]) were needed to reach adequate follicle maturation in the control group. LIMITATIONS, REASON FOR CAUTION The validity of this study is limited to mild peritoneal endometriosis, and does not apply to ovarian endometriosis, which is also commonly seen in infertility patients. WIDER IMPLICATIONS OF THE FINDINGS There is no indication for complementary medical treatment of peritoneal endometriosis in terms of IVF outcome. On the contrary, stimulation takes longer and requires a higher amount of medication. STUDY FUNDING/COMPETING INTERESTS There was no external funding for this clinical trial in the IVF Center, AZ Jan Palfijn, Ghent. There are no competing interests to declare. TRIAL REGISTRATION NUMBER EudraCT nr: 2012-000784-25. TRIAL REGISTRATION DATE First registration on 29 February 2012 and re-entered on 23 August 2012, NCT01682642 (due to a change of staff). DATE OF FIRST PATIENT'S ENROLLMENT 8 March 2012.
Collapse
Affiliation(s)
- W Decleer
- Fertility Center, Department of Obstetrics and Gynaecology, AZ Jan Palfijn, Henri Dunantlaan 5, 9000 Ghent, Belgium
| | - K Osmanagaoglu
- Fertility Center, Department of Obstetrics and Gynaecology, AZ Jan Palfijn, Henri Dunantlaan 5, 9000 Ghent, Belgium
| | - K Verschueren
- Living Statistics, Kunstenaarstraat 35, 9040 Sint-Amandsberg, Belgium
| | - F Comhaire
- Fertility Center, Weststraat 16/18, 9880 Aalter, Belgium
| | - P Devroey
- Fertility Center, Department of Obstetrics and Gynaecology, AZ Jan Palfijn, Henri Dunantlaan 5, 9000 Ghent, Belgium Center for Reproductive Medicine, Dutch Speaking Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| |
Collapse
|
6
|
Decleer W, Verschueren K, Vandeginste S, Osmanagaoglu K, Devroey P. Corifollitropin stimulation in combination with GnRH-antagonists after estradiol valerate pre-treatment. A pilot study on patientfriendly IVF. Facts Views Vis Obgyn 2015; 7:223-230. [PMID: 27729967 PMCID: PMC5058411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To demonstrate the feasibility of scheduling an IVF cycle, without disadvantages, in the new patient friendly stimulation protocol using the long acting Corifollitropin Alfa, in combination with GnRH-antagonist protection and GnRH-agonist triggering. STUDY DESIGN Two groups of ten patients were admitted in the study. Both received the same stimulation protocol with Corifollitropin Alfa in combination with GnRH-antagonist protection. After ultrasound evaluation on day 7 individually dosed Menopur was added. For triggering final oocyte maturation GnRH-agonists were used. The only difference between the two groups was that in the study group, estradiol valerate 4 mg/day was given from day 25 of the preceding cycle for a period of 10 days, thus postponing the start of follicular growth. RESULTS Scheduling the IVF stimulation by the administration of estradiol valerate 4 mg/day did not influence the hormonal curves, nor the embryological results in comparison to patients with the same stimulation, starting their stimulation at the beginning of menstruation. In this pilot study four out of ten patients turned out to be pregnant, demonstrating an acceptable pregnancy rate. CONCLUSION The combination of estradiol valerate 4 mg/day pre-treatment with the novel combination of Corifollitropin Alfa stimulation with GnRH-antagonist protection, individually topped off with Menopur, and triggered with GnRH-agonist proved to be a safe, patient-friendly (limited number of injections in comparison to classical IVF) (Patil, 2014) and efficient alternative to classical IVF stimulation protocols, allowing patients - and doctors - to schedule the treatment cycle to their convenience.
Collapse
Affiliation(s)
- W Decleer
- Fertility center, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium
| | - K Verschueren
- Living Statistics, Kunstenaarstraat 35, 9040 Sint-Amandsberg, Belgium
| | | | - K Osmanagaoglu
- Fertility center, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium
| | - P Devroey
- Fertility center, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium
| |
Collapse
|
7
|
Decleer W, Osmanagaoglu K, Meganck G, Devroey P. A new approach for ovarian stimulation in IVF using Corifollitropin Alfa in combination with GnRH analogues to trigger final oocyte maturation. A pilot study. Facts Views Vis Obgyn 2014; 6:159-65. [PMID: 25374659 PMCID: PMC4216982] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A pilot study of 10 patients undergoing IVF stimulation, using the new combination of Corifollitropin Alfa with highly purified hMG and GnRH antagonists has been performed, whereas final oocyte maturation was induced by GnRH analogues. The hormonal profiles were analyzed, as well as the clinical outcome. All patients were recruited between March 1st 2013 and June 30(th) 2013. They were all younger than 38 years, had a normal BMI (between 18,0 and 32,0) and did not have more than three previous IVF stimulations. The combination of long acting FSH with hphMG, and under protection of GnRH antagonists against spontaneous LH-surge, provided a normal hormonal profile for estradiol, progesterone, LH, and FSH. The average oocyte quality and embryo quality were excellent, which resulted in four pregnancies out of ten. We conclude that the described combination is a safe, efficient, and patient friendly alternative for the classical IVF stimulation.
Collapse
Affiliation(s)
- W. Decleer
- IVF Centrum, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium.
| | - K. Osmanagaoglu
- IVF Centrum, AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium.
| | - G. Meganck
- Onze Lieve Vrouw Ziekenhuis, dienst Gynaecologie, Moorselbaan 164, 9300 Aalst, Belgium.
| | - P. Devroey
- Centre for Reproductive Medicine, Dutch-speaking Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium and AZ Jan Palfijn Hospital, Henri Dunantlaan 5, 9000 Gent, Belgium.
| |
Collapse
|
8
|
Decleer W, Osmanagaoglu K, Meganck G, Devroey P. Slightly lower incidence of ectopic pregnancies in frozen embryo transfer cycles versus fresh in vitro fertilization-embryo transfer cycles: a retrospective cohort study. Fertil Steril 2014; 101:162-5. [DOI: 10.1016/j.fertnstert.2013.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 09/16/2013] [Accepted: 10/03/2013] [Indexed: 01/27/2023]
|
9
|
Decleer W, Osmanagaoglu K, Seynhave B, Kolibianakis S, Tarlatzis B, Devroey P. Comparison of hCG triggering versus hCG in combination with a GnRH agonist: a prospective randomized controlled trial. Facts Views Vis Obgyn 2014; 6:203-9. [PMID: 25593695 PMCID: PMC4286859] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A prospective randomized controlled trial comparing two groups of ICSI (intra-cytoplasmatic sperm injection) patients with a different form of triggering the final oocyte maturation has been performed. All patients received an ovarian stimulation for in vitro fertilisation (IVF) using an antagonist protocol using recombinant-FSH -(rec-FSH) and Ganirelix. 120 Patients were randomized into two groups with similar clinical parameters. The first group had triggering with hCG, whereas the second group received a combination of hCG + GnRH agonist (Gonadotropin Releasing Hormone). As the primary endpoint, the number of metaphase II oocytes were analysed, the secondary endpoints were the number of cumulus oocyte complexes (COC), the number of fertilized oocytes, embryo morphology, pregnancy rate and the number of cryopreserved embryos. The mean number of MII oocytes in the hCG triggered group was 9.2 compared with 10.3 in the hCG-GnRH agonist group. There was no statistically significant difference in the number of COCs or pregnancy rates. However, the number of patients who received at least one embryo of excellent quality was significantly higher (p = 0.001) in the group with the combined triggering (45 out of 61 patients or 73.8%) versus the group with hCG triggering alone (28 out of 59 patients or 47.5%). The number of cryopreserved embryos was also higher in this group.
Collapse
Affiliation(s)
- W. Decleer
- Fertility Centre, Department of Obstetrics and Gynaecology A.Z. Jan Palfijn, Gent, Belgium.
| | - K. Osmanagaoglu
- Fertility Centre, Department of Obstetrics and Gynaecology A.Z. Jan Palfijn, Gent, Belgium.
| | - B. Seynhave
- Department of Obstetrics and Gynaecology O.L.V. Ziekenhuis, Aalst, Belgium.
| | - S. Kolibianakis
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University, Thessaloniki, Greece.
| | - B. Tarlatzis
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University, Thessaloniki, Greece.
| | - P. Devroey
- Fertility Centre, Department of Obstetrics and Gynaecology A.Z. Jan Palfijn, Gent, Belgium.
| |
Collapse
|
10
|
Svitnev K, Provoost V, Wyverkens E, Van Parys H, Ravelingien A, Raes I, Somers S, Stuyver I, De Sutter P, Buysse A, Pennings G, Dondorp W, De Wert G, Cutas D, Dondorp W, De Wert G, Hens K, Dondorp WJ, de Wert GM, Tack S, Balthazar T, Osmanagaoglu K, Pennings G. Ethics and law. Hum Reprod 2013. [DOI: 10.1093/humrep/det212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Decleer W, Osmanagaoglu K, Devroey P. The role of oxytocin antagonists in repeated implantation -failure. Facts Views Vis Obgyn 2012; 4:227-9. [PMID: 24753913 PMCID: PMC3987474] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
A prospective cohort study has been performed to find out if the administration of an oxytocin antagonist (Atosiban) at the occasion of embryo transfer has an effect on the pregnancy rate in patients with repeated failure of implantation. A total of 52 women with repeated failure of implantation after IVF/ICSI were included in this study. The ongoing pregnancy rate (OPR) in the total group of patients was 12 out of 52 (23.1%). Based on embryo quality all cases were categorized in two groups. One with good embryo quality (Group A) and one with poor quality embryos (Group B). Of all patients who became pregnant, 11 belonged to the group of 26 patients with good quality embryos (OPR 42.3 %) and only one to the group of 26 patients with poor quality embryos (OPR 3.8 %). Our results indicate that when good quality embryos can be obtained, the use of Atosiban at the occasion of embryo transfer might offer a significant better implantation rate in women with repeated implantation failure after IVF/ICSI.
Collapse
Affiliation(s)
- W. Decleer
- IVF Centrum, AZ Jan Palfijn, Henri Dunantlaan 5, 9000 Gent, Belgium
| | - K. Osmanagaoglu
- IVF Centrum, AZ Jan Palfijn, Henri Dunantlaan 5, 9000 Gent, Belgium
| | - P. Devroey
- IVF Centrum, AZ Jan Palfijn, Henri Dunantlaan 5, 9000 Gent, Belgium
,Center of Reproductive Medicine, Dutch- Speaking Free University Brussels, Laarbeeklaan 101,1090 Brussels, Belgium
| |
Collapse
|
12
|
Hay CJ, Brady BM, Zitzmann M, Osmanagaoglu K, Pollanen P, Apter D, Wu FCW, Anderson RA, Nieschlag E, Devroey P, Huhtaniemi I, Kersemaekers WM. A multicenter phase IIb study of a novel combination of intramuscular androgen (testosterone decanoate) and oral progestogen (etonogestrel) for male hormonal contraception. J Clin Endocrinol Metab 2005; 90:2042-9. [PMID: 15671109 DOI: 10.1210/jc.2004-0895] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The effect of a novel combination of oral etonogestrel (ENG) and im testosterone decanoate (TD) on suppression of gonadotropins and spermatogenesis as a potential lead for male contraception was investigated. Healthy male volunteers were randomized into two groups receiving 300 microg ENG daily and 400 mg TD every 4 (n = 55) or 6 (n = 57) wk for 48 wk. At wk 48, all men except one in the 6-wk group suppressed sperm concentration to less than 1 million/ml. Faster suppression occurred in the 4-wk group. Gonadotropins were suppressed in both groups and most consistently in the 4-wk group. During treatment, trough testosterone levels increased into the normal range in the 4-wk group but remained just below normal in the 6-wk group. All peak levels were within the normal range. After treatment cessation, recovery of sperm counts and gonadotropins to normal levels occurred in both groups. Minor effects on weight and cholesterol were noted. Fourteen subjects withdrew because of an adverse event with those possibly related to the study medication reported more frequently in the 6-wk group (nine vs. one). In conclusion, the combination of 300 microg ENG with 400 mg TD every 4 wk was superior in terms of efficacy, hormone profiles, and safety. This represents a promising approach to male hormonal contraception.
Collapse
Affiliation(s)
- Cathy J Hay
- Department of Endocrinology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kolibianakis EM, Zikopoulos KA, Fatemi HM, Osmanagaoglu K, Evenpoel J, Van Steirteghem A, Devroey P. Endometrial thickness cannot predict ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for intrauterine insemination. Reprod Biomed Online 2004; 8:115-8. [PMID: 14759299 DOI: 10.1016/s1472-6483(10)60505-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To date, limited data exist concerning the relation between endometrial thickness on the day of human chorionic gonadotrohin (HCG) administration and ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for intrauterine insemination (IUI). In a prospective study, 168 couples were stimulated with clomiphene citrate from day 3 to day 7 of the cycle and endometrial thickness was assessed by ultrasound three times on the day of ovulation triggering. Ovulation was induced with HCG as soon as >/=1 follicle of >/=17 mm was present at ultrasound independently of endometrial thickness. IUI was performed 36 h after HCG administration. The main outcome measure was ongoing pregnancy. No difference was observed in endometrial thickness between patients who did or did not achieve an ongoing pregnancy (7.6 +/- 0.3 versus 7.6 +/- 0.2 respectively; P = 0.7). No discriminative ability of endometrial thickness on the achievement of ongoing pregnancy could be shown by receiver operating characteristic (ROC) curve analysis (area under the ROC curve 0.51, 95% CI: 0.44-0.59). In conclusion, endometrial thickness cannot predict ongoing pregnancy achievement in IUI cycles stimulated with clomiphene citrate.
Collapse
Affiliation(s)
- E M Kolibianakis
- Centre for Reproductive Medicine, Dutch-Speaking Brussels Free University, Brussels, Belgium.
| | | | | | | | | | | | | |
Collapse
|
14
|
Osmanagaoglu K, Kolibianakis E, Tournaye H, Camus M, Van Steirteghem A, Devroey P. Cumulative live birth rates after transfer of cryopreserved ICSI embryos. Reprod Biomed Online 2004; 8:344-8. [PMID: 15038902 DOI: 10.1016/s1472-6483(10)60915-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A cohort follow-up study was designed to assess the efficacy of an intracytoplasmic sperm injection cryopreservation programme through analysis of cumulative live birth rates in successive frozen-thawed cycles in a tertiary referral centre. There were 2013 patients and they underwent 2680 frozen-thawed embryo transfer cycles. The follow-up period was between 1992 and 2001. Only frozen-thawed embryo transfer cycles up to the fourth trial were included. Crude cumulative live birth rates were calculated in five age subgroups, i.e. <30, 30-34, 35-37, 38-39 and >/=40 years old and in surgically or non-surgically retrieved sperm subgroups. Expected cumulative live birth rates were calculated only for the total number of patients. Outcome measure was a live birth occurring after 25 weeks of gestation. Overall, the expected cumulative live birth rate was as high as 26.7% after four cycles while the crude cumulative delivery rate was 10.5%. Multiple cryopreserved embryo transfer cycles increase the chance of a couple to achieve a live birth.
Collapse
Affiliation(s)
- Kaan Osmanagaoglu
- Centre for Reproductive Medicine, Dutch-speaking Brussels Free University, Laarbeeklaan 101, B 1090 Brussels, Belgium.
| | | | | | | | | | | |
Collapse
|
15
|
Osmanagaoglu K, Vernaeve V, Kolibianakis E, Tournaye H, Camus M, Van Steirteghem A, Devroey P. Cumulative delivery rates after ICSI treatment cycles with freshly retrieved testicular sperm: a 7-year follow-up study. Hum Reprod 2003; 18:1836-40. [PMID: 12923135 DOI: 10.1093/humrep/deg346] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess cumulative delivery rates in patients with non-obstructive or obstructive azoospermia following treatment by testicular sperm extraction (TESE)-ICSI. METHODS A cohort follow-up study was conducted. Between January 1994 and December 2000, 364 couples with obstructive azoospermia underwent a total of 609 fresh TESE-ICSI treatment cycles. In addition, 303 fresh TESE-ICSI treatment cycles were performed in 235 couples for non-obstructive azoospermia. This study included only patients in whom sperm was recovered. In the non-obstructive group, only patients with maturation arrest, atrophic sclerosis and germ cell aplasia were included. The main outcome measure was a delivery beyond 25 weeks gestation. RESULTS In patients with obstructive azoospermia, the crude delivery rate after three cycles was 35% while the expected cumulative delivery rate was 48% [95% confidence interval (CI), 41-55]. On the other hand, in patients with non-obstructive azoospermia, the crude cumulative delivery rate after three treatment cycles was 17% while the expected delivery rate was 31% (95% CI, 15-46). A high dropout rate in couples with both non-obstructive and obstructive azoospermia was observed (75 and 50% respectively, after the first cycle). CONCLUSION This study shows that there is a value in performing several TESE-ICSI attempts in patients with obstructive and non-obstructive azoospermia. The estimates of the non-obstructive group beginning from the third cycle are less reliable due to fewer patients. However, overall, the obstructive group performed better than the non-obstructive group.
Collapse
Affiliation(s)
- Kaan Osmanagaoglu
- Center for Reproductive Medicine, Dutch-speaking Brussels Free University, Brussels, Belgium.
| | | | | | | | | | | | | |
Collapse
|
16
|
Platteau P, Laurent E, Albano C, Osmanagaoglu K, Vernaeve V, Tournaye H, Camus M, Van Steirteghem A, Devroey P. An open, randomized single-centre study to compare the efficacy and convenience of follitropin beta administered by a pen device with follitropin alpha administered by a conventional syringe in women undergoing ovarian stimulation for IVF/ICSI. Hum Reprod 2003; 18:1200-4. [PMID: 12773446 DOI: 10.1093/humrep/deg234] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A pen device, similar to an insulin pen, has been recently marketed for the administration of follitropin beta in cartridges. A randomized controlled trial was performed to compare the efficacy and convenience of this pen device delivering follitropin beta with a conventional syringe delivering follitropin alpha. METHODS A total of 200 patients needing IVF/ICSI treatment and willing to self-inject were enrolled in the study. All subjects had ovarian stimulation according to a long protocol and were randomized to the pen or the conventional syringe group during down-regulation by means of a computer-generated randomization list using random numbers. Patients were asked to fill in a daily local tolerance book after each injection. On the day of hCG the patients scored a Visual Analogue Scale (VAS) for pain and convenience. RESULTS The average duration, total dose of recombinant FSH and number of cumulus oocyte complexes retrieved were 10.8/12.0 days (P = 0.001), 1880/2226 IU (P < 0.001) and 15.2/13.1 respectively in the pen device and conventional syringe groups; the presence of pain after the daily injection was significantly higher in the conventional syringe group (P = 0.027); the visual analogue scale score was similar for pain but significantly more convenient for the pen device (P < 0.001). The live birth rate per embryo transfer was 32.9 and 34.4% respectively in the pen device and conventional syringe groups. CONCLUSIONS Self-injection with the pen device is safe and easy, more convenient and less painful for the patient, requires less FSH and shortens the treatment duration.
Collapse
Affiliation(s)
- Peter Platteau
- Centre for Reproductive Medicine, University Hospital and Medical school, Dutch-speaking Brussels Free University, Laarbeeklaan 101, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Vernaeve V, Tournaye H, Osmanagaoglu K, Verheyen G, Van Steirteghem A, Devroey P. Intracytoplasmic sperm injection with testicular spermatozoa is less successful in men with nonobstructive azoospermia than in men with obstructive azoospermia. Fertil Steril 2003; 79:529-33. [PMID: 12620435 DOI: 10.1016/s0015-0282(02)04809-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the efficiency of intracytoplasmic sperm injection (ICSI) using testicular spermatozoa in cases of nonobstructive azoospermia. DESIGN Retrospective case series. SETTING Tertiary university-based infertility center. PATIENT(S) Overall, 595 couples were included. In 360 couples, the man had normal spermatogenesis. In 118, 85, and 32 couples the man had germ-cell aplasia, maturation arrest, and tubular sclerosis/atrophy, all with focal spermatogenesis present. INTERVENTION(S) We performed 911 ICSI cycles using fresh sperm obtained after testicular biopsies: 306 ICSI cycles used testicular sperm from men with nonobstructive azoospermia, and 605 ICSI cycles used testicular sperm from men with obstructive azoospermia. MAIN OUTCOME MEASURE(S) Fertilization, cleavage, implantation, and pregnancy rates. RESULT(S) Overall, the 2PN fertilization rate was lower in the nonobstructive group: 48.5% vs. 59.7%. There were no differences in in vitro development or in the morphological quality of the embryos. In the nonobstructive group, a total of 718 embryos were transferred (262 transfers) vs. 1,525 embryos in the obstructive group (544 transfers). Both the clinical implantation rate and clinical pregnancy rate per cycle were significantly lower in the nonobstructive group compared with the obstructive group: 8.6% vs. 12.5% and 15.4% vs. 24.0%, respectively. CONCLUSION(S) A statistically significant lower rate of fertilization and pregnancy results from ICSI with testicular sperm from men with nonobstructive azoospermia, compared with men with obstructive azoospermia.
Collapse
Affiliation(s)
- Valérie Vernaeve
- Center for Reproductive Medicine, University Hospital, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Belgium.
| | | | | | | | | | | |
Collapse
|
18
|
Kolibianakis E, Osmanagaoglu K, De Catte L, Camus M, Bonduelle M, Liebaers I, Van Steirteghem A, Devroey P. Prenatal genetic testing by amniocentesis appears to result in a lower risk of fetal loss than chorionic villus sampling in singleton pregnancies achieved by intracytoplasmic sperm injection. Fertil Steril 2003; 79:374-8. [PMID: 12568848 DOI: 10.1016/s0015-0282(02)04578-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare pregnancy outcome after prenatal genetic testing by chorionic villus sampling (CVS) or amniocentesis in singleton pregnancies achieved by intracytoplasmic sperm injection (ICSI). DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENT(S) Eight hundred twenty-eight patients with singleton gestations achieved by ICSI. INTERVENTION(S) Midtrimester amniocentesis (685 patients) and first-trimester CVS (143 patients). MAIN OUTCOME MEASURE(S) Fetal loss rate, preterm delivery rate, and proportion of babies born with low or very low birth weight. RESULT(S) A significant difference was observed in fetal loss rate between CVS and amniocentesis (3.7% vs. 0.9%, respectively). On the other hand, a similar preterm delivery rate was present between the two methods (11.2% vs. 12.4%, respectively). No significant difference was observed between amniocentesis and CVS in the proportion of babies with birth weight of either <1,500 g (1.8% vs. 3.8%, respectively) or between 1,500 and 2,500 g (8.2% vs. 4.6%, respectively). CONCLUSION(S) Amniocentesis appears to result in a lower risk of fetal loss as compared with CVS in patients with a singleton pregnancy achieved by ICSI.
Collapse
Affiliation(s)
- Efstratios Kolibianakis
- Centre for Reproductive Medicine, University Hospital and Medical School, Dutch-Speaking Brussels Free University, Brussels, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Kolibianakis EM, Tournaye H, Osmanagaoglu K, Camus M, Van Waesberghe L, Van Steirteghem A, Devroey P. Outcome for donors and recipients in two egg-sharing policies. Fertil Steril 2003; 79:69-73. [PMID: 12524066 DOI: 10.1016/s0015-0282(02)04406-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effect of two different donation policies on results of egg-sharing. DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENT(S) One hundred five donor-recipient pairs participating in an egg-sharing program between 1998 and 2001. INTERVENTION(S) Egg-sharing was performed according to policy A (retrieval of at least 12 oocytes, with more oocytes allocated to the donor) or policy B (retrieval of at least 8 oocytes, with equal distribution of oocytes between donors and recipients). MAIN OUTCOME MEASURE(S) Delivery rate and cycle cancellation rate. RESULT(S) Policy B resulted in a decreased cycle cancellation rate in the recipient group compared with policy A (9.7% vs. 29.7%, respectively; P<or=.01). No significant difference in delivery rate per fresh transfer was observed between policy A and policy B in donors (30.2% vs. 27.8%, respectively) or recipients (28.2% vs. 25.7%, respectively). CONCLUSION(S) Decreasing the number of oocytes required to perform egg sharing from 12 to 8 and dividing the oocytes equally between donors and recipients significantly reduces the cycle cancellation rate while it does not appear to affect adversely the probability of delivery.
Collapse
|
20
|
Kolibianakis E, Bourgain C, Albano C, Osmanagaoglu K, Smitz J, Van Steirteghem A, Devroey P. Effect of ovarian stimulation with recombinant follicle-stimulating hormone, gonadotropin releasing hormone antagonists, and human chorionic gonadotropin on endometrial maturation on the day of oocyte pick-up. Fertil Steril 2002; 78:1025-9. [PMID: 12413988 DOI: 10.1016/s0015-0282(02)03323-x] [Citation(s) in RCA: 253] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the effect of ovarian stimulation with recombinant FSH, GnRH antagonists, and hCG on endometrial maturation on the day of oocyte pick-up. DESIGN Prospective study. SETTING Tertiary referral center. PATIENT(S) Fifty-five women undergoing controlled ovarian hyperstimulation for IVF/intracytoplasmic sperm injection (ICSI). INTERVENTION(S) [1] Ovarian stimulation with recombinant FSH, starting on day 2 of the cycle and GnRH antagonist, starting after a median of 6 days of recombinant FSH stimulation (range, 5-12 days); [2] hCG administration for ovulation induction; and [3] aspirational biopsy of endometrium at oocyte pick-up. MAIN OUTCOME MEASURE(S) Endometrial histology at oocyte pick-up by Noyes criteria. RESULT(S) Advancement of endometrial maturation (2.5 +/- 0.1 days) as compared to the expected chronological date was observed in all antagonist cycles at oocyte retrieval. Endometrial advancement at oocyte pick-up increased in line with values of LH at initiation of stimulation and the duration of recombinant FSH treatment before the antagonist was started. CONCLUSION(S) The higher the values of LH at initiation of stimulation and the longer the duration of recombinant FSH treatment before the antagonist is started, the more advanced the endometrial maturation at oocyte pick-up.
Collapse
Affiliation(s)
- Efstratios Kolibianakis
- Centre for Reproductive Medicine, Dutch-Speaking Brussels Free University, Brussels, Belgium.
| | | | | | | | | | | | | |
Collapse
|
21
|
Kolibianakis EM, Fatemi HM, Osmanagaoglu K, Evenepoel J, Steirteghem AV, Devroey P. Is endometrial thickness, assessed on the day of HCG administration, predictive of ongoing pregnancy in patients undergoing intrauterine insemination after ovarian stimulation with clomiphene citrate? Fertil Steril 2002. [DOI: 10.1016/s0015-0282(02)03788-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Osmanagaoglu K, Collins J, Kolibianakis E, Tournaye H, Camus M, Van Steirteghem A, Devroey P. Spontaneous pregnancies in couples who discontinued intracytoplasmic sperm injection treatment: a 5-year follow-up study. Fertil Steril 2002; 78:550-6. [PMID: 12215332 DOI: 10.1016/s0015-0282(02)03300-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the occurrence of deliveries after spontaneous conception in patients who have discontinued unsuccessful intracytoplasmic sperm injection (ICSI) treatment. DESIGN Cohort follow-up study. SETTING Tertiary referral center. PATIENT(S) Between July 1992 and December 1993, 200 Belgian women younger than 37 years underwent 433 consecutive unsuccessful ICSI cycles with freshly ejaculated sperm and eventually discontinued their treatment. INTERVENTION(S) Ultrasound-guided oocyte retrieval and ICSI. MAIN OUTCOME MEASURE(S) Delivery after 25 weeks following a spontaneous pregnancy. RESULT(S) The mean age at the time of the last oocyte pick-up was 31.0 +/- 3.9 years. The mean time interval between the last ICSI and the end of the follow-up period was 47.7 +/- 12.1 months. Twenty-three spontaneous pregnancies ending in delivery after 25 weeks were observed (11.5%). The cumulative delivery rate reached a plateau of 10% after 36 months of follow-up. The mean time interval (from last oocyte retrieval) for spontaneous pregnancy to occur after discontinuing ICSI treatment was 20.2 +/- 13.7 months. Proportional hazards analysis showed that delivery rate was reduced by 2.0% per year of infertility. CONCLUSION(S) This study suggests that duration of infertility appears to be predictive of the likelihood of live delivery after spontaneous conception following an unsuccessful ICSI treatment.
Collapse
Affiliation(s)
- Kaan Osmanagaoglu
- Center for Reproductive Medicine, Dutch-Speaking Brussels Free University, Belgium.
| | | | | | | | | | | | | |
Collapse
|
23
|
Kolibianakis E, Osmanagaoglu K, Camus M, Tournaye H, Van Steirteghem A, Devroey P. Effect of repeated assisted reproductive technology cycles on ovarian response. Fertil Steril 2002; 77:967-70. [PMID: 12009352 DOI: 10.1016/s0015-0282(02)02975-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effect of repeated assisted reproductive technology (ART) cycles on the ovarian response in patients treated with human menopausal gonadotropins and GnRH agonists. DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENT(S) Three thousand two hundred forty-nine patients who had completed at least two in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles (minimum two, maximum six cycles per patient). INTERVENTION(S) Nine thousand three hundred seventy-nine repeated IVF/ICSI cycles. MAIN OUTCOME MEASURE(S) Mean number of cumulus oocyte complexes (COC) retrieved per cycle, mean number of ampules used per attempt. RESULT(S) Repeated ART cycles did not exert a significant effect on the mean number of COC retrieved per attempt in contrast to maternal age, which was inversely related to the mean number of COC retrieved in all cycles performed. Across repeated ART attempts, an increase in the mean number of ampules used per cycle was observed. This was due to an effect of maternal age, which increased in line with the mean number of ampules used per cycle, as well as to an age-independent effect of repeated cycles. CONCLUSION(S) An age-independent deterioration of the ovarian response appears to occur across repeated ART cycles.
Collapse
Affiliation(s)
- Efstratios Kolibianakis
- Centre for Reproductive Medicine, Dutch-Speaking Brussels Free University, Brussels, Belgium.
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
BACKGROUND Female patients aged >37 years have a poor prognosis after ICSI. To determine the cumulative delivery rates in these women by life-table analysis, 228 patients aged >37 years who had undergone a total of 437 ICSI cycles were analysed retrospectively. METHODS Only cycles in which fresh ejaculated sperm was used, and in which at least one oocyte was micro-injected, were analysed. The main outcome measure was cumulative rate of deliveries. Any delivery after 25 weeks gestation was included in the study. RESULTS In women aged 38-39 years, the real cumulative delivery rate after two cycles was 21%, while the expected delivery rate was 26%. In patients aged 40-43 years, the real and expected cumulative delivery rates were 12 and 17% respectively after three cycles, when they reached a plateau. There was only one delivery in the age group >43 years, which consisted of 26 patients with 66 cycles. In women aged >37 years, an expected cumulative delivery rate of 30% may be obtained at the end of the fourth cycle. Women aged >43 years do not have a realistic chance of achieving a delivery with their own oocytes. CONCLUSIONS This life-table analysis provides a means by which to counsel couples about their chances of achieving a delivery by ICSI at an age >37 years.
Collapse
Affiliation(s)
- Kaan Osmanagaoglu
- Centre for Reproductive Medicine, Dutch-speaking Brussels Free University, Laarbeeklaan 101, B 1090 Brussels, Belgium.
| | | | | | | | | | | |
Collapse
|
25
|
Osmanagaoglu K, Kolibianakis E, Tournaye H, Devroey P. Estimation of spontaneous pregnancies in patients after unsuccessful ICSI treatment. Hum Reprod 2002; 17:250-1. [PMID: 11756399 DOI: 10.1093/humrep/17.1.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Posaci C, Smitz J, Camus M, Osmanagaoglu K, Devroey P. Progesterone for the luteal support of assisted reproductive technologies: clinical options. Hum Reprod 2000; 15 Suppl 1:129-48. [PMID: 10928425 DOI: 10.1093/humrep/15.suppl_1.129] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The role of progesterone in luteal support in assisted reproductive technologies (ART) is reviewed. There is insufficient data in ART treatment without gonadotrophin-releasing hormone (GnRH) analogues, to prove the necessity for luteal phase support using progesterone. Prospective studies have shown that ART cycles using GnRH analogues need to be supplemented. GnRH antagonists could have some adverse effects on the luteal phase. So far, no prospective randomized comparative study has been performed to investigate the necessity for luteal phase support when antagonists are used in ART cycles. Clinical outcome data (pregnancy and abortion rates) show similar success rates for human chorionic gonadotrophin (HCG) or progesterone supplementation. A major disadvantage of using HCG is the risk of maintaining or enhancing ovarian hyperstimulation syndrome. Of the several routes of administration of progesterone, the vaginal route is preferred because of its ease of use, reduced side-effects and, most importantly, the first uterine pass effect.
Collapse
Affiliation(s)
- C Posaci
- Centre for Reproductive Medicine, Dutch-speaking Brussels Free University, Belgium
| | | | | | | | | |
Collapse
|
27
|
Osmanagaoglu K, Tournaye H, Camus M, Vandervorst M, Van Steirteghem A, Devroey P. Cumulative delivery rates after intracytoplasmic sperm injection: 5 year follow-up of 498 patients. Hum Reprod 1999; 14:2651-5. [PMID: 10528002 DOI: 10.1093/humrep/14.10.2651] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The use of life-table analysis for infertility data has the advantages of clarity and ease of application. Success rates per cycle have been reported, but not cumulative delivery rates for intracytoplasmic sperm injection (ICSI). We selected retrospectively 498 Belgian patients <37 years old, who had their first ICSI cycle between July 1992 and December 1993. Follow-up was till the end of October 1997. Outcome measure was any delivery >25 weeks. These couples underwent 963 ICSI cycles using fresh ejaculated spermatozoa. The indications for ICSI were long-standing severe male infertility or fertilization failure after conventional in-vitro fertilization (IVF). Cumulative delivery rates were calculated by life-table analysis and compared according to age groups and sperm quality. There were 298 deliveries within a mean rate per cycle of 31%. The average number of cycles required for a delivery was 3.15 (CI 2.88; 3.43). Twenty-three (4.6%) spontaneous pregnancies occurred after the patients had finished therapy. There was no significant difference between the sperm quality groups but delivery rates decreased significantly with increasing female age. The real delivery rate after six cycles was 60%, while the expected cumulative delivery rate was 86%. This life-table analysis may provide a means by which to counsel couples on the likelihood of a delivery following ICSI.
Collapse
Affiliation(s)
- K Osmanagaoglu
- Centre for Reproductive Medicine, Dutch-speaking Brussels Free University, Laarbeeklaan 101, B 1090 Brussels, Belgium
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
We reviewed the place of tubal surgery in the era of assisted reproductive technology. Reversal of tubal ligation is one of the main indications for tubal microsurgery. Adhesiolysis has the best results if the adhesion is the only factor responsible for infertility. There are no differences between adhesiolysis by laparoscopy or by laparotomy, and so laparoscopy must be preferred. Proximal tubal obstructions can be successfully treated by microsurgical tubocornual anastomosis. As far as distal tubal lesions are concerned, success rates depend strictly on the pre-existing tubal disease in distal tubal lesions and tubal surgery frequently fails; in-vitro fertilization (IVF) must therefore be considered in such circumstances. In conclusion, we think that IVF and tubal surgery must be considered to be complementary rather than competitive procedures. Adequate selection of patients is crucial to find the best therapeutic approach.
Collapse
Affiliation(s)
- C Posaci
- Centre for Reproductive Medicine, Dutch-speaking Brussels Free University, Belgium
| | | | | | | |
Collapse
|
29
|
Affiliation(s)
- L De Catte
- Department of Feto-Maternal Medicine, University Hospital Brussels, Belgium
| | | | | |
Collapse
|
30
|
Osmanagaoglu K, Foulon W. Concerns about risks of irradiation during pregnancy. J Nucl Med 1998; 39:2194-5. [PMID: 9867172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
|
31
|
Van de Wiele C, Osmanagaoglu K, Audenaert K, Dierckx RA. Delayed epiphyseal closure attributable to androgen deficiency. Clin Nucl Med 1997; 22:567-8. [PMID: 9262912 DOI: 10.1097/00003072-199708000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C Van de Wiele
- Division of Nuclear Medicine, University Hospital, Gent, Belgium
| | | | | | | |
Collapse
|
32
|
van de Wiele C, Osmanagaoglu K, Monsieurs M, van Laere K, Kaufman JM, Dierckx RA. 201Tl scintigraphy does not allow visualization of the thyroid in euthyroid and hyperthyroid patients treated with amiodarone. Nucl Med Commun 1997; 18:513-6. [PMID: 9259521 DOI: 10.1097/00006231-199706000-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A retrospective study was performed to evaluate the usefulness of thallium scintigraphy for visualization of thyroid morphology and function. Moreover, applying absolute quantitation, we wished to confirm the qualitatively reduced 99Tc(m) uptake reported by Wiersinga et al. in both euthyroid and hyperthyroid patients treated with amiodarone. Over a period of 2 years (1995-96), 10 patients (group A; 2 females, 8 males, mean age 68.6 years, range 61-74 years) receiving amiodarone treatment for cardiac arrhythmias for at least 4 months were referred for exploration of either hyperthyroidism (n = 4) or for exclusion of parathyroid adenoma (n = 6). During the same period, 17 patients (group B; 10 females, 7 males, mean age 62 years, range 19-91 years) referred for Tc-Tl subtraction scintigraphy, and in whom follow-up revealed no thyroid or parathyroid pathology, were used as controls. In all patients, thyroid status was assessed by thyroid function tests. 201Tl and 99Tc(m) uptake was calculated as a percentage of the injected dose, taking account of net injected counts and background and isotope decay correction. Original images were scored using a 2-point scoring system (0 = poor, 1 = fair or good). Uptake of both 99Tc(m) and 201Tl was significantly reduced in group A (99Tc[m]: 0.16 +/- 0.21%; 201Tl: 0.30 +/- 0.21%; mean +/- S.D.) compared to group B (99Tc[m]: 1.58 +/- 1.07%; 201Tl: 0.72 +/- 0.37%) (P < 0.005). The mean relative reduction in 99Tc(m) uptake was more pronounced (90% decrease) than that of 201Tl (58% decrease). In group A, the 99Tc(m) and 201Tl image quality was poor in 10 of 10 and 8 of 10 patients respectively. In group B, the 99Tc(m) and 201Tl image quality was poor in 3 of 17 and 4 of 17 patients respectively. The decreased uptake of 201Tl may reflect the inhibitory effect of iodides on adenyl cyclase and its stimulation by TSH. In conclusion, the data presented confirm the qualitatively reduced pertechnetate uptake reported by Wiersinga et al. Furthermore, 201Tl uptake by the thyroid in euthyroid or hyperthyroid patients treated with amiodarone is also reduced. Although quantitatively less pronounced, it does not allow proper visualization of the thyroid.
Collapse
Affiliation(s)
- C van de Wiele
- Division of Nuclear Medicine, University Hospital Gent, Belgium
| | | | | | | | | | | |
Collapse
|
33
|
Osmanagaoglu K, Kuyvenhoven J, Dierckx RA, Hamers J, Cuvelier C, Uyttendaele D, Simons M. Thallium-201 accumulation in myositis ossificans and in juxta-articular ossification. J Nucl Med 1995; 36:2239-42. [PMID: 8523112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We present the findings on 201Tl and 99mTc-MDP scintigraphy in three patients suffering from heterotopic ossification (two patients presenting with myositis ossificans and one patient presenting with juxta-articular ossification in combination with myositis ossificans). Since resection of the lesions has to be delayed until stabilization, 99mTc-MDP is often used as a parameter of lesional activity, although it is not optimal. For this clinical problem, we evaluated 201Tl scintigraphy as a marker of metabolic activity. In addition to the well-documented uptake of 99mTc-MDP, marked accumulation of 201Tl was observed in all heterotopic ossification sites. Hence, our results support the use of 201Tl scintigraphy in the therapeutic management and monitoring of conditions associated with ectopic ossification. On the other hand, although myositis ossificans is sometimes clinically, radiographically and even histologically confused with extraosseous osteogenic sarcoma, 201Tl accumulation may not be a helpful factor in the differential diagnosis due to the presence of tracer accumulation in both disorders.
Collapse
Affiliation(s)
- K Osmanagaoglu
- Department of Nuclear Medicine, University Hospital, Ghent, Belgium
| | | | | | | | | | | | | |
Collapse
|
34
|
Ingels K, Van Hoorn V, Obrie E, Osmanagaoglu K. A modified technetium-99m isotope test to measure nasal mucociliary transport: comparison with the saccharine-dye test. Eur Arch Otorhinolaryngol 1995; 252:340-3. [PMID: 8679152 DOI: 10.1007/bf00178273] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In this study two indirect mucociliary transport tests were compared. Nine subjects underwent duplicate saccharine-dye tests and duplicate modified technetium-99m (99mTc) tests, in which the radioactive 99mTc was nebulized in the nostril by means of a pump spray. The efficacy of mucociliary transport was deduced from the transport time of saccharine, dye and 99mTc. Transport rate also provided additional information in the 99mTc test. Transport rate correlated best in the repeated tests (r = 0.46), but was not significant (P = 0.21). Use of a pump spray for the 99mTc test instead of placement of a single droplet on the nasal mucosa makes the test easier to perform.
Collapse
Affiliation(s)
- K Ingels
- Department of Otorhinolaryngology, University Hospital Ghent, Belgium
| | | | | | | |
Collapse
|
35
|
|
36
|
Osmanagaoglu K, Lippens M, Benoit Y, Obrie E, Schelstraete K, Simons M. A comparison of iodine-123 meta-iodobenzylguanidine scintigraphy and single bone marrow aspiration biopsy in the diagnosis and follow-up of 26 children with neuroblastoma. Eur J Nucl Med 1993; 20:1154-60. [PMID: 8299650 DOI: 10.1007/bf00171013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In staging neuroblastomas, the demonstration of tumoural invasion of the bone marrow is an important criterion with regard to the therapeutic prospects and the prognosis. Iliac crest aspiration sampling has been used routinely for the detection of bone marrow metastases in neuroblastoma. However, due to the limited character of the sampling, it sometimes leads to false-negative results. Another procedure which is used to determine the extent of neuroblastoma is metaiodobenzylguanidine (mIBG) scintigraphy. In order to establish the respective merits of both diagnostic techniques retrospectively, 148 iodine-123 mIBG scans of 26 children with neuroblastoma have been re-evaluated and compared with the results of routine bone marrow samples obtained within a 4-week period before or after scanning. Three types of mIBG uptake in the bone/bone marrow could be differentiated: (1) no visualization of the skeleton; (2) diffuse uptake in the skeleton with or without focally increased uptake, which indicates massive, diffuse bone marrow invasion by the tumour; and (3) focal tracer accumulation in one or several bones. No tracer uptake was observed in the skeleton in 91 scans. In 89 of the 91 the bone marrow biopsy was negative. Twenty-four scans showed diffuse skeletal uptake with or without foci. The bone marrow biopsies were negative for eight of those 24 scans. Hyperactive foci in one or more bones without diffuse tracer accumulation in the skeleton were detected in 33 scans. In only 7 of these 33 scans did bone marrow biopsy specimens from the iliac MDP crest contain neuroblastoma cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- K Osmanagaoglu
- Department of Radiotherapy and Nuclear Medicine, University Hospital, Ghent University, Belgium
| | | | | | | | | | | |
Collapse
|
37
|
Osmanagaoglu K, Schelstraete K, Lippens M, Obrie E, De Feyter I. Visualization of a parathyroid adenoma with Tc-99m MIBI in a case with iodine saturation and impaired thallium uptake. Clin Nucl Med 1993; 18:214-6. [PMID: 8384942 DOI: 10.1097/00003072-199303000-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A case of a parathyroid adenoma is presented in which the conventional Tl-201 minus Tc-99m subtraction technique failed to localize the adenoma because of prior iodide administration and a low Tl-201 uptake. Ultrasonography and CT could not provide useful data either. However, a Tc-99m methoxylisobutylisonitrile (MIBI) scintigram clearly delineated the adenoma and the thyroid tissue.
Collapse
Affiliation(s)
- K Osmanagaoglu
- Department of Radiotherapy and Nuclear Medicine, University Hospital, Ghent, Belgium
| | | | | | | | | |
Collapse
|