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Peralta S, Solernou R, Barral Y, Roca J, Fabregues F, Manau D, Carmona F. Antral follicle count measured at down-regulation as predictor of ovarian response and cumulative live birth: single center analysis including 2731 long agonist IVF cycles. Gynecol Endocrinol 2022; 38:1079-1086. [PMID: 36476268 DOI: 10.1080/09513590.2022.2154339] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Evaluate antral follicle count measured after pituitary suppression (AFCaps) with a GnRH agonist as predictor of ovarian response and cumulative live birth (CLB). METHODS This study is a large cohort analysis of retrospective data between January 2011 and September 2020 in a tertiary-care university hospital. All first initiated IVF/ICSI cycles in women under 43 years of age for whom AFCaps was registered in our database were included. To evaluate CLB rates (CLBRs), only finalized cycles were analyzed (at least one live birth and/or all embryos transferred), excluding PGT cycles and severe male factor requiring testicular sperm extraction. RESULTS AFCaps showed a good predictive ability in predicting ovarian response to ovarian stimulation. Predicting poor response, AFCaps presented an area under the receiver-operating characteristic curve (AUCROC) of 0.85 (95% CI 0.83-0.87), for high response prediction, the AUCROC was 0.80 (95% confidence interval [CI] 0.77-0.83).Although AFCaps was statistically higher in patients who achieved at least one live birth (13.6 ± 6.05 vs. 9.79 ± 6.33) and CLBRs per started cycle significantly increase between AFCaps quartiles (15.9%, 36.2%, 45.1% and 52.9%) its ability to predict CLBR was modest, with an AUCROC of 0.67 (95% CI 0.65-0.69). CONCLUSIONS Women undergoing their first IVF/ICSI cycle following a long agonist GnRH protocol can be counseled with AFCaps measurement about their probability of achieving poor/high response. Based on this marker physicians can personalize ovarian stimulation with the aim of optimizing ovarian response and minimizing its risks. However, AFCaps has failed to predict CLB per started IVF cycle as an isolated marker.
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Affiliation(s)
- Sara Peralta
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d ́Investigacions Biomèdiques August Pi i Sunyer (IDIBAP S), Faculty of Medicine-University of Barcelona, Barcelona, Spain
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Solernou R, Solsona M, Peralta S, Goday A, Casals G, Borras A, Manau D, Fabregues F. P–714 Insulin-like growth factor-I as a mediator of the effect of transdermal testosterone in poor responder patients. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is insulin-like growth factor-I (IGF-I) a mediator of the effect of transdermal testosterone (TT) in poor responder (PR) patients?
Summary answer
IGF-I might be a mediator of the effect of TT in PR patients who undergo an IVF cycle
What is known already
Many strategies have been tried to improve the results in PR patients. Androgen supplementation with TT is the only that has significantly increased live birth rate in these patients. The mechanism by which TT might influence on the better results remains unclear but it is likely mediated or facilitated by IGF-I. Testosterone increases the number of primordial follicles, increase IGF-I by threefold and increase IGF-I receptor mRNA by fivehold in primordial follicles in primates. Some studies have suggested that IGF-I could be a parameter that reflects the endocrinological environment of mature follicles, which is correlated with oocyte and embryonic quality
Study design, size, duration
This prospective cohort study of 93 women PR according Bologna criteria treated with TT and IVF/ICSI was conducted between May 2015 and December 2016
Participants/materials, setting, methods
Exogenous andogenization with TT for 5 days prior to ovarian stimulation was carried out. Hormonal parameters were evaluated: basal FSH, LH and Estradiol, AMH, IGF–1 pre and post TT. Ultrasound parameterswere also analysed: antral follicle count (AFC) and number of pre-ovulatory follicles the day of HCGr.
We compared these parameters according to the ovarian response: adequate (> 4 oocytes) or insufficient (<3 oocytes), as well as the pregnancy was achieved or not.
Main results and the role of chance
Baseline characteristics of the patients were: 36.9 years, FSH 11.8, AMH 0.86 and RFA 5.3. In 83% of the patients the oocyte retrieval was carried out, obtaining an average of 3.8 MII oocytes and 2.9 embryos of 2pn with a clinical pregnancy rate per transfer of 33.3%. The FORT Test (AFC/pre-ovulatory follicles x100) was 70%, higher than that observed in other studies with patients with PR without TT (55%).
In cases in which an insufficient response was obtained (<3 oocytes) or the cycle was canceled, a higher age and FSH and lower AMH were observed (p < 0.05). There were no differences in the rest of the parameters.
Evaluating the hormonal and ultrasound parameters depending on whether or not pregnancy was achieved, a significant increase in IGF1 pre and post-TT was observed in the cases of pregnancy (31.5%) compared to those cases where there was no pregnancy (10.9%) (p = 0’01). There were no differences in the rest of the parameters.
A significant correlation was found between AMH, AFC and increase in IGF-I levels (p < 0’05).
Limitations, reasons for caution
This a prospective cohort study with limited number of patients included.
Wider implications of the findings: The significant increase in serum levels of IGF–1 in pregnant patients would indicate the existence of a more favorable clinical setting for the administration of testosterone, probably related to a more favorable ovarian reserve as demonstrated by its correlation with serum levels of AMH and with the AF.
Trial registration number
Not applicable
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Affiliation(s)
- R Solernou
- Hospital Clínic of Barcelona, Assisted reproduction department, Barcelona, Spain
| | - M Solsona
- Hospital Clínic of Barcelona, Assisted reproduction department, Barcelona, Spain
| | - S Peralta
- Hospital Clínic of Barcelona, Assisted reproduction department, Barcelona, Spain
| | - A Goday
- Hospital Clínic of Barcelona, Assisted reproduction department, Barcelona, Spain
| | - G Casals
- Hospital Clínic of Barcelona, Assisted reproduction department, Barcelona, Spain
| | - A Borras
- Hospital Clínic of Barcelona, Assisted reproduction department, Barcelona, Spain
| | - D Manau
- Hospital Clínic of Barcelona, Assisted reproduction department, Barcelona, Spain
| | - F Fabregues
- Hospital Clínic of Barcelona, Assisted reproduction department, Barcelona, Spain
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Solernou R, Peralta S, Casals G, Guimera M, Solsona M, Borras A, Manau D, Fàbregues F. The Follicular Output Rate (FORT) as a method to evaluate transdermal testosterone efficacy in poor responders. JBRA Assist Reprod 2021; 25:229-234. [PMID: 33507716 PMCID: PMC8083864 DOI: 10.5935/1518-0557.20200086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/20/2022] Open
Abstract
Objective: Follicular Output Rate (FORT) is an efficient quantitative and qualitative marker of ovarian responsiveness to gonadotropins. Transdermal testosterone (TT) has been used as adjuvant therapy to gonadotrophins in order to improve ovarian response in poor responders (PR). The aim of this study was to analyze whether TT can improve follicular sensitivity to gonadotropins using FORT. Methods: This retrospective study, held in a tertiary-care university hospital included 90 PR patients, according to the Bologna criteria. Patients in Group 1 (n = 46) received transdermal application of testosterone preceding gonadotrophin ovarian stimulation under pituitary suppression. In Group 2 (n = 44) ovarian stimulation was carried out with high-dose gonadotrophin in association with minidose GnRH agonist protocol. We analyzed ovarian stimulation parameters and IVF outcomes. We determined antral follicle count (AFC) (3-8 mm) before ovarian stimulation, pre-ovulatory follicle count (PFC) (16-22 mm) and the day of hCG administration. We calculated the FORT using the PFCx100/AFC ratio. Results: Baseline characteristics and ovarian reserve parameters were similar in both groups. FORT and oocytes retrieved were significantly higher in group 1 vs group 2. There were no significant differences in pregnancy rates. In group 1 there was a significant correlation between FORT and AFC. Conclusions: This study suggests that the potential beneficial mechanism of TT in poor responder patients may be based on increasing the antral follicle sensitivity to gonadotrophin. FORT is an excellent tool to demonstrate this.
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Affiliation(s)
- Roser Solernou
- Institute Clinic of Gynecology, Obstetrics and Gynecology. Hospital Clinic. Barcelona, Spain
| | - Sara Peralta
- Institute Clinic of Gynecology, Obstetrics and Gynecology. Hospital Clinic. Barcelona, Spain
| | - Gemma Casals
- Institute Clinic of Gynecology, Obstetrics and Gynecology. Hospital Clinic. Barcelona, Spain
| | - Marta Guimera
- Institute Clinic of Gynecology, Obstetrics and Gynecology. Hospital Clinic. Barcelona, Spain
| | - Marina Solsona
- Institute Clinic of Gynecology, Obstetrics and Gynecology. Hospital Clinic. Barcelona, Spain
| | - Aina Borras
- Institute Clinic of Gynecology, Obstetrics and Gynecology. Hospital Clinic. Barcelona, Spain
| | - Dolores Manau
- Institute Clinic of Gynecology, Obstetrics and Gynecology. Hospital Clinic. Barcelona, Spain
| | - Francesc Fàbregues
- Institute Clinic of Gynecology, Obstetrics and Gynecology. Hospital Clinic. Barcelona, Spain
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Ferreri J, Fàbregues F, Calafell JM, Solernou R, Borrás A, Saco A, Manau D, Carmona F. Drug-free in-vitro activation of follicles and fresh tissue autotransplantation as a therapeutic option in patients with primary ovarian insufficiency. Reprod Biomed Online 2019; 40:254-260. [PMID: 31956062 DOI: 10.1016/j.rbmo.2019.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 06/11/2019] [Revised: 11/03/2019] [Accepted: 11/14/2019] [Indexed: 01/09/2023]
Abstract
RESEARCH QUESTION Could in-vitro action of follicles and fresh tissue autotransplantation without tissue culture (drug-free IVA) be useful in patients with primary ovarian insufficiency (POI)? DESIGN Prospective observational cohort study in a tertiary university hospital. Drug-Free IVA was carried out in 14 women with POI with a median age of 33 years (29-36 years), median length of amenorrhoea of 1.5 years (1-11 years), median FSH levels 69.2 mIU/ml (36.9-82.8 mIU/ml) and anti-Müllerian hormone of 0.02 ng/ml (0.01-0.1 ng/ml). The surgical procedure included laparoscopic removal of ovarian cortex, fragmentation of tissue and autografting. Human menopausal gonadotrophin (HMG) was started immediately after surgery. RESULTS Follicle development was detected in seven out of the 14 patients, and five women achieved successful oocyte retrieval. In six women, HCG was administered in 10 cycles. Six embryo transfers were carried out in five women resulting in four pregnancies; a clinical pregnancy rate of four in seven oocyte retrievals and four in six embryo transfers. CONCLUSIONS Drug-free IVA could be a useful therapeutic option for patients with POI, leading to successful IVF outcomes.
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Affiliation(s)
- Janisse Ferreri
- Institut Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Carrer de Villarroel, 170, Barcelona 08036, Spain.
| | - Francesc Fàbregues
- Institut Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Carrer de Villarroel, 170, Barcelona 08036, Spain
| | | | | | - Aina Borrás
- FIVClinic, Hospital Clinic of Barcelona, Spain
| | - Adela Saco
- Pathological Anatomy Service, Hospital Clinic de Barcelona
| | - Dolors Manau
- Institut Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Carrer de Villarroel, 170, Barcelona 08036, Spain
| | - Francisco Carmona
- Institut Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Carrer de Villarroel, 170, Barcelona 08036, Spain
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Fàbregues F, Solernou R, Ferreri J, Guimerá M, Peralta S, Casals G, Peñarrubia J, Creus M, Manau D. Comparison of GnRH agonist versus luteal estradiol GnRH antagonist protocol using transdermal testosterone in poor responders. JBRA Assist Reprod 2019; 23:130-136. [PMID: 30614665 PMCID: PMC6501741 DOI: 10.5935/1518-0557.20180090] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: Transdermal testosterone has been used in different doses and in different
stimulation protocols in poor responders. The aim of the present study is to
compare the luteal estradiol/GnRH antagonists protocol
versus long GnRH agonists in poor responder patients
according to the Bologna criteria, in which transdermal testosterone has
been used prior to the stimulation with gonadotropins. Methods: In this retrospective analysis, a total of 141 poor responder patients
according to the Bologna criteria were recruited. All patients were treated
with transdermal testosterone preceding ovarian stimulation with
gonadotropins during 5 days. In 53 patients we used the conventional
antagonist protocol (Group 1). In 88 patients (GrH pituitary suppression was
achieved by leuprolide acetate according to the conventional long protocol
(Group 2). We analyzed the ovarian stimulation parameters and IVF
outcomes. Results: Comparing groups 1 and 2, there were no significant differences between
cancellation rates and number of oocytes retrieved. However the total
gonadotropin dose used and the mean length of stimulation were significantly
lower in group 1 when compared to group 2. There were no significant
differences in pregnancy outcomes; however, there was a slight increase in
the implantation rate in group 1 vis-a-vis group 2, although statistical
significance was not achieved. Conclusion: TT in poor responder patients can be effective both with the conventional
agonist's long protocol and with the conventional antagonist's protocol.
However, short regimes with previous estradiol antagonists in the luteal
phase facilitate ovarian stimulation by shortening the days of treatment and
the consumption of gonadotropins
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Affiliation(s)
- Francesc Fàbregues
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
| | - Roser Solernou
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
| | - Janisse Ferreri
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
| | - Marta Guimerá
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
| | - Sara Peralta
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
| | - Gemma Casals
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
| | - Joana Peñarrubia
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
| | - Montserrat Creus
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
| | - Dolors Manau
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi iSunyer (IDIBAPS)
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Peralta S, Solernou R, Fabregues F, Minarro A, Puerto B, Penarrubia J, Casals G, Creus M, Manau D, Borras A, Vidal E. Antral follicle count measured after pituitary suppression as predictor of sub-optimal ovarian response and cumulative live birth: a review of 1542 long protocol IVF / ICSI cycles. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.645] [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: 10/18/2022]
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Grande M, Solernou R, Ferrer L, Borobio V, Jimenez JM, Bennasar M, Soler A, Borrell A. Is nuchal translucency a useful aneuploidy marker in fetuses with crown-rump length of 28-44 mm? Ultrasound Obstet Gynecol 2014; 43:520-524. [PMID: 24006271 DOI: 10.1002/uog.13203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/22/2013] [Accepted: 09/02/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate whether increased nuchal translucency (NT) in fetuses with a crown-rump length (CRL) below 45 mm needs to be re-evaluated at a later stage, or whether the early NT measurement can be used effectively as an aneuploidy marker. METHODS This was a prospective cohort study including all singleton fetuses with a CRL between 28 and 44 mm, scanned in our center during 2002-2012. The CRL, NT, fetal karyotype (when available) and pregnancy outcome were recorded. NT reference ranges were constructed using the Lambda-Mu-Sigma (LMS) method in non-referred pregnancies after exclusion of chromosomal anomalies. The 95(th) percentile was used to calculate detection rates for chromosomally abnormal fetuses. RESULTS NT was successfully measured in 643 of 672 fetuses with a CRL of 28-44 mm. Subsequent cytogenetic analysis revealed 11 cases of trisomy 21, 14 cases of trisomy 13 or 18, three cases of monosomy X, three sex trisomies, three triploidies and 12 balanced anomalies. NT was above the 95(th) percentile in 64% of the fetuses with trisomy 21, in 71% with trisomy 13 or 18 and in all three cases of monosomy X. CONCLUSION NT appears to be useful as a marker for the early detection of fetal trisomies at 9-10 weeks' gestation (28-44 mm CRL).
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Affiliation(s)
- M Grande
- Department of Maternal-Fetal Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic Barcelona, Catalonia, Spain; CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Spain
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