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Liu M, Mai Z, Lin H, Li Y, Chen X, Yang D. Does elevated luteinizing hormone level before trigger mean premature luteinizing hormone surge in advanced-aged women undergoing mild ovarian stimulation? Gynecol Endocrinol 2022; 38:314-317. [PMID: 35142255 DOI: 10.1080/09513590.2022.2037546] [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: 10/19/2022] Open
Abstract
OBJECTIVE To explore whether elevated luteinizing hormone (LH) level before trigger means premature LH surge in advanced aged women undergoing mild ovarian stimulation. METHODS To retrospectively analyze 235 in vitro fertilization/intracytoplasmic sperm injection cycles in women >35 years old with the poor ovarian response (POR) from January 2012 to March 2016. Cycles are named Group 1, Group 2, and Group 3, being treated with gonadotropin-releasing hormone antagonist protocol (76 cycles), mild stimulation protocol using clomiphene citrate (73 cycles), and tamoxifen (86 cycles), respectively. MAIN OUTCOME MEASURE(S) The dynamic change of LH level during stimulation; the proportion of an elevated LH level defined as >10 IU/L on trigger day; the proportion of premature ovulation in each group. RESULTS Serum LH level increased early in Group 2 and Group 3 and remained significantly higher than that in Group 1 during stimulation. In a sequence of three groups, the proportion of elevated LH levels before the trigger was 11.84, 43.8, and 37.21% (p<.001) respectively. And the proportion of premature ovulation in patients with elevated LH levels was 11.11, 18.75, and 25% (p = .11) respectively. CONCLUSION Elevated LH level before trigger does not mean premature LH surge in women more than 35 years old with POR undergoing mild ovarian stimulation with clomiphene or tamoxifen.
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Affiliation(s)
- Manlin Liu
- Department of Gynecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuoyao Mai
- Department of Gynecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiyan Lin
- Department of Gynecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Li
- Department of Gynecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoli Chen
- Department of Gynecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongzi Yang
- Department of Gynecology and Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Kuroda K, Katagiri Y, Ishihara O. Optimal individualization of patient-oriented ovarian stimulation in Japanese assisted reproductive technology clinics, a review for unique setting with advanced-age patients. J Obstet Gynaecol Res 2022; 48:521-532. [PMID: 35026870 DOI: 10.1111/jog.15150] [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: 08/20/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
Ovarian stimulation is a key issue in assisted reproductive technology (ART) treatment. ART practice in Japan is unique with various types of ovarian stimulation protocols, which may contribute to lower pregnancy rates compared to other countries. This review aims to clarify optimal individualized ovarian stimulation for improving the pregnancy rate per one oocyte retrieval cycle in Japan. We performed a literature review to describe ovarian stimulation, classification of infertile women depending on ovarian reserve and response, and Japanese ART data and discussed optimal conventional and mild ovarian stimulation protocols in Japan. According to Japanese ART registry data, the live birth rate of 30-35-year-old women was 32%-37% per ET cycle; therefore, four to five embryos are calculatedly needed when aiming a cumulative live birth rate of ≥80%. Mild stimulation aimed at collecting 5-10 oocytes can be alternative choice as an optimal ovarian stimulation protocol in young women. In 40-year-old women, the live birth rate is 18.8%, resulting in eight or more embryos as necessary. Conventional stimulation must be required in women with advanced age. In poor responders, however, mild stimulation may be sufficient for maximumly extracting their ovarian function. In Japan, mild ovarian stimulation can be selected in patients with a good prognosis and poor responders; however, conventional ovarian stimulation is necessary for women in advanced age.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yukiko Katagiri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
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Nakao K, Kuroda K, Horikawa T, Moriyama A, Juen H, Itakura A, Watanabe H, Takamizawa S, Ojiro Y, Nakagawa K, Sugiyama R. Therapeutic effects of an oral gonadotropin-releasing hormone receptor antagonist, relugolix, on preventing premature ovulation in mild ovarian stimulation for IVF. Reprod Med Biol 2021; 21:e12422. [PMID: 34938146 PMCID: PMC8656665 DOI: 10.1002/rmb2.12422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose Can relugolix, a novel oral gonadotropin-releasing hormone receptor (GnRH) antagonist, function as an alternative ovulation inhibitor to GnRH antagonist injections? Methods This single-center, cross-sectional retrospective study compared premature ovulation rates and clinical outcomes in IVF treatment after mild ovarian stimulation with 40 mg of relugolix (relugolix group) or 0.25-mg injections of ganirelix acetate or cetrorelix acetate (injection group) between March 2019 and January 2020. Of 247 infertile women (256 IVF cycles) aged ≤42 years, 223 women (230 cycles) were evaluated. In the relugolix and injection groups, we compared 104 and 85 cycles after GnRH antagonist use before the LH surge (LH levels <10 mIU/ml) and 22 and 19 cycles during the LH surge (LH levels ≥10 mIU/ml), respectively. Results Before the LH surge, the ovulation rates in the two groups were very low (p = 0.838), however; during the LH surge, the cycles using relugolix had a high ovulation rate of 40.9% compared with no ovulation in the injection group (p = 0.002). There were no significant differences in embryo culture findings and pregnancy outcomes between the two groups. Conclusions Although relugolix had a high ovulation suppressive effect, when the LH surge occurred, its effect was insufficient.
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Affiliation(s)
- Kazuki Nakao
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan.,Department of Obstetrics and Gynecology Faculty of Medicine Juntendo University Tokyo Japan
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Azusa Moriyama
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Hiroyasu Juen
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Akiko Itakura
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Hideaki Watanabe
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Yuko Ojiro
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
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Jiang X, Yan H, Zhong X, Tong G, Zhang W. Effect of Bushen Yutai Recipe on IVF Patients Subjected to Mild Ovarian Stimulation. Front Med (Lausanne) 2020; 7:541537. [PMID: 33282883 PMCID: PMC7689193 DOI: 10.3389/fmed.2020.541537] [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] [Received: 03/09/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022] Open
Abstract
This article investigated the effects of the traditional Chinese medicine (TCM) herbal recipe, Bushen Yutai, on in vitro fertilization (IVF) patients subjected to mild ovarian stimulation. Two hundred nineteen infertile patients were randomly divided into 2 groups: the control group and herbal treatment group. By studying, we found estrogen levels (E2) on the human chorionic gonadotropin (hCG) triggering day were significantly lower in the control group (P < 0.05), with positive blood flow being less detected by ultrasound scanning on both the day of hCG triggering and day of fresh embryo transfer for the control group (P < 0.05). Additionally, the blood flow index, retroactive and proactive inhibition, was higher in the control group, whereas the fertilization rate and number of high-quality embryos in the control group were lower than the control TCM experimental group (P < 0.01). The expression levels of the endometrial receptivity gene, vascular endothelial growth factor (VEGF), were lower in the control group vs. the TCM experimental group on the day of fresh embryo transfer (P < 0.05), whereas the rate of fresh embryo transfer in the control group was lower than the TCM experimental group (P < 0.05). In conclusion, the TCM could increase the E2 during the IVF stage, with a higher number of oocytes and higher-quality embryos. It also improved the endometrium and increased the level of VEGF gene expression. By enhancing the fresh embryo transfer rate in a minimal ovarian stimulation protocol and by improving the clinical pregnancy and ongoing pregnancy rates, the Bushen Yutai recipe could be able to increase fresh embryo transfer and higher-quality embryos.
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Affiliation(s)
- Xiaomei Jiang
- Department of Urology and Reproductive Medicine, Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hua Yan
- Department of Reproductive Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiufang Zhong
- Department of Reproductive Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guoqing Tong
- Department of Reproductive Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wuwen Zhang
- Department of Reproductive Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Datta AK, Maheshwari A, Felix N, Campbell S, Nargund G. Mild versus conventional ovarian stimulation for IVF in poor, normal and hyper-responders: a systematic review and meta-analysis. Hum Reprod Update 2020; 27:229-253. [PMID: 33146690 PMCID: PMC7902993 DOI: 10.1093/humupd/dmaa035] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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] [Received: 03/23/2020] [Revised: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mild ovarian stimulation has emerged as an alternative to conventional IVF with the advantages of being more patient-friendly and less expensive. Inadequate data on pregnancy outcomes and concerns about the cycle cancellation rate (CCR) have prevented mild, or low-dose, IVF from gaining wide acceptance. OBJECTIVE AND RATIONALE To evaluate parallel-group randomised controlled trials (RCTs) on IVF where comparisons were made between a mild (≤150 IU daily dose) and conventional stimulation in terms of clinical outcomes and cost-effectiveness in patients described as poor, normal and non-polycystic ovary syndrome (PCOS) hyper-responders to IVF. SEARCH METHODS Searches with no language restrictions were performed using Medline, Embase, Cochrane central, Pre-Medicine from January 1990 until April 2020, using pre-specified search terms. References of included studies were hand-searched as well as advance access articles to key journals. Only parallel-group RCTs that used ≤150 IU daily dose of gonadotrophin as mild-dose IVF (MD-IVF) and compared with a higher conventional dose (CD-IVF) were included. Studies were grouped under poor, normal or hyper-responders as described by the authors in their inclusion criteria. Women with PCOS were excluded in the hyper-responder group. The risk of bias was assessed as per Cochrane Handbook for the included studies. The quality of evidence (QoE) was assessed according to the GRADE system. PRISMA guidance was followed for review methodology. OUTCOMES A total of 31 RCTs were included in the analysis: 15 in the poor, 14 in the normal and 2 in the hyper-responder group. Live birth rates (LBRs) per randomisation were similar following use of MD-IVF in poor (relative risk (RR) 0.91 (CI 0.68, 1.22)), normal (RR 0.88 (CI 0.69, 1.12)) and hyper-responders (RR 0.98 (CI 0.79, 1.22)) when compared to CD-IVF. QoE was moderate. Cumulative LBRs (5 RCTs, n = 2037) also were similar in all three patient types (RR 0.96 (CI 0.86 1.07) (moderate QoE). Risk of ovarian hyperstimulation syndrome was significantly less with MD-IVF than CD-IVF in both normal (RR 0.22 (CI 0.10, 0.50)) and hyper-responders (RR 0.47 (CI 0.31, 0.72)), with moderate QoE. The CCRs were comparable in poor (RR 1.33 (CI 0.96, 1.85)) and hyper-responders (RR 1.31 (CI 0.98, 1.77)) but increased with MD-IVF among normal responders (RR 2.08 (CI 1.38, 3.14)); all low to very low QoE. Although fewer oocytes were retrieved and fewer embryos created with MD-IVF, the proportion of high-grade embryos was similar in all three population types (low QoE). Compared to CD-IVF, MD-IVF was associated with less gonadotrophin use and lower cost. WIDER IMPLICATIONS This updated review provides reassurance on using MD-IVF not only for the LBR per cycle but also for the cumulative LBR, with moderate QoE. With risks identified with ‘freeze-all’ strategies, it may be time to recommend mild-dose ovarian stimulation for IVF for all categories of women i.e. hyper, poor and normal responders to IVF.
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Affiliation(s)
| | | | | | - Stuart Campbell
- St George's University of London, London, UK.,Create Fertility, London, UK
| | - Geeta Nargund
- Create Fertility, London, UK.,St Georges University Hospitals NHS Trust London, London, UK
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Fan Y, Zhang X, Hao Z, Ding H, Chen Q, Tian L. Effectiveness of mild ovarian stimulation versus GnRH agonist protocol in women undergoing assisted reproductive technology: a meta-analysis. Gynecol Endocrinol 2017; 33:746-756. [PMID: 28508683 DOI: 10.1080/09513590.2017.1320385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/19/2022] Open
Abstract
OBJECTIVE our meta-analysis was conducted to evaluate the effectiveness of the mild ovulation induction protocol using CC/gonadotropin/GnRH antagonist compared to the conventional GnRH agonist protocol in women undergoing ART. METHOD Six electronic databases were searched from their date of establishment until August 2016. Outcomes in our analysis were calculated in terms of relative risk (RR) and weighted mean differences (WMD) and standard mean differences (SMD) with 95% confidence intervals (CI) using random effect models or fixed effect models. RESULTS Six prospective controlled clinical trials with 1543 women comparing the clinical impacts of the two protocols were included. The synthesized results suggested a significant reduction in the quantity of gonadotropins (SMD: -1.96, 95% CI: -2.28 to 1.64, I2 = 78.5%), the incidence of OHSS (RR: 0.16, 95% CI 0.03-0.86, I2 = 0%) and an increase in the cycle cancelation rate (RR: 1.46, 95% CI 1.05-2.03, I2 = 89.4%). While no evidence of statistically significant differences between the groups existed in the other clinical outcomes. CONCLUSION This study suggested that the probable benefits of the mild protocol, including its less costs and safer process without reducing the overall IVF treatment success rates, seemed to make it a better treatment option. Larger sample prospective trials evaluating live birth, clinical pregnancy, OHSS, multiple pregnancy incidence and so on were desired to establish.
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Affiliation(s)
- Yuan Fan
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Xiaowei Zhang
- b Department of Urology , Peking University People's Hospital , Beijing , China , and
| | - Zhidong Hao
- c Department of Obstetrics and Gynecology , Haidian Maternal & Child Health Hospital , Beijing , China
| | - Huanfei Ding
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Quanyu Chen
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Li Tian
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
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7
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Youssef MA, van Wely M, Al-Inany H, Madani T, Jahangiri N, Khodabakhshi S, Alhalabi M, Akhondi M, Ansaripour S, Tokhmechy R, Zarandi L, Rizk A, El-Mohamedy M, Shaeer E, Khattab M, Mochtar MH, van der Veen F. A mild ovarian stimulation strategy in women with poor ovarian reserve undergoing IVF: a multicenter randomized non-inferiority trial. Hum Reprod 2016; 32:112-118. [PMID: 27836979 DOI: 10.1093/humrep/dew282] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 06/14/2016] [Revised: 09/23/2016] [Accepted: 10/10/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION In subfertile women with poor ovarian reserve undergoing IVF does a mild ovarian stimulation strategy lead to comparable ongoing pregnancy rates in comparison to a conventional ovarian stimulation strategy? SUMMARY ANSWER A mild ovarian stimulation strategy in women with poor ovarian reserve undergoing IVF leads to similar ongoing pregnancy rates as a conventional ovarian stimulation strategy. WHAT IS KNOWN ALREADY Women diagnosed with poor ovarian reserve are treated with a conventional ovarian stimulation strategy consisting of high-dose gonadotropins and pituitary downregulation with a long mid-luteal start GnRH-agonist protocol. Previous studies comparing a conventional strategy with a mild ovarian stimulation strategy consisting of low-dose gonadotropins and pituitary downregulation with a GnRH-antagonist have been under powered and their effectiveness is inconclusive. STUDY DESIGN, SIZE, DURATION This open label multicenter randomized trial was designed to compare one cycle of a mild ovarian stimulation strategy consisting of low-dose gonadotropins (150 IU FSH) and pituitary downregulation with a GnRH-antagonist to one cycle of a conventional ovarian stimulation strategy consisting of high-dose gonadotropins (450 IU HMG) and pituitary downregulation with a long mid-luteal GnRH-agonist in women of advanced maternal age and/or women with poor ovarian reserve undergoing IVF between May 2011 and April 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Couples seeking infertility treatment were eligible if they fulfilled the following inclusion criteria: female age ≥35 years, a raised basal FSH level >10 IU/ml irrespective of age, a low antral follicular count of ≤5 follicles or poor ovarian response or cycle cancellation during a previous IVF cycle irrespective of age. The primary outcome was ongoing pregnancy rate per woman randomized. Analyses were on an intention-to-treat basis. We randomly assigned 195 women to the mild ovarian stimulation strategy and 199 women to the conventional ovarian stimulation strategy. MAIN RESULTS AND THE ROLE OF CHANCE Ongoing pregnancy rate was 12.8% (25/195) for mild ovarian stimulation versus 13.6% (27/199) for conventional ovarian stimulation leading to a risk ratio of 0.95 (95% CI: 0.57-1.57), representing an absolute difference of -0.7% (95% CI: -7.4 to 5.9). This 95% CI does not extend below the predefined threshold of 10% for inferiority. The duration of ovarian stimulation was significantly lower in the mild ovarian stimulation strategy than in the conventional ovarian stimulation strategy (mean difference -1.2 days, 95% CI: -1.88 to -0.62). Also, a significantly lower amount of gonadotropins was used in the mild simulation strategy, with a mean difference of 3135 IU (95% CI: -3331 to -2940). LIMITATIONS, REASONS FOR CAUTION A limitation of our study was the lack of data concerning the cryopreservation of surplus embryos, so we are not informed on cumulative pregnancy rates. Another limitation is that we were not able to follow up on the ongoing pregnancies in all centers, so we are not informed on live birth rates. WIDER IMPLICATIONS OF THE FINDINGS The results are directly applicable in daily clinical practice and may lead to considerable cost savings as high dosages of gonadotropins are not necessary in women with poor ovarian reserve undergoing IVF. A health economic analysis of our data planned to test the hypothesis that mild ovarian stimulation strategy is more cost-effective than the conventional ovarian stimulation strategy is underway. STUDY FUNDING/COMPETING INTERESTS This study was supported by NUFFIC scholarship (the Netherlands) and STDF short-term fellowship (Egypt). TRIAL REGISTRATION NUMBER NTR2788 (Trialregister.nl). TRIAL REGISTER DATE 01 March 2011. DATE OF FIRST PATIENT'S ENROLMENT May 2011.
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Affiliation(s)
- M A Youssef
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, 1100 DD Amsterdam, The Netherlands .,Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Kasr-Alaini St. El-manial district, Giza, Egypt
| | - M van Wely
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - H Al-Inany
- Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Kasr-Alaini St. El-manial district, Giza, Egypt
| | - T Madani
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, 2, Hafez St., Banihashem St., Resalat Ave., 16635-148 Tehran, Iran
| | - N Jahangiri
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, 2, Hafez St., Banihashem St., Resalat Ave., 16635-148 Tehran, Iran
| | - S Khodabakhshi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, 2, Hafez St., Banihashem St., Resalat Ave., 16635-148 Tehran, Iran
| | - M Alhalabi
- Division of Embryology and Reproductive Medicine, Faculty of Medicine, and Assisted Reproduction Unit, Orient Hospital, Damascus University, Damascus, Syria
| | - M Akhondi
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Shahid Beheshti University, Evin, PO Box 19615-1177 Tehran, Iran
| | - S Ansaripour
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Shahid Beheshti University, Evin, PO Box 19615-1177 Tehran, Iran
| | - R Tokhmechy
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Shahid Beheshti University, Evin, PO Box 19615-1177 Tehran, Iran
| | - L Zarandi
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Shahid Beheshti University, Evin, PO Box 19615-1177 Tehran, Iran
| | - A Rizk
- Department of Obstetrics & Gynecology, Faculty of Medicine, Banha University, El-Shaheed Farid Nada, Qism Banha, Banha, Al Qalyubia Governorate 13511 Banha, Egypt
| | - M El-Mohamedy
- Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Kasr-Alaini St. El-manial district, Giza, Egypt
| | - E Shaeer
- Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Kasr-Alaini St. El-manial district, Giza, Egypt
| | - M Khattab
- Department of Obstetrics & Gynecology, Faculty of Medicine, Cairo University, Kasr-Alaini St. El-manial district, Giza, Egypt
| | - M H Mochtar
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - F van der Veen
- Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
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Tatsumi T, Jwa SC, Kuwahara A, Irahara M, Kubota T, Saito H. No increased risk of major congenital anomalies or adverse pregnancy or neonatal outcomes following letrozole use in assisted reproductive technology. Hum Reprod 2016; 32:125-132. [PMID: 27821708 DOI: 10.1093/humrep/dew280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 03/26/2016] [Revised: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Does letrozole use increase the risk of major congenital anomalies and adverse pregnancy and neonatal outcomes in fresh, single-embryo transfer? SUMMARY ANSWER Letrozole significantly decreases the risk of miscarriage and does not increase the risk of major congenital anomalies or adverse pregnancy or neonatal outcomes compared with natural cycles in patients undergoing ART. WHAT IS KNOWN ALREADY Letrozole is the most commonly used aromatase inhibitor for mild ovarian stimulation in ART. However, its safety in terms of pregnancy and neonatal outcomes is unclear. STUDY DESIGN SIZE, DURATION This retrospective cohort study used data from the Japanese national ART registry from 2011 to 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 3136 natural cycles and 792 letrozole-induced cycles associated with fresh, single-embryo transfer and resulting in a clinical pregnancy were included in the analysis. The main pregnancy outcomes were miscarriage, ectopic pregnancy and still birth, and the neonatal outcomes were preterm delivery, low birth weight, small/large for gestational age and major congenital anomalies. Terminated pregnancies were included in the analysis of major congenital anomalies. Odds ratios (ORs) and 95% CIs were calculated using multivariate logistic regression analysis adjusted for maternal age and calendar year. MAIN RESULTS AND THE ROLE OF CHANCE The risk of miscarriage was significantly lower in women administered letrozole (adjusted OR [aOR], 0.37, 95% CI, 0.30-0.47, P < 0.001). There was no significant difference in the overall risk of major congenital anomalies between the two groups (natural cycle 1.5% vs letrozole 1.9%, aOR, 1.24, 95% CI, 0.64-2.40, P = 0.52), and no increased risk for any specific organ system. Subgroup analysis demonstrated that the risk of major congenital anomalies was not increased in patients who underwent either in vitro fertilization or ICSI, or in those who received early cleavage stage or blastocyst embryo transfer. All other pregnancy and neonatal outcomes were comparable between the two groups. LIMITATIONS REASONS FOR CAUTION Despite the large sample size, we were only able to rule out the possibility that letrozole might cause large increases in birth-defect risks in ART patients. WIDER IMPLICATIONS OF THE FINDINGS The results suggest that letrozole stimulation reduces the risk of miscarriage, with no increase in the risk of major congenital anomalies or adverse pregnancy or neonatal outcomes compared with natural cycles in women undergoing ART. Letrozole may thus be a safe option for mild ovarian stimulation. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- T Tatsumi
- Division of Reproductive Medicine, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan.,Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan
| | - S C Jwa
- Division of Reproductive Medicine, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan .,Sora no Mori Clinic, 229-1, Yagibaru, Yaese-cho, Shimajiri-gun, Okinawa 901-0406, Japan
| | - A Kuwahara
- Department of Obstetrics and Gynecology, School of Medicine, University of Tokushima, 3-18-15, Kuramoto-chou, Tokushima-shi, Tokushima 770-8503, Japan
| | - M Irahara
- Department of Obstetrics and Gynecology, School of Medicine, University of Tokushima, 3-18-15, Kuramoto-chou, Tokushima-shi, Tokushima 770-8503, Japan
| | - T Kubota
- Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan
| | - H Saito
- Division of Reproductive Medicine, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan
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Yan G, Xie X, Wang Y, Shi L, Zhou W, Liu Y, Tong X, Ji Y. Twin pregnancy after intracytoplasmic sperm injection in woman aged 49 using autologous oocytes by mild ovarian stimulation: a case report. Int J Clin Exp Med 2015; 8:21707-21709. [PMID: 26885131 PMCID: PMC4723976] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/10/2015] [Indexed: 06/05/2023]
Abstract
There were few reports about infertile women aged 45 and above undergoing IVF/ICSI. We are reporting the case of an aged 49 woman who delivered the twins after ICSI using autologous oocytes by mild ovarian stimulation. The patient who presented with 26-year primary infertility was caused by double fallopian tubes obstruction and man oligoasthenozoospermia. We gave her the treatment with mild ovarian stimulation cycle of clomiphene citrate (CC) and follicle stimulating hormone (FSH) undergoing ICSI, and transferred two fertilization-blastocysts. The outcome measured was the live birth. The twins were delivered by cesarean section operation at 37 pregnancy weeks for the moderate pregnancy-induced hypertension. Our study showed that the successof advanced agewomen undergoing ART was feasible to some extent, while, the accompanied risk of pregnancy complications and other issues need to be further evaluated.
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Affiliation(s)
- Guimin Yan
- Reproductive Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Xiaodong Xie
- Reproductive Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Yanqiu Wang
- Reproductive Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Lihong Shi
- Reproductive Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Wei Zhou
- Reproductive Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Yingling Liu
- Reproductive Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Xiaowen Tong
- Reproductive Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Yazhong Ji
- Reproductive Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine Shanghai, China
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Yan G, Xie X, Wang Y, Shi L, Zhou W, Liu Y, Tong X, Ji Y. Twin pregnancy after intracytoplasmic sperm injection in woman aged 49 using autologous oocytes by mild ovarian stimulation: a case report. Int J Clin Exp Med 2015; 8:19506-19508. [PMID: 26770601 PMCID: PMC4694501] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/05/2015] [Indexed: 06/05/2023]
Abstract
There were few reports about infertile women aged 45 and above undergoing IVF/ICSI. We are reporting the case of an aged 49 woman who delivered the twins after ICSI using autologous oocytes by mild ovarian stimulation. The patient presented with 26-year primary infertility caused by double fallopian tubes obstruction and man oligoasthenozoospermia. We gave her the treatment with mild ovarian stimulation cycle of clomiphene citrate (CC) and follicle stimulating hormone (FSH) undergoing ICSI, and transferred two fertilization-blastocysts. The outcome measured was the live birth. The twins were delivered by cesarean section operation at 37 pregnancy weeks for the moderate pregnancy-induced hypertension. In summary, we found it is feasible for women with advanced age to undergo ART while the accompanied risk of pregnancy complications and other issues need to be further evaluated.
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Affiliation(s)
- Guimin Yan
- Reproductive Medical Center, Shanghai Tongji Hospital Affiliated to Tongji University Shanghai, China
| | - Xiaodong Xie
- Reproductive Medical Center, Shanghai Tongji Hospital Affiliated to Tongji University Shanghai, China
| | - Yanqiu Wang
- Reproductive Medical Center, Shanghai Tongji Hospital Affiliated to Tongji University Shanghai, China
| | - Lihong Shi
- Reproductive Medical Center, Shanghai Tongji Hospital Affiliated to Tongji University Shanghai, China
| | - Wei Zhou
- Reproductive Medical Center, Shanghai Tongji Hospital Affiliated to Tongji University Shanghai, China
| | - Yingling Liu
- Reproductive Medical Center, Shanghai Tongji Hospital Affiliated to Tongji University Shanghai, China
| | - Xiaowen Tong
- Reproductive Medical Center, Shanghai Tongji Hospital Affiliated to Tongji University Shanghai, China
| | - Yazhong Ji
- Reproductive Medical Center, Shanghai Tongji Hospital Affiliated to Tongji University Shanghai, China
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Abstract
BACKGROUND The value of oocyte cryopreservation in older women remains controversial. The aim of this study was to report the oocyte freezing experience in women aged 40 and older at a single fertility center. FINDINGS One hundred fifty eight women (mean age 43.9 ± 0.2) who underwent minimal ovarian stimulation IVF were enrolled. IVF protocol included the use of clomiphene citrate (50 mg/day) or letrozole (2.5 mg/day) with or without low dose gonadotropins (started at 75 IU/day and increased as needed to 150 IU/day). 584 retrieved oocytes (2.1 ± 0.15 per patient) yielded 532 mature MII oocytes that were frozen. After thawing and fertilization by ICSI, a total of 344 embryos (1.9 ± 0.1 per patient) were formed. A total of 57 relatively good embryos were transferred and yielded three live births (5.3 % per embryo transfer), three spontaneous abortions, and one chemical pregnancy. CONCLUSIONS These data are important in counseling older women who desire autologous oocyte freezing.
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Affiliation(s)
- John J Zhang
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, 4 Columbus Avenue, New York, NY, USA.
| | - Simon Choo
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, 4 Columbus Avenue, New York, NY, USA.
| | - Mingxue Yang
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, 4 Columbus Avenue, New York, NY, USA.
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