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Kirshenbaum M, Gil O, Haas J, Nahum R, Zilberberg E, Lebovitz O, Orvieto R. Recombinant follicular stimulating hormone plus recombinant luteinizing hormone versus human menopausal gonadotropins- does the source of LH bioactivity affect ovarian stimulation outcome? Reprod Biol Endocrinol 2021; 19:182. [PMID: 34886872 PMCID: PMC8655989 DOI: 10.1186/s12958-021-00853-7] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Luteinizing hormone (LH) and human chorionic gonadotropin (hCG) activate distinct intracellular signaling cascades. However, due to their similar structure and common receptor, they are used interchangeably during ovarian stimulation (OS). This study aims to assess if the source of LH used during OS affects IVF outcome. PATIENTS AND METHODS This was a cross sectional study of patients who underwent two consecutive IVF cycles, one included recombinant follicular stimulating hormone (FSH) plus recombinant LH [rFSH+rLH, (Pergoveris)] and the other included urinary hCG [highly purified hMG (HP-hMG), (Menopur)]. The OS protocol, except of the LH preparation, was identical in the two IVF cycles. RESULTS The rate of mature oocytes was not different between the treatment cycles (0.9 in the rFSH+rLH vs 0.8 in the HP-hMG, p = 0.07). Nonetheless, the mean number of mature oocytes retrieved in the rFSH+rLH treatment cycles was higher compared to the HP-hMG treatment cycles (10 ± 5.8 vs 8.3 ± 4.6, respectively, P = 0.01). Likewise, the mean number of fertilized oocytes was higher in the rFSH+rLH cycles compared with the HP-hMG cycles (8.5 ± 5.9 vs 6.4 ± 3.6, respectively, p = 0.05). There was no difference between the treatment cycles regarding the number of top-quality embryos, the ratio of top-quality embryos per number of oocytes retrieved or fertilized oocytes or the pregnancy rate. CONCLUSION The differences in treatment outcome, derived by different LH preparations reflect the distinct physiological role of these molecules. Our findings may assist in tailoring a specific gonadotropin regimen when assembling an OS protocol.
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Affiliation(s)
- M Kirshenbaum
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - O Gil
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
| | - J Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Nahum
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Zilberberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Lebovitz
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, at the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Bühler KF, Fischer R, Verpillat P, Allignol A, Guedes S, Boutmy E, Bilger W, Richter E, D'Hooghe T. Comparative effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa) versus highly purified urinary human menopausal gonadotropin (hMG HP) in assisted reproductive technology (ART) treatments: a non-interventional study in Germany. Reprod Biol Endocrinol 2021; 19:90. [PMID: 34134695 PMCID: PMC8207759 DOI: 10.1186/s12958-021-00768-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study compared the effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa; GONAL-f®) with urinary highly purified human menopausal gonadotropin (hMG HP; Menogon HP®), during assisted reproductive technology (ART) treatments in Germany. METHODS Data were collected from 71 German fertility centres between 01 January 2007 and 31 December 2012, for women undergoing a first stimulation cycle of ART treatment with r-hFSH-alfa or hMG HP. Primary outcomes were live birth, ongoing pregnancy and clinical pregnancy, based on cumulative data (fresh and frozen-thawed embryo transfers), analysed per patient (pP), per complete cycle (pCC) and per first complete cycle (pFC). Secondary outcomes were pregnancy loss (analysed per clinical pregnancy), cancelled cycles (analysed pCC), total drug usage per oocyte retrieved and time-to-live birth (TTLB; per calendar week and per cycle). RESULTS Twenty-eight thousand six hundred forty-one women initiated a first treatment cycle (r-hFSH-alfa: 17,725 [61.9%]; hMG HP: 10,916 [38.1%]). After adjustment for confounding variables, treatment with r-hFSH-alfa versus hMG HP was associated with a significantly higher probability of live birth (hazard ratio [HR]-pP [95% confidence interval (CI)]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; relative risk [RR]-pFC [95% CI]: 1.09 [1.05, 1.15], ongoing pregnancy (HR-pP [95% CI]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; RR-pFC [95% CI]: 1.10 [1.05, 1.15]) and clinical pregnancy (HR-pP [95% CI]: 1.10 [1.05, 1.14]; HR-pCC [95% CI]: 1.14 [1.10, 1.19]; RR-pFC [95% CI]: 1.10 [1.06, 1.14]). Women treated with r-hFSH-alfa versus hMG HP had no statistically significant difference in pregnancy loss (HR [95% CI]: 1.07 [0.98, 1.17], were less likely to have a cycle cancellation (HR [95% CI]: 0.91 [0.84, 0.99]) and had no statistically significant difference in TTLB when measured in weeks (HR [95% CI]: 1.02 [0.97, 1.07]; p = 0.548); however, r-hFSH-alfa was associated with a significantly shorter TTLB when measured in cycles versus hMG HP (HR [95% CI]: 1.07 [1.02, 1.13]; p = 0.003). There was an average of 47% less drug used per oocyte retrieved with r-hFSH-alfa versus hMG HP. CONCLUSIONS This large (> 28,000 women), real-world study demonstrated significantly higher rates of cumulative live birth, cumulative ongoing pregnancy and cumulative clinical pregnancy with r-hFSH-alfa versus hMG HP.
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Affiliation(s)
- Klaus F Bühler
- Department of Gynaecology, Jena-University Hospital-Friedrich Schiller University, 07737, Jena, Germany
- Scientific-Clinical Centre for Endometriosis of the University Hospitals of Saarland, 66121, Saarbrücken, Germany
| | - Robert Fischer
- Gynecological Endocrinology and Reproductive Medicine, Fertility Centre Hamburg, 20095, Hamburg, Germany
| | - Patrice Verpillat
- Global Epidemiology, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Arthur Allignol
- Global Epidemiology, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Sandra Guedes
- Global Epidemiology, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Emmanuelle Boutmy
- Global Epidemiology, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Wilma Bilger
- Medical Affairs Fertility, Endocrinology and General Medicine, Merck Serono GmbH, an affiliate of Merck KGaA, Darmstadt, Germany, Alsfelder Str. 17, 64289, Darmstadt, Germany
| | - Emilia Richter
- Global Medical Affairs Fertility, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany.
- Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven (University of Leuven), Oude Markt 13, 3000, Leuven, Belgium.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, 333 Cedar St, New Haven, CT, 06510, USA.
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Ob'edkova KV, Kogan IY, Muller VC, Tapilskaya NI, Krikhely IO, Dzhemlikhanova LK, Abdulkadirova ZK, Mekina ID, Lesik EA, Komarova EA, Ishchuk MA, Gzgzian AM. IVF protocol efficacy in women with expected suboptimal response depending on ovary stimulation mode. Gynecol Endocrinol 2021; 37:44-48. [PMID: 34937512 DOI: 10.1080/09513590.2021.2006526] [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
INVESTIGATION OBJECTIVE IVF protocol efficacy estimation in women with expected suboptimal response depending on ovary stimulation mode. MATERIALS AND TECHNIQUE A randomized controlled study embracing results of 51 IVF cycle in women with ovary suboptimal response. The suboptimal response prognostic analysis was performed basing on ≤9 oocyte cumulus complexes obtained in previous IVF programs, the presence of no less than 5-9 antral follicles in both oocytes and amount of anti-Mullerian Hormone ≥0,8 ng/mL. In Group I (n = 25), the stimulation was performed by recombinant corifollitropin alfa combined with highly purified urinary gonadotropin, while in Group II (n = 26) it was made by means of recombinant follitropin/lutropin alfa within the protocol of applying gonadotropin-releasing hormone antagonists. RESULTS The total gonadotropin dose in Group II patients was authentically lower compared to Group I (p˂,01). No statistical difference between the two studied groups was detected concerning the number of obtained oocytes, 2pn zygote, good-quality transferred embryos and clinical pregnancy rate (p>.05). Embryo cryopreservation was performed only for group-II patients. CONCLUSION Corifollitropin alfa administration combined with highly purified menotropin in IVF cycles for suboptimal responders is quite effective, however, this strategy has no preference over other stimulation modes. The strategy of using recombinant follitropin/lutropin alfa can be promotive to IVF outcomes for suboptimal responders by means of embryo banking. ClinicalTrials.gov Identifier: NCT03177538.
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Affiliation(s)
- K V Ob'edkova
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
| | - I Y Kogan
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
- FSBEI of HE St. Petersburg State University, St. Petersburg, Russia
| | - V C Muller
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
| | - N I Tapilskaya
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
- FSBEI of HE St. Petersburg State Pediatriс Medical University under The Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia
| | - I O Krikhely
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
| | - L Kh Dzhemlikhanova
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
- FSBEI of HE St. Petersburg State University, St. Petersburg, Russia
| | - Z K Abdulkadirova
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
- FSBEI of HE St. Petersburg State University, St. Petersburg, Russia
| | - I D Mekina
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
| | - E A Lesik
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
| | - E A Komarova
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
| | - M A Ishchuk
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
| | - A M Gzgzian
- FSBSI 'The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott', St. Petersburg, Russia
- FSBEI of HE St. Petersburg State University, St. Petersburg, Russia
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Hosseini-Najarkolaei A, Moini A, Kashani L, Farid Mojtahedi M, Hosseini-Najarkolaee E, Salehi E. The effect of letrozole versus artificial hormonal endometrial preparation on pregnancy outcome after frozen-thawed embryos transfer cycles: a randomized clinical trial. Reprod Biol Endocrinol 2020; 18:115. [PMID: 33218350 PMCID: PMC7678072 DOI: 10.1186/s12958-020-00675-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/13/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Considering that clinical trial studies are limited in polycystic ovary syndrome (PCOS) patients, and there is no consensus on an optimum endometrial preparation protocol for frozen embryo transfer (FET), the present study was designed as a randomized clinical trial to compare the reproductive outcomes following stimulated cycles with letrozole plus human menopausal gonadotropin (HMG) for endometrial preparation compared with routine AC-FET. METHODS This randomized controlled trial was carried out on infertile PCOS patients who underwent IVF/ICSI and FET cycles in Arash Women's Hospital affiliated to Tehran University of Medical Sciences between September 2018 and January 2020. PCOS diagnosis was based on the Rotterdam criteria. Eligible patients were randomly allocated into two groups: stimulated cycle with letrozole plus (HMG) (intervention group) and routine artificial hormonal endometrial preparation (control group). RESULTS One hundred seventy-seven infertile patients were recruited for participation in the study. Of these, 57 women were excluded due to non-eligibility for entering the study, and a total of 120 patients were randomly assigned to two study groups. After follow up, the cycle outcomes of 57 patients in the intervention group and 59 patients in the control group were compared. The data analysis showed that the two groups did not have significant differences in fundamental and demographic characteristics. After the intervention, there were no significant differences in implantation rate, chemical, ectopic, and clinical pregnancy rates between groups. Moreover, the rates of miscarriage and ongoing pregnancy were similar between groups (P > 0.05). CONCLUSIONS We found similar pregnancy outcomes with two endometrial preparation methods. Noting that each treatment centre should select the most beneficial and cost-effective method with the least adverse effects for patients, letrozole preparations for FET could be incorporated into possible options; however, establishing this approach as first-line treatment is premature in light of current evidence, and future randomized clinical trials with larger sample sizes are required for widespread application. TRIAL REGISTRATION The study was also registered in the Iranian Registry of Clinical Trials on March 20th, 2020. ( IRCT20090526001952N12 at www.irct.ir , registered retrospectively).
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Affiliation(s)
- Azadeh Hosseini-Najarkolaei
- Department of Gynecology and Obstetrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Department of Gynecology and Obstetrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
| | - Ladan Kashani
- Department of Gynecology and Obstetrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farid Mojtahedi
- Department of Gynecology and Obstetrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Infertility Ward, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Hosseini-Najarkolaee
- Laparoscopic Research Centre, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ensieh Salehi
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Ezra O, Haas J, Nahum R, Maman E, Cohen Y, Segev-Zahav A, Orvieto R. Do poor-responder patients undergoing IVF benefit from splitting and increasing the daily gonadotropin dose? Gynecol Endocrinol 2019; 35:890-893. [PMID: 31032673 DOI: 10.1080/09513590.2019.1608520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/26/2022] Open
Abstract
We aim to retrospectively evaluate the role of increasing the gonadotropin daily dose from 450 IU/day to 300 IU twice a day on IVF-ET outcome in poor responder patients. All consecutive women admitted to our IVF unit and underwent COH consisting of daily gonadotropin dose of 450 IU, followed by an IVF cycle using 300 IU twice a day, were included. Ovarian stimulation characteristics, number of oocytes retrieved, number of embryo transferred and pregnancy rate was assessed. Twenty-three patients undergoing both cycles were evaluated. While there was no between-group difference in the duration of COH, number of 2PN embryos, fertilization rate and number of embryos transferred, patients receiving daily gonadotropin 300 IU twice a day achieved a significantly higher peak estradiol levels (3350.39 ± 2364.26 vs. 2223.74 ± 1299.91; p < .03, respectively), and yielded significantly higher number of follicles >15 mm in diameter on day of hCG administration (3.2 ± 2.4 vs 1.8 ± 1; p < .03, respectively) and higher number of oocytes retrieved (3.48 ± 2.54 vs 1.87 ± 1.1; p < .02, respectively) with an acceptable live birth rate (5%). To conclude, in poor responders undergoing COH a daily gonadotropin dose of 450 IU, increasing the dose to 300 IU twice daily may result in higher oocyte yield, with the possible improvement in IVF outcome.
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Affiliation(s)
- Osnat Ezra
- Infertility and IVF Unit Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jigal Haas
- Infertility and IVF Unit Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Nahum
- Infertility and IVF Unit Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ettie Maman
- Infertility and IVF Unit Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Cohen
- Infertility and IVF Unit Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aliza Segev-Zahav
- Infertility and IVF Unit Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- Infertility and IVF Unit Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Xia X, Shi Y, Geng L, Liu D, Hou Z, Lin H, Li R, Wang H, Tao L, Meng F, Da J, Chen Y, Qiao J, Qian W, Li H. A cohort study of both human menopausal gonadotropin (HMG) and recombinant luteinizing hormone addition at early follicular stage in in vitro fertilization outcome: A STROBE-compliant study. Medicine (Baltimore) 2019; 98:e15512. [PMID: 31083194 PMCID: PMC6531138 DOI: 10.1097/md.0000000000015512] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
At present, the precise role of human menopausal gonadotropin (HMG) and recombinant luteinizing hormone (rLH) supplementation at an early time of follicular phase on in vitro fertilization (IVF)/intra cytoplasmatic sperm injection (ICSI) outcomes remains uncertain.Here infertile women of normal ovarian function undergoing their first cycle of IVF/ICSI were studied and were randomly allocated into 3 groups. Group 1, ovarian stimulation with 150IU recombinant follicle-stimulating hormone (FSH) alone. Group 2, patients received 75IU rFSH and 75IU HMG. Group 3 patients were given 150IU rFSH and 75IU rLH.There were no significant differences in the clinical characteristics, ovarian response, the biochemical, clinical and ongoing pregnancy rates among the 3 groups. No significant differences were found in biochemical, clinical and ongoing pregnancy rates between the patients whose LH levels were lower than 0.75 mIU/ml and those above this threshold in group 1. Furthermore, there were also no significant differences in biochemical, clinical and ongoing pregnancy rates among the 3 group patients whose LH level lower than 0.75 mIU/ml.The results showed that either the addition of HMG or rLH supplementation at an early time of follicular phase produce no significant benefit on IVF outcome in patients with normal ovarian function.
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Affiliation(s)
- Xi Xia
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North HuaYuan Road, HaiDian District, Beijing, China
| | - Yu Shi
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Lan Geng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Dan Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Zhenhui Hou
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Hongbo Lin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North HuaYuan Road, HaiDian District, Beijing, China
| | - Haiyan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North HuaYuan Road, HaiDian District, Beijing, China
| | - Liyuan Tao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North HuaYuan Road, HaiDian District, Beijing, China
| | - Fanhua Meng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Jian Da
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Yun Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North HuaYuan Road, HaiDian District, Beijing, China
| | - Weiping Qian
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120 Lotus Road, FuTian District, Shenzhen, Guangdong
| | - Hongzhen Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North HuaYuan Road, HaiDian District, Beijing, China
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Iwami N, Kawamata M, Ozawa N, Yamamoto T, Watanabe E, Moriwaka O, Kamiya H. New trial of progestin-primed ovarian stimulation using dydrogesterone versus a typical GnRH antagonist regimen in assisted reproductive technology. Arch Gynecol Obstet 2018; 298:663-671. [PMID: 30069600 DOI: 10.1007/s-00404-018-4856-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/28/2018] [Indexed: 05/27/2023]
Abstract
PURPOSE To compare the clinical and ongoing pregnancy rates between a protocol using oral dydrogesterone with human menopausal gonadotropin (HMG) for progestin-primed ovarian stimulation (PPOS) and the typical gonadotropin-releasing hormone (GnRH) antagonist regimen in women undergoing controlled ovarian hyperstimulation (COH). METHODS This was a prospective, controlled study of 251 women who underwent COH for in vitro fertilization between October 2016 and July 2017. The patients were allocated alternately into two groups: a dydrogesterone protocol (study group) and a GnRH antagonist protocol (control group). In study group, dydrogesterone (20 mg/day) plus HMG (150 or 225 IU) were administered simultaneously beginning on days 2 or 3 of the menstrual cycle. In both groups, all high-quality embryos were cryopreserved for later transfer. The primary outcome was the ongoing pregnancy rate at 12 weeks per frozen-thawed embryo transfer (FET) and the secondary outcome was the clinical pregnancy rate. RESULTS None of the patients experienced a premature luteinizing hormone surge. During the follow-up period, 397 FET cycles were completed. The ongoing pregnancy rates at 12 weeks were 40.0% in study group versus 38.1% in control group (absolute difference 1.9%; 95% CI - 6.83 to 17.2%). The clinical pregnancy rate in study group (52.8%) was also not inferior to that in control group (49.5%; absolute difference 3.3%; 95% CI - 4.02 to 20.2%). CONCLUSIONS The clinical and ongoing pregnancy rates in study group were comparable to those in control group. Therefore, PPOS with dydrogesterone is a reasonable option to provide COH.
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Affiliation(s)
- Nanako Iwami
- Department of Reproductive Health, Kamiya Ladies Clinic, Nittsu Bldg 2nd Floor 2-1, Nishi 2chome, Kita 3jo, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan.
| | - Miho Kawamata
- Department of Reproductive Health, Kamiya Ladies Clinic, Nittsu Bldg 2nd Floor 2-1, Nishi 2chome, Kita 3jo, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Naoko Ozawa
- Department of Reproductive Health, Kamiya Ladies Clinic, Nittsu Bldg 2nd Floor 2-1, Nishi 2chome, Kita 3jo, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Takahiro Yamamoto
- Department of Reproductive Health, Kamiya Ladies Clinic, Nittsu Bldg 2nd Floor 2-1, Nishi 2chome, Kita 3jo, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Eri Watanabe
- Department of Reproductive Health, Kamiya Ladies Clinic, Nittsu Bldg 2nd Floor 2-1, Nishi 2chome, Kita 3jo, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Osamu Moriwaka
- Department of Reproductive Health, Kamiya Ladies Clinic, Nittsu Bldg 2nd Floor 2-1, Nishi 2chome, Kita 3jo, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Hirobumi Kamiya
- Department of Reproductive Health, Kamiya Ladies Clinic, Nittsu Bldg 2nd Floor 2-1, Nishi 2chome, Kita 3jo, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
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Huang P, Wei L, Li X, Lin Z. Modified hMG stimulated: an effective option in endometrial preparation for frozen-thawed embryo transfer in patients with normal menstrual cycles. Gynecol Endocrinol 2018; 34:772-774. [PMID: 29676585 DOI: 10.1080/09513590.2018.1460342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/17/2022] Open
Abstract
To evaluate the clinical efficacy of modified human menopausal gonadotropin (hMG) stimulated, hormone replacement therapy (HRT), natural cycling and letrozole ovulation induction during endometrial preparation for frozen-thawed embryo transfer (FET) in patients with normal menstrual cycles. This retrospective analysis included a total of 5070 cycles of patients with normal menstrual patterns who underwent FET between October 2009 and September 2015. The patients were divided into four groups according to the method of endometrial preparation for FET: 1838 cycles were natural, 1666 underwent HRT, 340 underwent letrozole ovulation induction and 1226 underwent modified hMG stimulated. Reproduction-related clinical outcomes in the four groups were compared. The clinical pregnancy rates and live birth rates of patients in the modified hMG stimulated group were significantly higher than that in the other groups p < .05. While abortion rates were not significantly different among all four groups (all p >.05). Modified hMG stimulated resulted in a higher pregnancy rate compared to the other treatment groups. Therefore, modified hMG stimulated may be an effective option in endometrial preparation for FET in patients with normal menstrual cycles.
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Affiliation(s)
- Pinxiu Huang
- a Reproductive Medicine Center , Liuzhou Maternal and Child Healthcare Hospital , Guangxi , China
| | - Lihong Wei
- a Reproductive Medicine Center , Liuzhou Maternal and Child Healthcare Hospital , Guangxi , China
| | - Xinlin Li
- a Reproductive Medicine Center , Liuzhou Maternal and Child Healthcare Hospital , Guangxi , China
| | - Zhong Lin
- a Reproductive Medicine Center , Liuzhou Maternal and Child Healthcare Hospital , Guangxi , China
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Al-Jaroudi D, Salim G, Baradwan S. Neonate female to male ratio after assisted reproduction following antagonist and agonist protocols. Medicine (Baltimore) 2018; 97:e12310. [PMID: 30235681 PMCID: PMC6160105 DOI: 10.1097/md.0000000000012310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/15/2018] [Indexed: 11/26/2022] Open
Abstract
We retrospectively compared neonatal sex after antagonist- versus long-stimulation protocols followed by fresh in vitro fertilization (IVF) or fresh intracytoplasmic sperm injection (ICSI) with either protocol. We reviewed data for 762 IVF/ICSI cycles in 2015, including 23 IVF procedures. We summarized sex outcomes in the entire cohort, and for the additional subgroups: embryo transfer day and number of embryos transferred, and number of oocytes recovered and maternal age. Among 169 live births for all protocols combined, 50.9% of babies were male, and we saw no difference between the antagonist versus long-stimulation groups (52.3% vs 48.3% male babies, respectively; P = .740). Our results also showed no significant difference in sex proportion when comparing IVF versus ICSI, although a higher proportion of babies were male with the antagonist-ICSI protocol. Differences between the additional subgroups were also neither clinically nor statistically significant.
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Affiliation(s)
| | - Gamar Salim
- Reproductive Endocrine and Infertility Medicine Department
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia
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Sopa N, Larsen EC, Nyboe Andersen A. Low dose HP-hMG in an antagonist protocol for IVF in ovulatory and anovulatory patients with high AMH. Gynecol Endocrinol 2018; 34:623-626. [PMID: 29345163 DOI: 10.1080/09513590.2018.1428302] [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: 10/18/2022] Open
Abstract
Women with high-AMH levels have an increased risk of ovarian hyperstimulation syndrome (OHSS). Studies have suggested that highly purified menotropin (HP-hMG) Menopur® reduces the risk. We, therefore, studied use of low-dose (112.5 IU/day) HP-hMG in ovulatory and anovulatory patients with high AMH (>32 pmol/L). The primary endpoint was the distribution of patients with appropriate, excessive, and inadequate response (5-14, ≥15, and ≤4 oocytes). Another endpoint was frequency of OHSS. Totally 115 women were included and 78 (67.8%) had an appropriate, 8 (7.0%) an excessive, and 29 (25.2%) an inadequate response. The number of oocytes was independent on AMH levels and ovulatory status but declined significantly with increasing bodyweight (R2 = 0.07, p < .01). The ongoing pregnancy rate per started cycle was 47.0%. Three (2.6%) developed OHSS, two had cancelation of the cycle and seven patients had GnRH agonist triggering to prevent OHSS. Selective use of a low dose of HP-hMG in patients with high levels of AMH provides 5-14 oocytes in more than two-thirds of the patients and is safe with low risk of OHSS. The number of aspirated oocytes was independent of AMH levels and ovulatory status, but inversely related to body weight.
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Affiliation(s)
- Negjyp Sopa
- a The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Elisabeth Clare Larsen
- a The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - Anders Nyboe Andersen
- a The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
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Coccia ME, Rizzello F, Cozzolino M, Turillazzi V, Capezzuoli T. The effect of low-dose ovarian stimulation with HMG plus progesterone on pregnancy outcome in women with history of recurrent pregnancy loss and secondary infertility: a retrospective cohort study. Gynecol Endocrinol 2018; 34:528-531. [PMID: 29433402 DOI: 10.1080/09513590.2017.1416463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/18/2022] Open
Abstract
We assessed the outcome of pregnancy in women with a history of recurrent pregnancy loss (RPL) following treatment with low-dose human menopausal gonadotropin (HMG)+progesterone or progesterone alone. This single-center retrospective cohort study included data from women diagnosed with RPL and treated between February 2005 and December 2012 with one cycle of HMG + progesterone or progesterone alone. Primary endpoint was the rate of ongoing pregnancies and losses by treatment, age (<38 vs. ≥38 years) and in the subgroup with unexplained RPL. Of 169 RPL patients, 35.5% (n = 60) received HMG + progesterone and 64.5% (n = 109) progesterone alone. Compared to progesterone alone, HMG + progesterone led to a lower, although not significant, frequency of losses (3.3% vs. 11.9%, p = .09) and a twofold higher rate of ongoing pregnancies (41.7% vs. 19.3%, p = .002). Similar results were obtained in the subgroup of patients with unexplained RPL (ongoing pregnancies: 48.1% upon HMG + progesterone vs. 21.3% upon progesterone, p = .03; losses: 0% vs. 8.5%, respectively, p = .29) and in those <38 years (ongoing pregnancies: 47.4% vs. 18.8%, respectively, p = .003; losses: 5.3% vs. 10.9% respectively, p = .47). These findings suggest that HMG in women with RPL may reduce the rate of miscarriages and increase that of live births regardless of RPL cause and in women aged <38 years.
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Affiliation(s)
- Maria Elisabetta Coccia
- a Department of Clinical and Experimental Biomedical Sciences , University of Florence , Florence , Italy
| | - Francesca Rizzello
- a Department of Clinical and Experimental Biomedical Sciences , University of Florence , Florence , Italy
| | - Mauro Cozzolino
- b Instituto Valenciano de Infertilidad,IVI - Madrid , Madrid , ES
| | - Valentina Turillazzi
- a Department of Clinical and Experimental Biomedical Sciences , University of Florence , Florence , Italy
| | - Tommaso Capezzuoli
- a Department of Clinical and Experimental Biomedical Sciences , University of Florence , Florence , Italy
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Yu R, Jin H, Huang X, Lin J, Wang P. Comparison of modified agonist, mild-stimulation and antagonist protocols for in vitro fertilization in patients with diminished ovarian reserve. J Int Med Res 2018; 46:2327-2337. [PMID: 29695208 PMCID: PMC6023056 DOI: 10.1177/0300060518770346] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/21/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the efficacy of three protocols for ovarian stimulation in patients with diminished ovarian reserve during in vitro fertilization (IVF) treatment. Methods This prospective randomized study enrolled patients with diminished ovarian reserve who underwent cycles of IVF or intracytoplasmic sperm injection. The patients were randomly divided into three groups: a modified gonadotrophin releasing hormone (GnRH) agonist protocol (group A); (ii) a mild stimulation protocol (group B); or (iii) an antagonist protocol (group C). Demographic characteristics, clinical variables and pregnancy outcomes were compared between the groups. Results A total of 116 patients were enrolled in the study: 54 in group A, 52 in group B and 60 in group C. Group B (32.69%) had a significantly higher cycle cancellation rate compared with groups A (11.11%) and C (16.67%). The early abortion rate of group C (44.44%) was significantly higher than group A (12.50%), but not significantly different from group B (16.67%). There were no significant differences in the clinical pregnancy rates and live birth rates among the three groups. Conclusion A modified GnRH agonist protocol achieved a comparable pregnancy rate to those of the mild stimulation protocol and antagonist protocol, whilst having lower cycle cancellation and early abortion rates.
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Affiliation(s)
- Rong Yu
- Reproductive Centre, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Hao Jin
- Organ Transplant Centre, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xuefeng Huang
- Reproductive Centre, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jinju Lin
- Reproductive Centre, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Peiyu Wang
- Reproductive Centre, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Jiang S, Kuang Y. Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization. Medicine (Baltimore) 2017; 96:e7540. [PMID: 28796038 PMCID: PMC5556204 DOI: 10.1097/md.0000000000007540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of this study was to explore the effect of clomiphene citrate (CC) on the cycle characteristics and outcomes of obese women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation for in vitro fertilization (IVF).This is a retrospective cohort study, and it was conducted at the tertiary-care academic medical center.This study included 174 obese PCOS patients undergoing IVF.In the study group (n = 90), CC and human menopausal gonadotropin (HMG) were administered simultaneously beginning on cycle day 3, while in control group (n = 84) HMG was used only. Both of the 2 groups used medroxyprogesterone acetate (MPA) for preventing premature luteinizing hormone (LH) surges. Ovulation was cotriggered by a GnRH agonist and hCG when dominant follicles matured.The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the number of top-quality embryos, maturation rate, fertilization rate, cleavage rate, incidence of premature LH surge, and OHSS.The study group received obviously lower total HMG dose [1650 (975-4800) vs 2025 (1350-3300) IU, P = 2.038E-4] but similar HMG duration. While the antral follicle count (AFC) is higher in study group, the number of oocytes retrieved and top-quality embryos are remarkably less [5 (0-30) vs 13 (0-42), P = 6.333E-5; 2 (0-14) vs 3.5 (0-15), P = .003; respectively]. The mature oocyte rate is higher in study group (P = .036). No significant differences were detected in fertilization rate and cleavage rate between 2 groups.CC has a positive influence on cycle characteristics, but might be correlated with the impaired IVF outcomes (less oocytes retrieved and top quality embryos, lower oocyte retrieval rate) in obese PCOS patients undergoing IVF, when HMG and MPA are used simultaneously.
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Zhao Y, Ruan X, Mueck AO. Letrozole combined with low dose highly purified HMG for ovulation induction in clomiphene citrate-resistant infertile Chinese women with polycystic ovary syndrome: a prospective study. Gynecol Endocrinol 2017; 33:462-466. [PMID: 28277124 DOI: 10.1080/09513590.2017.1292241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
BACKGROUND AND AIM There are still open questions about ovulation induction in clomiphene citrate-(CC)-resistant infertile women. Especially little is known about efficacy and safety of letrozole (LTZ) combined with low-dose highly purified human menopausal gonadotropin (Hp-HMG) in women with polycystic ovary syndrome (PCOS). METHODS Prospective, single-arm single-center trial in 200 infertile PCOS patients refractory for at least three CC-treatment cycles. Women with hyperandrogenism took Diane-35 for at least 3 months. All patients got LTZ on day 3 for 5 d in combination with Hp-HMG, starting with 75 IU from cycle day 7 and maintained for up to 3 d. The maximum dose was 150 IU. Primary end-points were ongoing and clinical pregnancy rate, secondary end-points mono-follicular development, ovulation rate, OHSS, multiple pregnancy and early pregnancy loss. Major safety end-point was the incidence of adverse events. RESULTS Within 395 cycles the ongoing pregnancy rate was 28.24%, for cycles 35.23%, for patients 68%. The rate of ovulation per cycle was 97.7%, percentage of mono-follicular development 70.9%. No severe OHSS, multiple pregnancy, local or systemic side effects were seen. CONCLUSIONS LTZ combined with low-dose Hp-HMG is an effective and safe choice for reducing hyperstimulation and increasing pregnancy rate in CC-resistant women with PCOS.
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Affiliation(s)
- Yue Zhao
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , PR China and
| | - Xiangyan Ruan
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , PR China and
- b Department of Women's Health , University Hospital and Faculty of Medicine of the Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - Alfred O Mueck
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , PR China and
- b Department of Women's Health , University Hospital and Faculty of Medicine of the Eberhard Karls University Tuebingen , Tuebingen , Germany
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Haller L, Severac F, Rongieres C, Ohl J, Bettahar K, Lichtblau I, Pirrello O. [Intra-uterine insemination at either 24 or 48hours after ovulation induction: Pregnancy and birth rates]. Gynecol Obstet Fertil Senol 2017; 45:210-214. [PMID: 28343907 DOI: 10.1016/j.gofs.2017.02.002] [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] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Comparing rates of pregnancy and childbirth between IUI at either 24 or 48hours after injection of HCG. METHODS This is a single-center retrospective study of couples who underwent intrauterine insemination between January 2013 and December 2014 at Medical-Surgical Obstetrical Centre of Schiltigheim. Stimulation of ovulation was done by FSH or HMG, and ovulation induction by 250μg of recombinant HCG. The insemination was performed after 2 days (group D2) or the day after (group D1). RESULTS Among the 1092 intrauterine insemination cycles included in our study, 62 were done the day after ovulation induction by HCG (D1), and 1030 the day after (D2). Our study showed no significant difference in the rate of biological pregnancy, defined by a rate of BHCG>15IU/L, between the group D1 (19.35%) and the group D2 (18.12%), P=0.94, and no difference in live birth rate: respectively 14,50% and 11.75%, P=0.18. CONCLUSION Our study reported similar rates of pregnancy and childbirth in the group who underwent IUI at D1 and D2 of ovulation induction, suggesting the possibility of IUI on day 1 when the organization of the service needs it, without loss of opportunity for pregnancy.
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Affiliation(s)
- L Haller
- Centre médico-chirurgical obstétrical (CMCO), 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
| | - F Severac
- Service de santé publique, hôpital Civil, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg, France
| | - C Rongieres
- Centre médico-chirurgical obstétrical (CMCO), 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - J Ohl
- Centre médico-chirurgical obstétrical (CMCO), 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - K Bettahar
- Centre médico-chirurgical obstétrical (CMCO), 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - I Lichtblau
- Centre médico-chirurgical obstétrical (CMCO), 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - O Pirrello
- Centre médico-chirurgical obstétrical (CMCO), 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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Lauritsen MP, Loft A, Pinborg A, la Cour Freiesleben N, Cohen A, Petersen JH, Mikkelsen AL, Bjerge MR, Nyboe Andersen A. Individualised gonadotrophin ovulation induction in women with normogonadotrophic anovulatory infertility: A prospective, observational study. Eur J Obstet Gynecol Reprod Biol 2016; 210:76-82. [PMID: 27960134 DOI: 10.1016/j.ejogrb.2016.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/30/2016] [Accepted: 12/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate an individualised gonadotrophin starting dose regimen for women with anovulatory infertility. STUDY DESIGN We included 71 normogonadotrophic anovulatory infertile women in a prospective, observational study. All underwent one ovulation induction cycle in a flexible, low-dose step-up protocol. The gonadotrophin starting dose (75-150IU/day) was individualised according to a nomogram incorporating menstrual cycle pattern (oligo- or amenorrhoea), BMI, and mean ovarian volume. The number of women who fulfilled the criteria for human chorionic gonadotrophin (hCG) administration (one follicle ≥17mm or 2-3 follicles ≥15mm) was assessed. RESULTS Of the 50 women (70.4%) who fulfilled the hCG criteria and underwent intrauterine insemination, 34 (47.9%) achieved monofollicular growth and 16 (22.5%) developed 2-3 mature follicles. Seventeen (23.9%) cycles were converted to in vitro fertilisation (IVF) due to the development of >3 mature follicles, and one (1.4%) cycle was cancelled due to risk of ovarian hyperstimulation syndrome. Baseline total antral follicle count was found to be significantly associated with fulfillment of the hCG criteria (OR 0.96, 95% CI: 0.92-0.99, P=0.01). CONCLUSIONS The nomogram-based dose regimen was not considered suitable for ovulation induction due to a tendency to overestimate the gonadotrophin starting dose. However, the model may serve as a mild IVF regimen, especially in women prone to excessive follicle growth.
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Affiliation(s)
- Mette Petri Lauritsen
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Anne Loft
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Anja Pinborg
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; The Fertility Clinic, Department of Obstetrics and Gynaecology, Hvidovre Hospital, 2650 Hvidovre, Denmark
| | - Nina la Cour Freiesleben
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Arieh Cohen
- Department of Clinical Biochemistry and Immunology, Statens Serum Institute, 2300 Copenhagen, Denmark
| | | | - Anne Lis Mikkelsen
- The Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, 4300 Holbæk, Denmark
| | - Marianne Rich Bjerge
- The Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, 4300 Holbæk, Denmark
| | - Anders Nyboe Andersen
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
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Lu X, Hong Q, Sun L, Chen Q, Fu Y, Ai A, Lyu Q, Kuang Y. Dual trigger for final oocyte maturation improves the oocyte retrieval rate of suboptimal responders to gonadotropin-releasing hormone agonist. Fertil Steril 2016; 106:1356-1362. [PMID: 27490046 DOI: 10.1016/j.fertnstert.2016.07.1068] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/28/2016] [Accepted: 07/11/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify the risk factors for suboptimal response to GnRH agonist (GnRH-a) trigger and evaluate the effect of hCG on the outcome of patients with suboptimal response to GnRH-a. DESIGN A retrospective data analysis. SETTING A tertiary-care academic medical center. PATIENT(S) A total of 8,092 women undergoing 8,970 IVF/intracytoplasmic sperm injection (ICSI) treatment cycles. INTERVENTION(S) All women underwent hMG + medroxyprogesterone acetate (MPA)/P treatment cycles during IVF/ICSI, which were triggered using a GnRH-a alone or in combination with hCG (1,000, 2,000, or 5,000 IU). Viable embryos were cryopreserved for later transfer. MAIN OUTCOME MEASURE(S) The rates of oocyte retrieval, mature oocytes, fertilization, and the number of oocytes retrieved, mature oocytes, and embryos frozen. RESULT(S) In total, 2.71% (243/8,970) of patients exhibited a suboptimal response to GnRH-a. The suboptimal responders (LH ≤15 mIU/mL) had a significantly lower oocyte retrieval rate (48.16% vs. 68.26%), fewer mature oocytes (4.10 vs. 8.29), and fewer frozen embryos (2.32 vs. 3.54) than the appropriate responders. Basal LH levels served as the single most valuable marker for differentiating suboptimal responders with the areas under the receiver operating curve of 0.805. Administering dual trigger (GnRH-a and hCG 1,000, 2,000, 5,000 IU) significantly increased oocyte retrieval rates (60.04% vs. 48.16%; 68.13% vs. 48.16%; and 65.76% vs. 48.16%, respectively) in patients with a suboptimal response. CONCLUSION(S) Basal LH level was useful predictor of the suboptimal response to GnRH-a trigger. Administrating dual trigger including 1,000 IU hCG for final oocyte maturation could improve the oocytes retrieval rate of GnRH-a suboptimal responder.
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Affiliation(s)
- Xuefeng Lu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Qingqing Hong
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - LiHua Sun
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Qiuju Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yonglun Fu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Ai Ai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Qifeng Lyu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
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Shavit T, Agdi M, Son WY, Hasson J, Dahan MH. A comparison between r-LH and urinary supplements containing LH activity in patients undergoing the microdose GnRH agonist flare protocol for in-vitro fertilization: a pilot study. Minerva Ginecol 2016; 68:393-399. [PMID: 26986651] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The aim of this study was to compare pregnancy rates and stimulation parameters in patients with diminished ovarian reserve, who were treated with recombinant human luteinizing hormone (r-LH) or menopausal gonadotropins (hMG), as part of a microdose flare protocol. METHODS A retrospective cohort study was performed. Comparisons between the group that was stimulated with r-LH plus follicle stimulating hormone (FSH) to those treated with hMG and FSH, were performed. Measurements included: medication doses, number of oocyte collected, number of embryos obtained, pregnancy and clinical pregnancy rates. RESULTS Patients in the r-LH group (N.=40) had significant higher clinical pregnancy rates (33% vs. 14%; P=0.04) and used lower dose of LH (1938 IU vs. 2807 IU; P=0.02) compared to patients that were stimulated with hMG (N.=39). CONCLUSIONS r-LH may offer advantages for the treatment of diminished ovarian reserve when performing a microdose flare protocol when compared to hMG. Both larger and prospective studies should be carried out to confirm these findings.
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Affiliation(s)
- Tal Shavit
- McGill Reproductive Center, McGill University, Royal Victoria Hospital, Montreal, Canada -
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Abstract
Poor oocyte quality is a main concern for decreased reproductive outcomes in women with polycystic ovarian syndrome (PCOS) during controlled ovarian hyperstimulation (COH). A primary way to improve oocyte quality is to optimize the COH protocol. It was demonstrated that the viable embryo rate per oocyte retrieved in the Utrogestan and hMG protocol, a novel regimen based on frozen-thawed embryo transfer (FET), is statistically higher than that in the short protocol. Thus, a retrospective study was conducted to evaluate the endocrine characteristics and clinical outcomes in PCOS patients subjected to the Utrogestan and hMG protocol compared with those subjected to the short protocol.One hundred twenty three PCOS patients enrolled in the study group and were simultaneously administered Utrogestan and human menopausal gonadotropin (hMG) from cycle day 3 until the trigger day. When the dominant follicles matured, gonadotropin-releasing hormone agonist (GnRH-a) 0.1 mg was used as the trigger. A short protocol was applied in the control group including 77 PCOS women. Viable embryos were cryopreserved for later transfer in both groups. The primary outcome was the viable embryo rate per oocyte retrieved. The secondary outcomes included the number of oocytes retrieved, fertilization rate, and clinical pregnancy outcomes from FET cycles.The pituitary luteinizing hormone (LH) level was suppressed in most patients; however, the LH level in 13 women, whose basic LH level was more than 10 IU/L, surpassed 10 IU/L on menstruation cycle day (MC)9-11 and decreased subsequently. No significant between-group differences were observed in the number of oocytes retrieved (13.27 ± 7.46 vs 13.1 ± 7.98), number of viable embryos (5.57 ± 3.27 vs 5 ± 2.79), mature oocyte rate (90.14 ± 11.81% vs 93.02 ± 8.95%), and cleavage rate (97.69 ± 6.22% vs 95.89 ± 9.57%). The fertilization rate (76.11 ± 19.04% vs 69.34 ± 21.81%; P < 0.05), viable embryo rate per oocyte retrieved (39.85% vs 34.68%; P < 0.05), biochemical pregnancy rate (71.72% vs 56.67%; P < 0.05), clinical pregnancy rate (64.65% vs 51.65%; P < 0.05), and implantation rate (46.46% vs 31.35%; P < 0.05) in the study group were significant higher than those in the control group.This study shows that the Utrogestan and hMG protocol was feasible to improve the oocyte quality, possibly providing a new choice for PCOS patients undergoing IVF/ICSI treatments in combination with embryo cryopreservation.
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Affiliation(s)
| | | | - Yonglun Fu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Correspondence: Yonglun Fu, Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (e-mail: )
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Wang Y, Chen Q, Wang N, Chen H, Lyu Q, Kuang Y. Controlled Ovarian Stimulation Using Medroxyprogesterone Acetate and hMG in Patients With Polycystic Ovary Syndrome Treated for IVF: A Double-Blind Randomized Crossover Clinical Trial. Medicine (Baltimore) 2016; 95:e2939. [PMID: 26945402 PMCID: PMC4782886 DOI: 10.1097/md.0000000000002939] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation is a current challenge for patients with polycystic ovarian syndrome (PCOS). Our previous studies indicated that progestin can prevent premature luteinizing hormone (LH) surge or moderate/severe OHSS in the general subfertile population, both in the follicular-phase and luteal-phase ovarian stimulation but it is unclear if this is true for patients with PCOS. The aim of the article was to analyze cycle characteristics and endocrinological profiles using human menopausal gonadotropin (hMG) in combination with medroxyprogesterone acetate (MPA) for PCOS patients who are undergoing IVF/intracytoplasmic sperm injection (ICSI) treatments and investigate the subsequently pregnancy outcomes of frozen embryo transfer (FET). In the randomized prospective controlled study, 120 PCOS patients undergoing IVF/ICSI were recruited and randomly classified into 2 groups according to the ovarian stimulation protocols: hMG and MPA (group A, n = 60) or short protocol (group B, n = 60). In the study group, hMG (150-225IU) and MPA (10 mg/d) were administered simultaneously beginning on cycle day 3. Ovulation was cotriggered by a gonadotropinreleasing hormone (GnRH) agonist (0.1 mg) and hCG (1000IU) when dominant follicles matured. A short protocol was used as a control. The primary end-point was the ongoing pregnancy rate per transfer and incidence of OHSS. Doses of hMG administrated in group A are significantly higher than those in the controls. LH suppression persisted during ovarian stimulation and no incidence of premature LH surge was seen in both groups. The fertilization rate and the ongoing pregnant rate in the study group were higher than that in the control. The number of oocytes retrieved, mature oocytes, clinical pregnancy rates per transfer, implantation rates, and cumulative pregnancy rates per patient were comparable between the 2 groups. The incidence of OHSS was low between the 2 groups, with no significant difference. The study showed that MPA has the advantages of an oral administration route, easy access, more control over LH levels. A possible reduction in the incidence of moderate or severe OHSS with the MPA protocol should be viewed with caution as the data is small. Large randomized trials with adequate sample size remain necessary.
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Affiliation(s)
- Yun Wang
- From the Department of Assisted Reproduction, Shanghai Ninth People's Hospital, JiaoTong University School of Medicine, Shanghai, China
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21
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Barroso-Villa JG, Colín-Valenzuela A, Valdespín-Fierro C, Ávila-Lombardo R, Estrada-Gutiérrez G. [The effect of corifollitropin alfa on in vitro fertilization-ICSI patients with previous failure with an FSH/HMG protocol: Preliminary report in Mexico]. Ginecol Obstet Mex 2016; 84:7-13. [PMID: 27290841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The daily application of drugs, often in high doses, is a factor of stress for the infertile couple. During the last decade corifollitropin alpha has allowed a friendlier scheme comparable to traditional protocols (rFSH-HMG) results. OBJECTIVE To compare the results of corifollitropin alpha in patients with a previous cycle of IVF-ICSI with traditional scheme ovarian stimulation. MATERIALS AND METHODS Observational, retrospective cohort study type that infertile couples were included. RESULTS No significant differences in the dose used HFRS (2023U/ total ± 712 vs 636 U/total ± 307) and serum estradiol day shooting HGCr (1972 pg/dL vs 1107 ± 1152 pg/dL ± 775). A higher pregnancy rate was found corifollitropin alpha perhaps because it was a second attempt at in vitro fertilization. CONCLUSIONS Reproductive outcomes in a cycle of ovarian stimulation with corifollitropin are comparable with the results of a traditional ovarian stimulation cycle. It is important to broaden the experience of the drug indication in Mexican patients.
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Dakhly DMR, Bayoumi YA, Gad Allah SH. Which is the best IVF/ICSI protocol to be used in poor responders receiving growth hormone as an adjuvant treatment? A prospective randomized trial. Gynecol Endocrinol 2016; 32:116-9. [PMID: 26416521 DOI: 10.3109/09513590.2015.1092136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/13/2022] Open
Abstract
This open label randomized study aims to define the best protocol to be used with growth hormone in poor responders, with comparison performed to delineate which protocol offers the best cycle outcomes. Two-hundred eighty-seven poor responders were included. The patients were randomly allocated into four groups receiving growth hormone (GH) as an adjuvant therapy added to either long or short agonist protocol, miniflare or antagonist protocols. The short/GH gave significantly lower mean number of oocytes when compared with the long/GH, antagonist/GH and miniflare/GH (4 ± 1.69 versus 5.06 ± 1.83, 4.95 + / = 1.90 and4.98 ± 2.51, respectively p = 0.005). Considering the number of fertilized oocytes, the long/GH showed significantly higher levels than short/GH and antagonist/GH (3.73 ± 1.47 versus 3.02 ± 1.52 and 2.89 ± 1.14, respectively). The main drawback is that it required significantly higher HMG dose and longer duration of stimulation. The long/GH was superior when compared with the three protocols regarding the number of oocytes retrieved and fertilized. But, when considering the clinical pregnancy rates, there was a difference in favor of the long/GH but not reaching a statistically significant value (ClinicalTrials.gov Identifier: NCT01897324).
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Affiliation(s)
- Dina M R Dakhly
- a Department of Obstetrics and Gynecology , Cairo University , Giza , Egypt
| | - Yomna A Bayoumi
- a Department of Obstetrics and Gynecology , Cairo University , Giza , Egypt
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Zhang CJ, Zhang Y, Hu GZ, Diao H. Twin delivery after IVF-ET with variable dose letrozole-FSH protocol of lower estradiol in a patient previously treated for breast cancer: a case report. EUR J GYNAECOL ONCOL 2016; 37:278-281. [PMID: 27172763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To present a case of twin pregnancy obtained by in vitro fertilization and embryo transfer (IVF-ET) with variable dose letrozole-FSH protocol of lower peak estradiol level, after treatment of carcinoma of the breast. MATERIALS AND METHODS A 34-year-old patient diagnosed with mucinous breast carcinoma undergoing assisted fertilization treatment after breast cancer operation and treatment including controlled ovarian stimulation (COS), oocyte retrieval, IVF, and embryo culture and transfer. RESULTS Four oocytes were obtained in three COS procedures in the three IVF cycle. All oocytes were fertilized. In the third cycle, two fresh embryos were transferred, and two healthy girls were born at 37 gestational weeks. CONCLUSION Variable dose letrozole-FSH protocol can maintain lower peak estradiol levels and reduce estrogen exposure after breast cancer operation and chemotherapy.
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Zhu X, Zhang X, Fu Y. Utrogestan as an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization. Medicine (Baltimore) 2015; 94:e909. [PMID: 26020402 PMCID: PMC4616424 DOI: 10.1097/md.0000000000000909] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A major cause of cycle cancellation during controlled ovarian hyperstimulation (COH) in women undergoing in vitro fertilization (IVF) is the occurrence of premature luteinizing hormone (LH) surges. Steroidal preparations can modulate the secretion of gonadotropins (Gn); however, few studies using progesterone to inhibit the premature LH surges in COH have been published. The purpose of the study was to evaluate the oral delivery of progesterone soft capsules (Utrogestan) to prevent LH surges from the follicular phase and to compare cycle characteristics as well as to evaluate pregnancy outcomes in subsequent frozen-thawed embryo transfer (FET) cycles. A total of 374 patients were enrolled in this retrospective study, among which 187 patients were simultaneously administered Utrogestan and human menopausal gonadotrophin (hMG) from cycle day 3 until the trigger day. A short protocol including 187 controls with comparable age, body mass index (BMI), infertility duration, and antral follicle count was also used. GnRH agonist (0.1 mg) or hCG (3000 IU) was used for a trigger when the dominant follicles matured. Viable embryos were cryopreserved for later transfer in both groups. The primary outcome was the number of oocytes retrieved. The secondary outcomes included the number of mature oocytes, incidence of premature LH surge, and clinical pregnancy outcomes from FET cycles. Consistent LH suppression was achieved during COH, with a range of 0.07 to 8.9 IU/L, and no premature LH surge was detected. The number of oocytes retrieved in the Utrogestan and hMG protocol was comparable with that in the short protocol (10.92 ± 5.74 vs 10.6 ± 6.22, P > 0.05), and the dose of hMG was higher than that used in the short protocol (1884.22 ± 439.47 IU vs 1446.26 ± 550.48 IU, P < 0.05). No significant between-group difference was observed in the mature oocyte rate (88.88% vs 90.12%), cleavage rate (96.58% vs 96.58%), clinical pregnancy rate (54.27% vs 51.65%), or implantation rate (33.59% vs 34.02%). The study shows that Utrogestan is an effective oral alternative for preventing premature LH surges in women undergoing COH, which will help to establish a convenient user regimen in combination with FET.
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Affiliation(s)
- Xiuxian Zhu
- From the Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine (XZ, YF); Department of Gynecology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai, China (XZ)
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25
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Barros-Delgadillo JC, Ruiz-Balderrama CI, Ríos-Barba M. [Comparison of results of two flexible ovarian hiperestimulation protocols with two different initial doses (150 vs ≥ 225)]. Ginecol Obstet Mex 2015; 83:1-15. [PMID: 26016311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND With the use of new protocols Controlled ovarian hyperstimulation (COH) with lower doses of gonadotropins to the classics protocols and current trend of fewer embryos transferred, there is no agreement until today on the optimal dose start of a COH protocol. OBJECTIVE Compare the results of two flexible protocols of HOC with different starting doses (150 vs 225 lU rFSH/hMG) plus a GnRH antagonist in cycles of IVF / ICSI. METHODS Retrospective, descriptive study, we analyzed 231 cycles of IVF/ICSI being the primary variables: total FSH dose, dose increase, retrieved oocytes, embryos available for transfer and for cryopreservation. RESULTS The total dose of FSH in group 11 was significantly higher versus group 1 (2096.0 vs 1447.9). The percentage of patients in whom the dose increased was higher in Group I vs Group 11 (26.4% vs 9.1%, p = 0.001). The number of retrieved oocytes was similar between the groups (10.5 vs 10.2, p = 0.76) as well as the number of embryos available the day of the transfer and the number of embryos that were vitrified 6.73 vs 6.08 (p = 0.97) and 1.5 and 1.3 (p=0.820) for Group I and I respectively. The clinical pregnancy rate was 39.3% (n = 91), and for groups I and 11 were 41.6 and 37.7% respectively. CONCLUSIONS No significant differences between two loading dose was found (150 vs ≥ 225) in most of the primary endpoint.
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Sahmay S, Usta TA, Zebitay G, Senturk LM, Oral E, Ocal P, Idil M, Irez T. Comparison of follitropin alfa and urinary gonadotropins in IVF cycles. Minerva Ginecol 2014; 66:341-346. [PMID: 25020053] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this study was to compare human menopausal gonadotropins with recombinant follicle stimulating hormone-follitropin alpha following a long down-regulation protocol in intra cytoplasmic sperm injection cycles in our clinic, and to review the outcomes in the light of preceding studies. METHODS This was a retrospective study. Among a total number of 2798 patients who had undergone IVF/ICSI applications, 579 eligible patients were included, and their data were evaluated retrospectively. Three hundred eighteen patients were treated with follitropin alpha and 255 patients were treated with hMG. Total units of follitropin alpha preparations used in ovulation induction, total number of meiois-2 phase oocytes, total number of used oocytes in ICSI cycle, fertilization rate and clinical pregnancy rates of both groups were analyzed. RESULTS Mean duration of stimulation was longer in the group of patients treated with rFSH-α compared to the second group of patients treated with hMG (8.88 days and 8.55 days, respectively; P<0.05). The number of transferred embryos were 3.08 and 2.68 for patients treated with follitropin alpha and hMG, respectively (P<0.05). Clinical pregnancy rates were %28 and %33 in the groups of patients treated with follitropin alpha and hMG, respectively. Even though a greater clinical pregnancy rate was noted in the hMG group, there was no statistically significant difference between the two groups (P>0.05). CONCLUSION Our results indicate that there is no statistically significant difference between follitropin alpha and human menopausal gonadotropin in terms of the clinical pregnancy rates.
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Affiliation(s)
- S Sahmay
- Department of Obstetrics and Gynecology Division Of Reproductive Endocrinology,IVF-ET Unit, Cerrahpaşa Medical School, Istanbul University, Istanbul, Turkey -
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Santibáñez Morales A, Colín Licea EO, Durán Boullosa E, Sánchez Serrano P, Pashkova O. [Ovarian stimulation with gonadotropins: comparison between recombinant FSH plus menotropins versus recombinant FSH + LH]. Ginecol Obstet Mex 2014; 82:307-313. [PMID: 24937946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Nowadays various assisted reproduction ovarian stimulation schemes are used for different clinical outcomes is interesting to compare. OBJECTIVE Compare two ovarian stimulation protocols: recombinant FSH + LH versus recombinant FSH + Menotropins. MATERIAL AND METHODS Observational, retrospective study, 38 cycles were analyzed, made from 2010 until 2013, assigned to two groups (n = 19 each), group 1 received FSHr + LHr, group 2 received FSHr + menotropins. Study variables were: days of ovarian stimulation, total gonadotropin dose, retrieved oocytes, fertilization rate, pregnancy rate and number of vitrified embryos. RESULTS Fewer stimulation days (8.5 +/- 1.5 vs 9 +/- 1.1) were found in group 1 (recombinant gonadotropins). Group 2 (FSHr + Menotropins), had a greater total dose of gonadotropins (1930.2 +/- 346.2 vs 2000 +/- 418.8) and more retrieved oocytes (8.15 +/- 3.9 vs 8.57 +/- 4). Group 1 patients had higher pregnancy and fertilization rates (56.2 vs 36.8%, and 75.4 vs 69.3%) respectively, no statistical significance was found. CONCLUSION This study found higher pregnancy and fertilization rates in patients treated with recombinant gonadotropins (FSH + LH) for ovarian stimulation.
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Goldman RH, Batsis M, Petrozza JC, Souter I. Patient-specific predictions of outcome after gonadotropin ovulation induction/intrauterine insemination. Fertil Steril 2014; 101:1649-55.e1-2. [PMID: 24690238 DOI: 10.1016/j.fertnstert.2014.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/14/2014] [Accepted: 02/14/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To use patient-specific and cycle-specific characteristics to predict clinical pregnancy, multiple pregnancy, and spontaneous abortion rates after gonadotropin ovulation induction (OI)/IUI. DESIGN Retrospective chart review. SETTING Academic fertility center. PATIENT(S) A total of 1,438 women who underwent 3,375 gonadotropin OI/IUI cycles. INTERVENTION(S) Individual and cycle-specific characteristics were evaluated to determine predictors of the rates of clinical pregnancy, multiple pregnancy, and spontaneous abortion. Logistic regression using individual parameters was used to create predictive models. MAIN OUTCOME MEASURE(S) Clinical pregnancy (CPR), multiple pregnancy (MPR), and spontaneous abortion rates (SABR). RESULT(S) Multiple predictors were identified for CPR, MPR, and SABR. The presence of at least two follicles ≥ 13 mm at ovulation trigger significantly increased CPR (odds ratio [OR], 95% confidence interval [CI] = 1.45, 1.18-1.78) and MPR (OR, 95% CI = 5.17, 2.16-12.41). An E2 level >400 pg/mL significantly increased MPR (OR, 95% CI = 9.54, 2.31-39.42). Logistic regression models were developed for individualized predictions of outcome. CONCLUSION(S) Regression analysis reveals the patient and cycle-specific characteristics that are significant predictors of CPR, MPR, and SABR after OI/IUI. Logistic models using significant or nearly significant predictors for CPR, MPR, and SABR offer improved predictive power relative to simpler models, and allow for the development of a risk calculator for personalized patient counseling.
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Affiliation(s)
- Randi H Goldman
- Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, Massachusetts.
| | - Maria Batsis
- Reproductive Endocrinology and Infertility Division, Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, Massachusetts
| | - John C Petrozza
- Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, Massachusetts; Reproductive Endocrinology and Infertility Division, Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, Massachusetts
| | - Irene Souter
- Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, Massachusetts; Reproductive Endocrinology and Infertility Division, Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, Massachusetts
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Requena A, Cruz M, Ruiz FJ, García-Velasco JA. Endocrine profile following stimulation with recombinant follicle stimulating hormone and luteinizing hormone versus highly purified human menopausal gonadotropin. Reprod Biol Endocrinol 2014; 12:10. [PMID: 24476504 PMCID: PMC3907361 DOI: 10.1186/1477-7827-12-10] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/19/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Luteinizing hormone (LH) activity in human menopausal gonadotropin (hMG) preparations is derived from human chorionic gonadotropin (hCG) rather than LH. Therefore, we aimed to determine whether there are similarities in the endocrine and follicular profiles of serum and follicular fluid from controlled ovarian stimulation with the recombinant gonadotropins follicle-stimulating hormone plus luteinizing hormone (rFSH + rLH) or highly purified human menopausal gonadotropin (HP-hMG). METHODS We performed a prospective observational study with 50 oocyte donors that received either a combination of recombinant gonadotropins (rFSH + rLH) or a mixture of urinary gonadotropins (HP-hMG) plus purified urinary FSH (uFSH). Results were analyzed using Student's t-test to compare continuous variables and the chi-squared test to compare proportions. P-values < 0.05 were considered statistically significant. RESULTS Although more oocytes were retrieved after treatment with recombinant than urinary gonadotropins (16.5 vs. 11.8; P = 0.049), a higher proportion of metaphase II ova (71.2% vs. 80.6%; P = 0.003) were obtained using urinary gonadotropins. On day 6 and on the day of triggering, serum steroid hormone levels were slightly but not significantly elevated in the recombinant group compared with the urinary group. In follicular fluid, no statistical differences were observed for intra-follicular levels of steroid hormones between the two protocols; ongoing pregnancy rates were similar (46.1% vs. 46.1%). CONCLUSIONS Our data suggest that endocrinological and follicular profiles do not differ between rFSH + rLH and HP-hMG stimulation.
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Affiliation(s)
- Antonio Requena
- Reproductive Medicine Department, Instituto Valenciano de Infertilidad IVI Madrid, Avenida del Talgo 68-70, Aravaca, Madrid 28023, Spain
| | - María Cruz
- Reproductive Medicine Department, Instituto Valenciano de Infertilidad IVI Madrid, Avenida del Talgo 68-70, Aravaca, Madrid 28023, Spain
| | - Francisco J Ruiz
- Reproductive Medicine Department, Instituto Valenciano de Infertilidad IVI Madrid, Avenida del Talgo 68-70, Aravaca, Madrid 28023, Spain
| | - Juan A García-Velasco
- Reproductive Medicine Department, Instituto Valenciano de Infertilidad IVI Madrid, Avenida del Talgo 68-70, Aravaca, Madrid 28023, Spain
- Nursing, Gynecology and Obstetrics, Pediatrics and Psychiatry Department, Faculty of Health Sciences, Rey Juan Carlos University, Avda. Atenas s/n, Alcorcón, Madrid 28922, Spain
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Amer SA, Mahran A, Abdelmaged A, El-Adawy AR, Eissa MK, Shaw RW. The influence of circulating anti-Müllerian hormone on ovarian responsiveness to ovulation induction with gonadotrophins in women with polycystic ovarian syndrome: a pilot study. Reprod Biol Endocrinol 2013; 11:115. [PMID: 24341292 PMCID: PMC3878562 DOI: 10.1186/1477-7827-11-115] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with polycystic ovarian syndrome (PCOS) are known to have elevated circulating Anti-Müllerian hormone (AMH), which has been found to desensitize ovarian follicles to follicle stimulating hormone (FSH). The purpose of this study was to investigate the impact of high circulating AMH on ovarian responsiveness to ovulation induction with gonadotrophins in PCOS women. METHODS This prospective observational pilot study was conducted in two collaborating Fertility Centres in the UK and Egypt. The study included 20 consecutive anovulatory women with PCOS who underwent 34 cycles of human menopausal gonadotrophin (hMG) ovarian stimulation using chronic low-dose step up protocol. Blood samples were collected for the measurement of serum AMH concentrations in the early follicular (day 2-3) phase in all cycles of hMG treatment. The serum levels of AMH were compared between cycles with good vs. poor response. The good response rates and the total dose and duration of hMG treatment were compared between cycles with high vs. low serum AMH concentrations. RESULTS Cycles with poor response (no or delayed ovulation requiring >20 days of hMG treatment) had significantly (p = .007) higher median{range} serum AMH concentration (6.5{3.2-13.4}ng/ml) compared to that (4.0{2.2-10.2}ng/ml) of cycles with good response (ovulation within 20 days of hMG treatment). ROC curve showed AMH to be a useful predictor of poor response to hMG stimulation (AUC, 0.772; P = 0.007). Using a cut-off level of 4.7 ng/ml, AMH had a sensitivity of 100% and specificity of 58% in predicting poor response. The good response rate was significantly (p < .001) greater in cycles with lower AMH (<4.7 ng/ml) compared to that in those with AMH > = 4.7 ng/ml (100% vs. 35%, respectively). All cycles with markedly raised serum AMH levels (> 10.2 ng/ml) were associated with poor response. Cycles with high AMH (> = 4.7 ng/ml) required significantly (p < .001) greater amounts (median {range}, 1087{450-1650}IU) and longer duration (20 {12-30}days) of hMG stimulation than cycles with lower AMH (525 {225-900}IU and 8{6-14}days). CONCLUSIONS PCOS women with markedly raised circulating AMH seem to be resistant to hMG ovulation induction and may require a higher starting dose.
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Affiliation(s)
- Saad A Amer
- Department of Obstetrics and Gynaecology, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby DE22 3DT, UK
| | - Ahmad Mahran
- Department of Obstetrics and Gynaecology, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby DE22 3DT, UK
- Faculty of Medicine, Minia University, Minia, Egypt
| | | | | | | | - Robert W Shaw
- Department of Obstetrics and Gynaecology, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby DE22 3DT, UK
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Alviggi C, Cognigni GE, Morgante G, Cometti B, Ranieri A, Strina I, Filicori M, De Leo V, De Placido G. A prospective, randomised, investigator-blind, controlled, clinical study on the clinical efficacy and tolerability of two highly purified hMG preparations administered subcutaneously in women undergoing IVF. Gynecol Endocrinol 2013; 29:695-9. [PMID: 23638621 DOI: 10.3109/09513590.2013.788641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/13/2022] Open
Abstract
The aim of this multicentre, prospective, randomised, investigator blind, controlled clinical trial was to evaluate the clinical efficacy and tolerability of a highly purified human menopausal gonadotrophin (hMG) preparation (Merional-HG) when administered to patients undergoing controlled ovarian stimulation (COS) for in-vitro fertilisation (IVF) procedure enrolled in hospital departments. One hundred fifty-seven patients were randomised in two parallel groups: 78 started COS with Merional-HG and 79 with Menopur. Results of the study showed that both highly purified hMG preparations were equivalent in terms of number of oocytes retrieved (primary endpoint: 8.8 ± 3.9 versus 8.4 ± 3.8, p = 0.54). In the patients treated with Merional-HG, we observed a higher occurrence of mature oocytes (78.3% versus 71.4%, p = 0.005) and a reduced quantity of gonadotrophins administered per cycle (2.556 ± 636 IU versus 2.969 ± 855 IU, p < 0.001). Fertilisation, cleavage, implantation rates and the number of positive β-human chorionic gonadotrophin (hCG; pregnancy) tests and the clinical pregnancy rate were comparable in the two groups. Both treatments were well tolerated. In conclusion, the results of this study support the efficacy and safety of Merional-HG administered subcutaneously for assisted reproduction techniques. Efficiency of Merional-HG appears to be higher due to reduced quantity of drug used and the higher yield of mature oocytes retrieved.
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Affiliation(s)
- C Alviggi
- Dipartimento di Scienze Ostetriche, Ginecologiche, Urologiche e Medicina della Riproduzione, Centro di Sterilità e Infertilità di Coppia, Università degli Studi di Napoli Federico II, Napoli, Italy
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Rashidi M, Aaleyasin A, Aghahosseini M, Loloi S, Kokab A, Najmi Z. Advantages of recombinant follicle-stimulating hormone over human menopausal gonadotropin for ovarian stimulation in intrauterine insemination: a randomized clinical trial in unexplained infertility. Eur J Obstet Gynecol Reprod Biol 2013; 169:244-7. [PMID: 23541417 DOI: 10.1016/j.ejogrb.2013.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/30/2013] [Accepted: 03/01/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare two different gonadotropin preparations, human menopausal gonadotropin (hMG) and recombinant follicle-stimulating hormone (rFSH), combined with clomiphene citrate (CC) in women with unexplained infertility undergoing intrauterine insemination (IUI). STUDY DESIGN In this prospective clinical trial, couples prepared for IUI cycles were randomly allocated to two groups either to receive CC and hMG (group A, n=127) or CC and rFSH (group B, n=132) for ovarian stimulation. Outcomes including rates of clinical pregnancy, miscarriage, OHSS, multiple pregnancy, cancellation, and live birth were compared between groups. RESULTS Duration of gonadotropin therapy was significantly shorter in group B (5.1±0.84 vs. 4.7±0.8 days, CI=95%, P<0.001). The total dose of administered gonadotropin was also significantly lower in group B (386.9±68.2 vs. 348.2±56.3IU, CI=95%, P<0.001). Dominant follicle number (>17mm), mean follicular diameter, and endometrial thickness on the day of hCG injection were similar. Clinical pregnancy, multiple pregnancies, abortion, live birth, ovarian hyperstimulation syndrome (OHSS), and cancellation rates were not statistically different between the groups. CONCLUSION IUI cycles in which rFSH had been administered may require shorter duration and a lower total gonadotropin dose.
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Affiliation(s)
- Mandana Rashidi
- Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Mohsen IA, El Din RE. Minimal stimulation protocol using letrozole versus microdose flare up GnRH agonist protocol in women with poor ovarian response undergoing ICSI. Gynecol Endocrinol 2013; 29:105-8. [PMID: 23134528 DOI: 10.3109/09513590.2012.730569] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 11/13/2022] Open
Abstract
BACKGROUND To compare the IVF outcomes of letrozole/antagonist and microdose GnRH agonist flare up protocols in poor ovarian responders undergoing intracytoplasmic sperm injection. MATERIALS AND METHODS A randomized controlled trial was performed in patients with one or more previous failed IVF cycles in which four or less oocytes were retrieved when the gonadotrophin starting dose was at least 300 IU/day. Sixty patients were randomized by computer-generated list to receive either letrozole/antagonist (mild stimulation) n = 30 or GnRH-a protocol (microdose flare) n = 30. RESULTS Both groups were similar with respect to background and hormonal characteristics (age, duration of infertility, BMI, FSH, LH and E2). The clinical pregnancy rate per cycle was similar in both groups (13.3 vs. 16.6%; OR = 0.769; 95% CI = 0.185, 3.198). The doses of used gonadotropins and the number of stimulation days were significantly lower in the letrozole/antagonist protocol. The peak E2 level on the day of hCG, the endometrial thickness, the retrieved oocytes, the number of fertilized oocytes, the number of transferred embryos and the cancellation rate were statistically similar in both groups. CONCLUSIONS The letrozole/antagonist protocol is a cost-effective and patient-friendly protocol that may be used in poor ovarian responders for IVF/ICSI.
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Affiliation(s)
- Iman Abdel Mohsen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Check JH. Gonadotropinoma presenting as a case of pseudo-ovarian failure changing to macroprolactinoma. CLIN EXP OBSTET GYN 2013; 40:295-296. [PMID: 23971264] [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: 06/02/2023]
Abstract
PURPOSE To present the first gonadotropinoma presenting as pseudo-menopause in a teenager. METHODS Human menopausal gonadotropins (hMG) were given to a 37-year-old woman whose hypergonadotropic amenorrhea with estrogen deficiency as a teenager was changed to hypogonadotropic amenorrhea by the growth and prolactin secretion of a macroprolactinoma. RESULTS The patient responded multiple times, and every time to stimulation with hMG and each time produced several dominant follicles. She delivered two babies including conception at age 40. CONCLUSIONS The fact that this woman could respond consistently to hMG 20 years after the diagnosis of premature menopause, it is clear that initially the etiology of the extremely high LH and FSH levels in an estrogen-deficient 18-year-old was the presence of gonadotropinoma secreting inert LH and FSH. Since serum prolactin was measured the first time at age 37, it is not clear whether the endogenous biologically active gonadotropine were suppressed by replacement of the gonadotroph cells with tumor cells or suppression of endogenous gonadotropins by hyperprolactinoma.
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Affiliation(s)
- J H Check
- The University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, NJ, USA.
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Arce JC, Smitz J. Live-birth rates after HP-hMG stimulation in the long GnRH agonist protocol: association with mid-follicular hCG and progesterone concentrations, but not with LH concentrations. Gynecol Endocrinol 2013; 29:46-50. [PMID: 22809021 PMCID: PMC3518295 DOI: 10.3109/09513590.2012.705379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this retrospective study was to investigate the impact of endogenous and exogenous luteinizing hormone (LH) activity on treatment outcome, when taking into consideration potential confounding variables. Data were derived from IVF patients (n = 358) stimulated with highly purified menotrophin (HP-hMG) in a long gonadotrophin-releasing hormone (GnRH) agonist protocol. Simple retrospective logistic regression analysis showed that the mid-follicular exogenous concentrations of human chorionic gonadotrophin (hCG) (p = 0.027), provided by the HP-hMG preparation, and female age (p = 0.009) were significantly associated with live-birth rate, while the mid-follicular progesterone concentration (p = 0.075), the estradiol concentration on last stimulation day (p = 0.075) and number of embryos transferred (p = 0.071) were borderline significant. Endogenous LH was not associated with live-birth rate; neither at start of stimulation (p = 0.123), nor in the mid-follicular phase (p = 0.933) or on the last day of stimulation (p = 0.589). In the multiple regression analysis of life birth, mid-follicular hCG (p = 0.016) was identified as a positive predictor, and age (p = 0.004) and mid-follicular progesterone (p = 0.029) as negative predictors. In conclusion, mid-follicular concentrations of exogenous hCG and progesterone, but not endogenous LH, are associated with live-birth rate in IVF patients treated with HP-hMG in a long GnRH agonist cycle.
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Affiliation(s)
- Joan-Carles Arce
- Reproductive Health, Global Clinical & Non-Clinical R&D, Ferring Pharmaceuticals A/S, Copenhagen, Denmark.
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Gleicher N, Kim A, Weghofer A, Barad DH. Lessons from elective in vitro fertilization (IVF) in, principally, non-infertile women. Reprod Biol Endocrinol 2012; 10:48. [PMID: 22716082 PMCID: PMC3495227 DOI: 10.1186/1477-7827-10-48] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/09/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We here report the first investigation of exclusively elective in vitro fertilization (IVF) cycles in women with no apparent history of infertility. Since IVF outcome in women with infertility are always influenced by underlying causes of infertility, a study on non-infertile women may offer new insights. METHODS We investigated 88 females without history of infertility in 109 consecutive elective IVF cycles, almost exclusively performed for purposes of preimplantation genetic screening (PGS; i.e., elective gender selection). The following questions were addressed: (i) impact of PGS on IVF pregnancy chances; (ii) impact of transfer of 1 vs. ≥2 embryos on IVF pregnancy chances; (iii) correlation of anti-Müllerian hormone (AMH) levels to embryo ploidy (iv) effect of gonadotropin dosage used in stimulation on available embryos for transfer; and (v) in form of a 1:1 case control study, compared 33 elective PGS cycles with matched control cycles without PGS, performed in couples with either prior tubal ligations and/or severe male factor infertility as indication of IVF. RESULTS The overall clinical pregnancy rate for the group was 36.7%; pregnancy was associated with number of euploid (P = 0.009) and number of embryos transferred (P = 0.001). Odds of pregnancy were 3.4-times higher if ≥4 euploid embryos were produced in comparison to <4 (95% CI 1.2 to 9.2; P = 0.019), and odds of pregnancy were 6.6-times higher if greater than or equal to 2 rather than <1 euploid embryos were transferred (95% CI 2.0 to 21.7; P = 0.002). Increasing AMH (P = 0.001) and gonadotropin dosage used in ovarian stimulation (P = 0.024), was, independently, associated with number of available euploid embryos. Increasing AMH, but not follicle stimulating hormone (FSH), was associated with number of embryos available for biopsy and PGS (P = 0.0001). Implantation rates were 26.4% with PGS and 9.5% without (P = 0.008). Women undergoing PGS, demonstrated 4.58-times higher odds of pregnancy than matched controls (95% CI 1.102 to 19.060, Exp 4.584, P = 0.036). CONCLUSIONS This study suggests that outcomes of elective IVF cycles may significantly deviate from infertility-associated cycles. Affirming proof of concept for PGS, utilizing day-3 embryo biopsy and fluorescence in-situ hybridization (FISH), both widely held responsible for earlier failures to establish such proof, suggests that the principal cause of prior failures were likely not insufficient laboratory techniques but poor patient selection for PGS. Such a conclusion questions the current reintroduction of PGS with improved techniques and technologies in absence of prior determination of suited patient populations.
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Affiliation(s)
- Norbert Gleicher
- Center for Human Reproduction, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, 10021, USA
| | - Ann Kim
- Center for Human Reproduction, New York, NY, 10021, USA
| | - Andrea Weghofer
- Center for Human Reproduction, New York, NY, 10021, USA
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University Vienna, 1090, Vienna, Austria
| | - David H Barad
- Center for Human Reproduction, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, 10021, USA
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Tsutsumi R, Fujimoto A, Osuga Y, Harada M, Takemura Y, Koizumi M, Yano T, Taketani Y. Successful pregnancy following low-dose hCG administration in addition to hMG in a patient with hypothalamic amenorrhea due to weight loss. Gynecol Endocrinol 2012; 28:460-2. [PMID: 22103675 DOI: 10.3109/09513590.2011.633650] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe successful ovulation induction with low-dose hCG administration in addition to hMG in a patient with refractory hypothalamic amenorrhea. A 24-year-old woman with weight loss-related amenorrhea underwent ovulation induction and intracytoplasmic sperm injection (ICSI). Administration of exogenous gonadotropins was ineffective in ovulation induction. Supplementation with low-dose hCG in order to increase luteinizing hormone (LH) activity in the late follicular phase produced late folliculogenesis and steroidogenesis, and ovulation was then successfully induced. This report reacknowledges the critical role that LH plays cooperatively with follicle-stimulating hormone in both folliculogenesis and steroidogenesis.
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Affiliation(s)
- Ryo Tsutsumi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Kawamura M, Suzuki A, Kanda R, Kiseki H, Tsukahara Y, Hashimura N. Modified repeated intracyclic clomiphene citrate therapy after conventional clomiphene therapy. CLIN EXP OBSTET GYN 2012; 39:317-320. [PMID: 23157033] [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: 06/01/2023]
Abstract
PURPOSE OF INVESTIGATION We compared modified repeated intracyclic clomiphene citrate therapy (RICCT) to gonadotropin therapy to determine whether this modified regimen was an effective alternative after conventional clomiphene therapy. METHODS Patients with ovulation disorder received treatment with modified RICCT and gonadotropin, and ovulation, pregnancy, total drug cost, and adverse effects were compared. RESULTS Among a total of 16 patients, 14 successfully ovulated after modified RICCT and 11 ovulated after gonadotropin therapy; two did not respond to either therapy. The total drug cost was US $36.3+/-17.9 for modified RICCT, which was significantly lower than the cost of gonadotropin therapy, US $213.9+/-100.4 (p=0.0001). CONCLUSIONS Because modified RICCT does not require the discomfort of daily injection and has excellent ovulation-inducing effects, it is a useful treatment after conventional clomiphene therapy.
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Affiliation(s)
- M Kawamura
- Department of Obstetrics and Gynecology, Kohseichuo General Hospital, Tokyo, Japan.
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Johnston-MacAnanny EB, DiLuigi AJ, Engmann LL, Maier DB, Benadiva CA, Nulsen JC. Selection of first in vitro fertilization cycle stimulation protocol for good prognosis patients: gonadotropin releasing hormone antagonist versus agonist protocols. J Reprod Med 2011; 56:12-16. [PMID: 21366121] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The objective of this study was to compare outcome parameters in patients anticipated to have a good response to stimulation based upon baseline characteristics using either a gonadotropin releasing hormone (GnRH) agonist or antagonist protocol in their first in vitro fertilization (IVF) cycle. STUDY DESIGN A retrospective chart review of all first-time IVF cycles performed during the time period 2005 through 2007 in an academic teaching center. Patients <40 years of age with a normal baseline follicle stimulating hormone (<10 mIU/mL) and normal antral follicle counts (> or = 3 in each ovary) were included. All patients studied were undergoing their first IVF cycle. The main outcome measures were clinical pregnancy and live birth rates. RESULTS Included in the study were 755 patients undergoing a GnRH agonist protocol and 378 patients undergoing a GnRH antagonist cycle. Implantation rates (39.4% vs. 39.5%), cancellation rates (22.4% vs. 19.2%), clinical pregnancy rates (43.6% vs. 48.6%) and live birth rates (34.9% vs. 40.1%) were similar between GnRH antagonist and GnRH agonist protocol groups, respectively. CONCLUSION Clinical pregnancy and live birth rates are similar in good responders utilizing either a GnRH agonist or antagonist during their first cycle of IVF.
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Trew GH, Brown AP, Gillard S, Blackmore S, Clewlow C, O'Donohoe P, Wasiak R. In vitro fertilisation with recombinant follicle stimulating hormone requires less IU usage compared with highly purified human menopausal gonadotrophin: results from a European retrospective observational chart review. Reprod Biol Endocrinol 2010; 8:137. [PMID: 21059191 PMCID: PMC2993713 DOI: 10.1186/1477-7827-8-137] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/08/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have reported conflicting results for the comparative doses of recombinant follicle stimulating hormone (rFSH) and highly purified human menopausal gonadotrophin (hMG-HP) required per cycle of in vitro fertilisation (IVF); the aim of this study was to determine the average total usage of rFSH versus hMG-HP in a 'real-world' setting using routine clinical practice. METHODS This retrospective chart review of databases from four European countries investigated gonadotrophin usage, oocyte and embryo yield, and pregnancy outcomes in IVF cycles (± intra-cytoplasmic sperm injection) using rFSH or hMG-HP alone. Included patients met the National Institute for Health and Clinical Excellence (NICE) guideline criteria for IVF and received either rFSH or hMG-HP. Statistical tests were conducted at 5% significance using Chi-square or t-tests. RESULTS Of 30,630 IVF cycles included in this review, 74% used rFSH and 26% used hMG-HP. A significantly lower drug usage per cycle for rFSH than hMG-HP (2072.53 +/- 76.73 IU vs. 2540.14 +/- 883.08 IU, 22.6% higher for hMG-HP; p < 0.01) was demonstrated. The median starting dose was also significantly lower for rFSH than for hMG-HP (150 IU vs. 225 IU, 50% higher for hMG-HP, p < 0.01). The average oocyte yield per IVF cycle in patients treated with rFSH was significantly greater than with hMG-HP (10.80 +/- 6.02 vs. 9.77 +/- 5.53; p < 0.01), as was the average mature oocyte yield (8.58 +/- 5.27 vs. 7.72 +/- 4.59; p < 0.01). No significant differences were observed in pregnancy outcomes including spontaneous abortion between the two treatments. There was a significantly higher rate of OHSS (all grades) with rFSH (18.92% vs. 14.09%; p < 0.0001). The hospitalisation rate due to OHSS was low but significantly higher in the rFSH group (1.07% of cycles started vs. 0.67% of cycles started with rFSH and hMG-HP, respectively; p = 0.002). CONCLUSIONS Based on these results, IVF treatment cycles with rFSH yield statistically more oocytes (and more mature oocytes), using significantly less IU per cycle, versus hMG-HP. The incidence of all OHSS and hospitalisations due to OHSS was significantly higher in the rFSH cycles compared to the hMG-HP cycles. However, the absolute incidence of hospitalisations due to OHSS was similar to that reported previously. These results suggest that the perceived required dosage with rFSH is currently over-estimated, and the higher unit cost of rFSH may be offset by a lower required dosage compared with hMG-HP.
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Affiliation(s)
- Geoffrey H Trew
- Consultant in Reproductive Medicine and Surgery, Hammersmith Hospital, London UK
| | | | | | | | - Christine Clewlow
- Merck Serono, Bedfont Cross, Stanwell Road, Feltham, Middlesex, TW14 8NX, UK
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Beigi Boroujeni M, Salehnia M, Khalatbary R, Pourbeiranv S, Boroujeni NB, Ebrahimi S. Effect of ovarian stimulation on the endometrial apoptosis at implantation period. Iran Biomed J 2010; 14:171-177. [PMID: 21283260 PMCID: PMC3632425] [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] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/26/2010] [Accepted: 08/01/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Apoptosis is a process that plays an important role during early stage of implantation. The aim of this study was to investigate the incidence of apoptosis in mice endometrium after ovarian stimulation at implantation period. METHODS NMRI female mice were divided into two groups: 1) control group, which were rendered pseudopregnant by vaginal stimulation and 2) experimental group, which were stimulated using an intrapritoneal injection of 10 IU hMG followed by another injection of 10 IU hCG after 48 h. In the evening of the second injection, the mice were rendered pseudopregnant the same as control group. Samples were obtained from 1/3 middle part of uterine horns during implantation period. Apoptosis was assessed in two groups at implantation period using light and electron microscopic studies, TUNEL staining and semiquantitative RT-PCR. RESULTS Our morphological and ultrastructural results showed apoptosis in both groups, while TUNEL analysis showed that the percentage of TUNEL-positive cells was higher in stimulated group than in the control group (P≤0.05). The expression of P53, Fas and FasL mRNA was similar in two groups but Bax and Bcl2 were much higher in control group than in the stimulated group (P≤0.05). The ratio of Bax/Bcl2 expression was much higher in stimulated group than in the control group (P≤0.05). CONCLUSION The ovarian stimulation could change the expression of some apoptosis-related genes and enhance the incidence of endometrial apoptosis at implantation period; thus, it could affect on the implantation rate and endometrial receptivity.
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Affiliation(s)
| | - Mojdeh Salehnia
- Dept. of Anatomical Sciences, Tarbiat Modares University, School of Medicine, Tehran;
| | - Reza Khalatbary
- Dept. of Anatomical Sciences, Lorestan University of Medical Sciences, Khorramabad;
| | - Shahram Pourbeiranv
- Dept. of Anatomical Sciences, Tarbiat Modares University, School of Medicine, Tehran;
| | - Nasim Beigi Boroujeni
- Dept. of Clinical Pathology, Veterinary Medicine Faculty, Tehran University, Tehran, Iran
| | - Saedeh Ebrahimi
- Dept. of Anatomical Sciences, Tarbiat Modares University, School of Medicine, Tehran;
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Lehert P, Schertz JC, Ezcurra D. Recombinant human follicle-stimulating hormone produces more oocytes with a lower total dose per cycle in assisted reproductive technologies compared with highly purified human menopausal gonadotrophin: a meta-analysis. Reprod Biol Endocrinol 2010; 8:112. [PMID: 20846363 PMCID: PMC2954883 DOI: 10.1186/1477-7827-8-112] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 09/16/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human menopausal gonadotrophins and recombinant human follicle stimulating hormone are the two main gonadotrophin products utilized for controlled ovarian stimulation in assisted reproductive technologies. In this meta-analysis, the number of oocytes was designated as the most relevant endpoint directly resulting from ovarian stimulation, and therefore where the drug effect may be estimated with the best sensitivity. METHODS All published randomized controlled trials on ovarian stimulation comparing the two gonadotrophin products were evaluated. Internal validity was determined using Chalmers' validated scale. If trials did not meet the established quality criteria, a sensitivity analysis assessed the stability of the results. The comparison of continuous variables was conducted following the weighted mean difference and the standardized mean difference (Cohen's effect size) with the random model. Given the known relationship of baseline conditions on treatment endpoints, results were adjusted for age, body mass index and type of infertility. RESULTS Sixteen studies involving 4040 patients were included. Treatment with human menopausal gonadotrophins resulted in fewer oocytes (-1.54; 95% CI: -2.53 to -0.56; P < 0.0001) compared to recombinant human follicle-stimulating hormone. When adjusting for baseline conditions, the mean difference estimate was -2.10 (95% CI: -2.83 to -1.36; P < 0.001). A higher total dose of human menopausal gonadotrophin was necessary (mean difference, 235.46 IU [95% CI: 16.62 to 454.30; P = 0.03]; standardized mean difference, 0.33 [95% CI: 0.08 to 0.58; P = 0.01]). The pregnancy absolute risk difference (RD [hMG-r-hFSH]) for fresh transfers was 3% (P = 0.051), and the relative risk 1.10 (P = 0.06). When adjusted for baseline conditions, the relative risk was 1.04 (P = 0.49) and absolute difference was 0.01 (P = 0.34), respectively. CONCLUSIONS Because baseline conditions are predictive of outcome, meta-analytic results are more sensitive when these variables are considered. Using an endpoint closely associated with the stimulation period, sufficient sensitivity is achieved to compare gonadotrophin treatments. As the largest meta-analysis published to date on this subject, treatment with human menopausal gonadotrophins is characterized by fewer oocytes and a higher total dose. When considering only fresh transfers, pregnancy rates were similar.
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Affiliation(s)
- Philippe Lehert
- Department of Statistics, Faculty of Economics FUCAM, Louvain Academy, 151, chaussée de Binche, B-7000 Mons, Belgium
| | - Joan C Schertz
- EMD Serono, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), One Technology Place, Rockland, MA 02370, USA
| | - Diego Ezcurra
- Merck Serono S.A. - Geneva (an affiliate of Merck KGaA, Darmstadt, Germany), 9 Chemin des Mines, Geneva, CH-1202, Switzerland
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Barros-Delgadillo JC, Trejo-Castañeda H, E-Ormsby C, Gaviño-Gaviño F. [Differing response to GnRH antagonists in cycles of ovarian hyperstimulation plus intrauterine insemination]. Ginecol Obstet Mex 2010; 78:15-28. [PMID: 20931799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To compare two flexible protocols of GnRHant in OH plus IUI vs a control group without GnRHant. MATERIALS AND METHODS Randomized controlled trial 90 infertile patients were analyzed in 116 cycles of IUI. Cycles were randomized in 3 groups; group 1: started GnRHant when the leading follicle reached 14mm, group 2: when it reached 16mm and group 3: without GnRHant hormonal determinations were done during OH. Main outcomes were: premature LH raise incidence, premature luteinization (PL) and pregnancy rate per cycle. RESULTS Premature LH rise incidence was 2.6% (3 cycles) and PL 6% (7 cycles). Group 1 didn't present cycles with LH rise or PL, groups 2 and 3 presented LH rise in 3.1% and 1.8% and PL in 12.5% and 5.4% respectively. Pregnancy rate with GnRHant was 16.4% (95% IC 8.1-28.1) vs. 7.2% (95% le 2.0-17.5%) without GnRHant (group 3) (p = 0.16): groups 1 and 2 represented a pregnancy rate of 20.6% (95% IC 7.9-39.7) and 12.5% (95% IC 3.5-28.9%) respectively (p = 0.49). Mature follicles number reached meaning difference between all groups (p = 0.04) specially between groups 1 and 2 (p = 0.02). CONCLUSIONS A trend to elevate pregnancy rates was observed with GnRHant specially with when it was started when leading follicle reached 14 mm (p > 0.05). Starting GnRHant with 16 mm was not totally usefully to prevent PL.
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Sugaya S. Pregnancy following calcium ionophore oocyte activation in an oligozoospermia patient with repeated failure of fertilization after ICSI. CLIN EXP OBSTET GYN 2010; 37:261-262. [PMID: 21355452] [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: 05/30/2023]
Abstract
A successful pregnancy outcome after calcium ionophore A23187 oocyte activation in an infertile couple with a repeated failure of achieving fertilization after ICSI is reported. The secondary infertility couple with oligozoospermia underwent ICSI two times. However, none of the oocytes were fertilized. In the third ICSI attempt, three oocytes after ICSI were activated using calcium ionophore for five minutes. Two of three oocytes thus became fertilized. A successful pregnancy outcome was thereafter achieved with the delivery of a healthy infant without congenital abnormalities. Oocyte activation using calcium ionophore was thus found to be a useful method in a case of repeated failure of fertilization after ICSI.
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Affiliation(s)
- S Sugaya
- Department of Obstetrics and Gynecology, Niigata Workmen's Accident Hospital, Joetsu City, Japan.
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Sönmezer M, Iltemir Duvan C, Ozmen B, Taşçi T, Ozkavukçu S, Atabekoğlu CS. Outcomes after early or midfollicular phase LH supplementation in previous inadequate responders. Reprod Biomed Online 2009; 20:350-7. [PMID: 20093082 DOI: 10.1016/j.rbmo.2009.11.022] [Citation(s) in RCA: 7] [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] [Received: 02/26/2009] [Revised: 03/18/2009] [Accepted: 11/16/2009] [Indexed: 11/18/2022]
Abstract
Second cycle outcomes of 75 patients who had previous inadequate ovarian response with recombinant FSH (rFSH)-only ovarian stimulation during gonadotrophin-releasing hormone analogue (GnRHa) down-regulated cycles were evaluated retrospectively. In these second cycles, both rFSH and human menopausal gonadotrophin (HMG) in GnRHa long down-regulation were given to all patients, HMG initiated either on day 1 (group A, n=37) or day 5-6 of the ovarian stimulation (group B, n=38). Total HMG dose was higher (1198+/-514 IU versus 726+/-469 IU; P<0.001), cumulative rFSH consumption was lower (1823+/-804 IU versus 2863+/-1393 IU; P=0.001) and duration of stimulation was shorter (8.94+/-1.15 days versus 10.37+/-1.80 days; P<0.001) in group A than in group B. No significant differences were found regarding fertilization, implantation or pregnancy rates and embryo quality between the groups. Further analysis by supplementary HMG dose (75 IU versus 150 IU) revealed that total gonadotrophin and HMG consumption was lower in 75 IU-supplemented subgroups. Notably, pregnancy rate was higher in patients where 75 IU HMG was supplemented on day 5-6 of ovarian stimulation, which deserves further evaluation.
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Affiliation(s)
- M Sönmezer
- IVF Unit, Department of Obstetrics and Gynecology, School of Medicine, Ankara University, Ankara, Turkey.
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Abstract
This review aims to evaluate whether severe endometriosis has an impact on the outcome of in vitro fertilisation (IVF), whether IVF is associated with specific complications in this context, whether a specific ovarian stimulation protocol is most appropriate, whether the endometrial condition progresses following ovarian stimulation, and whether endometrial cysts pose a specific problem for IVF. In patients with severe endometriosis, IVF represents an effective treatment option for infertility, as a complement to surgery. The prognostic parameters of IVF are identical to those of other patients. However, the risks related to the severity of endometriosis, particularly the risk of ovarian deficiency, need to be considered. Because of this issue, to which endometriosis-related pain often adds, IVF treatment should be initiated as early as possible, using appropriate protocols and after having fully informed the patient about the specific oocytes retrieval-related risks.
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Affiliation(s)
- Herve Dechaud
- Department of OB/GYN and Reproductive Medicine, Faculty of Medicine, University Hospital Arnaud de Villeneuve, INSERM 637, University Montpellier I, 34295 Montpellier cedex 5, France.
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Reznikov OH, Borys OM, Nosenko ND, Sinitsyn PV, Tarasenko LV, Poliakova LI. [Enhancing effect of androgen receptor antagonist on gonadotropic inductors of ovulation in rats with polycystic ovaries]. Fiziol Zh (1994) 2009; 55:64-73. [PMID: 19827632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hormonal indices, phase pattern of estrous cycles, and histological structure of the ovaries were studied in female rats with polycystic ovaries caused by subcutaneous implantation of Silastic capsules with testosterone after consecutive treatment with non-steroid antiandrogen, flutamide (flutafarm), urinary FSH (menopur) and HCG (choragon). It was shown that while the plasma testosterone level was increased, administration of the drugs in subtherapeutical doses interrupted persistent diestrus, renewed estrous cycle, gonadal and uterine weights, induced appearance of postovulatory luteal bodies and restored fertility. Therefore, antiandrogen potentiation of pharmnnaco-dynamic effect of the gonadotropins with regard to their ability to ovulation induction was found out.
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Prapas N, Tavaniotou A, Panagiotidis Y, Prapa S, Kasapi E, Goudakou M, Papatheodorou A, Prapas Y. Low-dose human chorionic gonadotropin during the proliferative phase may adversely affect endometrial receptivity in oocyte recipients. Gynecol Endocrinol 2009; 25:53-9. [PMID: 19165663 DOI: 10.1080/09513590802360769] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 10/21/2022] Open
Abstract
The effect of low-dose human chorionic gonadotropin (hCG) administration in the proliferative phase of oocyte recipients was investigated in a prospective randomized trial. Sibling oocytes from the same donor were shared at random among two different recipients. In group I oocyte recipients received 750 IU of hCG every three days concomitant to endometrial preparation with estradiol until hCG injection to the donor, whereas in group II recipients received no hCG during endometrial priming with estradiol. Endometrial thickness was significantly lower in group I compared with group II, although similar endometrial thickness was detected during the mock cycle. Pregnancy rates were significantly lower in group I than in group II (13.6% vs. 45.4%, p<0.05). Implantation rates were also significantly lower in group I (1.7% vs. 22.4%, p<0.01). The study was discontinued prematurely for ethical reasons when 22 cycles were completed, as pregnancy rates were very low in group I. In conclusion, hCG administration in the proliferative phase might directly affect endometrial proliferation and receptivity.
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Affiliation(s)
- Nikos Prapas
- Iakentro Fertility Centre, Ag. Vasiliou 4 Street, Thessaloniki, Greece
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Kawamura M, Aoki Y, Kanda R, Nakagomi H, Tsukahara Y, Hashimura N. Repeated intracyclic clomiphene citrate therapy can be more effective than hMG therapy in inducing ovulation: case report. CLIN EXP OBSTET GYN 2009; 36:82-84. [PMID: 19688947] [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: 05/28/2023]
Abstract
PURPOSE OF INVESTIGATION When clomiphene citrate is ineffective in the treatment of anovulation, hMG administration is typically selected. However, high-dose hMG therapy is associated with a variety of adverse events. We describe the use of a modified clomiphene citrate regimen that was successful in increasing the effectiveness of ovulation induction. CASE REPORT A patient who did not initially respond to clomiphene citrate therapy required a total dose of 2400 IU hMG to prodeuce mature follicles. However, because of the physical and emotional burdens on the patient, and the possibility of multiple pregnancy and ovarian hyperstimulation syndrome, re-treatment with clomiphene citrate was then selected. Two courses of clomiphene citrate administered at a fixed interval during the same cycle safely induced ovulation. After initial induction of ovulation, her ovulatory failure improved and natural ovulation occurred. CONCLUSIONS Repeated intracycle clomiphene cirate therapy may be more effective than hMG therapy in inducing ovulation in some patients.
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Affiliation(s)
- M Kawamura
- Department of Obstetrics and Gynecology, Kohseichuo General Hospital, Tokyo, Japan.
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