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Han QS, Wu ZJ, Zhou Y, Liang JN, Jin QM, Song JY, Sun ZG. Effectiveness of oestrogen pretreatment in patients with expected poor ovarian response (POSEIDON groups 3 and 4) undergoing GnRH antagonist protocol: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e069840. [PMID: 37558441 PMCID: PMC10414096 DOI: 10.1136/bmjopen-2022-069840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Women characterised by diminished ovarian reserve are considered to have poor ovarian response (POR) according to Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. Patients in this population often have a poor prognosis for treatment with assisted reproductive technology. In previous studies, oestrogen pretreatment before ovarian stimulation has been shown to have a beneficial effect. However, recent studies presented conflicting conclusions. This study aims to evaluate the effectiveness of oestrogen pretreatment in patients with expected POR (POSEIDON groups 3 and 4) undergoing gonadotrophin releasing hormone antagonist (GnRH-ant) protocol. METHODS AND ANALYSIS A prospective superiority randomised parallel controlled trial will be conducted at a tertiary university-affiliated hospital. A total of 316 patients will be randomly divided into two groups at a ratio of 1:1. In the intervention group, oral oestrogen pretreatment will be administered from day 7 after ovulation until day 2 of the next menstrual cycle. Afterwards, a flexible GnRH-ant protocol will be initiated. The control group will receive no additional intervention beyond routine ovarian stimulation. The primary outcome is the number of oocytes retrieved. Secondary outcomes include the total number of retrieved metaphase II oocytes, average daily dose of gonadotropin, total gonadotropin dose and duration of ovarian stimulation, cycle cancellation rate, top quality embryos rate, blastocyst formation rate, embryo implantation rate, clinical pregnancy rate, early miscarriage rate and endometrial thickness on trigger day. All data will be analysed according to the intention-to-treat and per-protocol principles. ETHICS AND DISSEMINATION The ethical approval has been confirmed by the reproductive ethics committee of the affiliated hospital of Shandong University of Traditional Chinese Medicine (SDUTCM/2022.9.20). In addition, written informed consent will be obtained from all the participants before the study. The results will be disseminated via publications. TRIAL REGISTRATION NUMBER ChiCTR2200064812.
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Affiliation(s)
- Qiao-Song Han
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zhi-Juan Wu
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yue Zhou
- The College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jing-Nan Liang
- The College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qing-Mei Jin
- The College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Reproductive Center of Integrated Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, Shandong, China
| | - Zhen-Gao Sun
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Reproductive Center of Integrated Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, Shandong, China
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102
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Murillo F, Fanton M, Baker VL, Loewke K. Causal inference indicates that poor responders have similar outcomes with the antagonist protocol compared with flare. Fertil Steril 2023; 120:289-296. [PMID: 37044308 DOI: 10.1016/j.fertnstert.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To use causal inference to investigate whether the flare or antagonist protocol is better for poor responders going through controlled ovarian stimulation. DESIGN A retrospective study. SETTING Retrieval cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. PATIENTS Patients in the United States underwent autologous in vitro fertilization cycles from 2014 to 2019 using either the flare or antagonist protocol. INTERVENTION Not applicable. MAIN OUTCOME MEASURE Primary outcomes included oocytes retrieved, fertilized oocytes (2PNs), blastocysts, the cumulative live birth rate (CLBR), and cycle cancelation rate. RESULTS After propensity score matching, patients with a predicted poor response (antimüllerian hormone, <0.5) on their first in vitro fertilization cycle had similar outcomes on the antagonist protocol (CLBR of 14.2%, 95% confidence intervals [CIs]: 13.6%, 14.8%) compared with flare (CLBR of 13.6%, 95% CIs: 12.4%, 14.8%). We evaluated patients undergoing a second cycle after having a poor response (<4 oocytes retrieved) on their first cycle. Patients in the antagonist-to-antagonist group had a similar change in outcomes between the first and second cycles (average CLBR improvement of 13.9%, 95% CIs: 12.1%, 15.6%) compared with the antagonist-to-flare group (average CLBR improvement of 14.4%, 95% CIs: 10.9%, 18.3%). In addition, patients in the flare-to-antagonist group had a similar change in outcomes between the first and second cycles (average CLBR improvement of 10.4%, 95% CIs: 6.6%, 14.5%) compared with the flare-to-flare group (average CLBR improvement of 9.0%, 95% CIs: 5.1%, 13.4%). CONCLUSION Poor responders have similar outcomes on an antagonist protocol compared with a flare protocol for both the first and second cycles.
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Affiliation(s)
| | | | - Valerie L Baker
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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103
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Gharagozloo M, Jahanian Sadatmahalleh S, Kalhor M, Ghaffari F, Hasani F, Jahangiri N, Nasiri M, Khosravi A. Evaluation of the relationship between vitamin D levels with oocyte quality in breast cancer women: a cross-sectional study. Sci Rep 2023; 13:12083. [PMID: 37495647 PMCID: PMC10372054 DOI: 10.1038/s41598-023-39341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/24/2023] [Indexed: 07/28/2023] Open
Abstract
Recent evidence suggests that vitamin D deficiency could play an important role in the development of non-skeletal diseases, including cancer. Vitamin D also affects the function of the reproductive system. In the present study, the relationship between 25(OH)D levels with oocyte quality in Breast Cancer (BC) women and control group have been investigated. After initial evaluations, ovarian stimulation began with the GnRH antagonist protocol in the BC group (N = 16) and control group (N = 16). The serum and follicular fluid (FF) 25(OH)D levels were measured at the time of oocyte retrieval and their relationship to oocyte quality was examined. The mean levels of serum and FF 25(OH)D in BC women were significantly lower than in the control group (22.26 ± 7.98 vs. 29.61 ± 9.12, P = 0.02, 21.65 ± 7.59 vs. 28.00 ± 9.05, P = 0.04, respectively). There was a significant correlation between the levels of 25(OH)D in FF and serum in BC women (r = 0.873, P < 0.001). But there was no correlation between the serum or FF 25(OH)D levels with the parameters related to oocytes (P > 0.05). In the BC women, the number of dysmorph and highly dysmorph oocytes was higher than in the control group (P < 0.001). Women with BC referring to infertility centers for fertility preservation are more likely to be deficient in serum 25(OH)D level; this subsequently affects the FF 25(OH)D level. However, serum and FF 25(OH)D levels may not be suitable indicators for examining maturity and quality of oocytes in terms of morphology in BC women, and the poor morphological quality of oocytes in BC women may be due to other factors.
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Affiliation(s)
- Mahshid Gharagozloo
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 14115-111, Iran
| | - Shahideh Jahanian Sadatmahalleh
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 14115-111, Iran.
| | - Mehri Kalhor
- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Firouzeh Ghaffari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR,, Royan Allay, Eastern Hafez St., Banihashem Sq., Resalat Highway, Tehran, 1665659711, Iran.
| | - Fatemeh Hasani
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Nadia Jahangiri
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR,, Royan Allay, Eastern Hafez St., Banihashem Sq., Resalat Highway, Tehran, 1665659711, Iran
| | - Malihe Nasiri
- Department of Basic Sciences, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, School of Public Health, Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
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104
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Zhu F, Yin S, Yang B, Li S, Feng X, Wang T, Che D. TEAS, DHEA, CoQ10, and GH for poor ovarian response undergoing IVF-ET: a systematic review and network meta-analysis. Reprod Biol Endocrinol 2023; 21:64. [PMID: 37464357 DOI: 10.1186/s12958-023-01119-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Assisted reproductive technology (ART) has brought good news to infertile patients, but how to improve the pregnancy outcome of poor ovarian response (POR) patients is still a serious challenge and the scientific evidence of some adjuvant therapies remains controversial. AIM Based on previous evidence, the purpose of this systematic review and network meta-analysis was to evaluate the effects of DHEA, CoQ10, GH and TEAS on pregnancy outcomes in POR patients undergoing in vitro fertilization and embryo transplantation (IVF-ET). In addition, we aimed to determine the current optimal adjuvant treatment strategies for POR. METHODS PubMed, Embase, The Cochrane Library and four databases in China (CNKI, Wanfang, VIP, SinoMed) were systematically searched up to July 30, 2022, with no restrictions on language. We included randomized controlled trials (RCTs) of adjuvant treatment strategies (DHEA, CoQ10, GH and TEAS) before IVF-ET to improve pregnancy outcomes in POR patients, while the control group received a controlled ovarian stimulation (COS) regimen only. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The surface under the cumulative ranking curve (SUCRA) was used to provide a pooled measure of cumulative ranking for each outcome. RESULTS Sixteen RCTs (2323 women) with POR defined using the Bologna criteria were included in the network meta-analysis. Compared with the control group, CoQ10 (OR 2.22, 95% CI: 1.05 to 4.71) and DHEA (OR 1.92, 95% CI: 1.16 to 3.16) had obvious advantages in improving the clinical pregnancy rate. CoQ10 was the best in improving the live birth rate (OR 2.36, 95% CI: 1.07 to 5.38). DHEA increased the embryo implantation rate (OR 2.80, 95%CI: 1.41 to 5.57) and the high-quality embryo rate (OR 2.01, 95% CI: 1.07 to 3.78) and number of oocytes retrieved (WMD 1.63, 95% CI: 0.34 to 2.92) showed a greater advantage, with GH in second place. Several adjuvant treatment strategies had no significant effect on reducing the cycle canceling rate compared with the control group. TEAS was the least effective of the four adjuvant treatments in most pooled results, but the overall effect appeared to be better than that of the control group. CONCLUSION Compared with COS regimen, the adjuvant use of CoQ10, DHEA and GH before IVF may have a better clinical effect on the pregnancy outcome of POR patients. TEAS needs careful consideration in improving the clinical pregnancy rate. Future large-scale RCTs with direct comparisons are needed to validate or update this conclusion. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022304723.
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Affiliation(s)
- Fengya Zhu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Zigong First People's Hospital, Zigong, China
| | - Shao Yin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bin Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siyun Li
- Zigong First People's Hospital, Zigong, China
| | - Xia Feng
- Zigong First People's Hospital, Zigong, China
| | - Tianyu Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Deya Che
- Zigong First People's Hospital, Zigong, China.
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105
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Cai J, Chen S, Guo S, Wang S, Li L, Liu X, Zheng K, Liu Y, Chen S. RegEMR: a natural language processing system to automatically identify premature ovarian decline from Chinese electronic medical records. BMC Med Inform Decis Mak 2023; 23:126. [PMID: 37464410 PMCID: PMC10353087 DOI: 10.1186/s12911-023-02239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The ovarian reserve is a reservoir for reproductive potential. In clinical practice, early detection and treatment of premature ovarian decline characterized by abnormal ovarian reserve tests is regarded as a critical measure to prevent infertility. However, the relevant data are typically stored in an unstructured format in a hospital's electronic medical record (EMR) system, and their retrieval requires tedious manual abstraction by domain experts. Computational tools are therefore needed to reduce the workload. METHODS We presented RegEMR, an artificial intelligence tool composed of a rule-based natural language processing (NLP) extractor and a knowledge-based disease scoring model, to automatize the screening procedure of premature ovarian decline using Chinese reproductive EMRs. We used regular expressions (REs) as a text mining method and explored whether REs automatically synthesized by the genetic programming-based online platform RegexGenerator + + could be as effective as manually formulated REs. We also investigated how the representativeness of the learning corpus affected the performance of machine-generated REs. Additionally, we translated the clinical diagnostic criteria into a programmable disease diagnostic model for disease scoring and risk stratification. Four hundred outpatient medical records were collected from a Chinese fertility center. Manual review served as the gold standard, and fivefold cross-validation was used for evaluation. RESULTS The overall F-score of manually built REs was 0.9444 (95% CI 0.9373 to 0.9515), with no significant difference (paired t test p > 0.05) compared with machine-generated REs that could be affected by training set sizes and annotation portions. The extractor performed effectively in automatically tracing the dynamic changes in hormone levels (F-score 0.9518-0.9884) and ultrasonographic measures (F-score 0.9472-0.9822). Applying the extracted information to the proposed diagnostic model, the program obtained an accuracy of 0.98 and a sensitivity of 0.93 in risk screening. For each specific disease, the automatic diagnosis in 76% of patients was consistent with that of the clinical diagnosis, and the kappa coefficient was 0.63. CONCLUSION A Chinese NLP system named RegEMR was developed to automatically identify high risk of early ovarian aging and diagnose related diseases from Chinese reproductive EMRs. We hope that this system can aid EMR-based data collection and clinical decision support in fertility centers.
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Affiliation(s)
- Jie Cai
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Shenglin Chen
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Siyun Guo
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Suidong Wang
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Lintong Li
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaotong Liu
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Keming Zheng
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yudong Liu
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Shiling Chen
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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106
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Yung Y, Maydan SA, Bart Y, Orvieto R, Aizer A. Human granulosa cells of poor ovarian responder patients display telomeres shortening. J Assist Reprod Genet 2023:10.1007/s10815-023-02860-6. [PMID: 37432588 PMCID: PMC10371957 DOI: 10.1007/s10815-023-02860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE We aimed to compare the telomere length in granulosa cells of the young normal and poor ovarian responder patients and elderly patients undergoing ovarian stimulation for IVF. METHODS The main outcome measures granulosa cells telomere Length in the 3 study groups of patients undergoing IVF treatment in our center. 1) young normal responder patients (< 35 years); 2) young (< 35 years) poor ovarian responder patients; and 3) Elderly patients (40-45 years). Granulosa cells were obtained at the time of oocyte retrieval. Granulosa cells telomere length was assessed by absolute human telomere length quantification qPCR Assay. RESULTS The telomere length of the young normal responder was significantly longer as compared to young poor ovarian responder (15.5 vs 9.6 KB, p < 0.001) and the elderly patients (15.5 vs 10.66 KB, p < 0.002). No significant difference was observed in the telomere length between the young poor ovarian responder and the elderly patients. CONCLUSIONS Granulosa cells telomere length of the young normal responder was found to be significantly longer than young poor ovarian responder or elderly patients, highlighting the role of telomere length as a predictor, or contributor to poor oocyte yield following IVF treatment.
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Affiliation(s)
- Yuval Yung
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Avhar Maydan
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Adva Aizer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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107
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Al-Hussaini TK, Mohamed AA, Askar A, Abden AA, Othman YM, Hussein RS. Ovarian Stimulation in Patient-oriented Strategies Encompassing Individualised Oocyte Number-4 Category; Antagonist versus Short-agonist Protocols. J Hum Reprod Sci 2023; 16:212-217. [PMID: 38045497 PMCID: PMC10688281 DOI: 10.4103/jhrs.jhrs_72_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background Recently POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) classification was proposed to categorize patients with expected poor response to conventional stimulation. Searching for the ideal management of poor responders in IVF is still an active research area. Aims This study compares GnRH-antagonist and GnRH-agonist short protocols in ICSI cycles for the POSEIDON-4 group. Settings and Design This retrospective study was conducted in a tertiary infertility unit between January 2016 and December 2020. Materials and Methods Infertile women who met the criteria for POSEIDON 4 group and underwent fresh ICSI-ET in using GnRH-antagonist and GnRH-agonist short protocols was performed. POSEIDON-4 includes patients ≥ 35 years with poor ovarian reserve markers; AFC < 5 and AMH < 1.2 ng/ml. Statistical Analysis Used Numerical variables were compared between both groups by student's t test and Mann Whitney test when appropriate. Chi-square test used to compare categorical variables. Multivariate logistic regression models were utilized to adjust for the effect of the different study confounders on live birth rate. Results One hundred ninety fresh ICSI cycles were analyzed. Of the total cohort, 41.6 % (79) patients pursued antagonist protocol compared to 58.4% (111) underwent short agonist protocol. Fresh embryo transfer was accomplished in 55.7 % (44/79) vs. 61.3 % (68/111), P = 0.44 in antagonist vs. short protocol respectively. Cycle cancellation due to poor ovarian response was encountered in (32.9%vs. 27.9%, P = 0.50) in the antagonist and short groups, whereas no good-quality embryos were developed after ovum pickup in 11.4% vs. 10.8%, P>0.05. Comparable total gonadotropins dose, number of retrieved and mature oocytes, and good-quality embryos were found in both groups. Likewise, clinical pregnancy rate was not different for the antagonist and short groups [11/79 (13.9%) vs. 20/111 (18%), P = 0.45]. The live birth rate was comparable between both groups (8.9% vs. 10.8%, P = 0.659) for antagonist and short groups respectively. No significant impact for the protocol type on live birth rate was revealed after adjusting to cycle confounders in multivariate analysis (OR: 0.439, 95%CI 0.134-1.434, P = 0.173). Conclusion This study shows comparable pregnancy outcomes for antagonist and short-agonist protocols in IVF/ICSI cycles for POSEIDON-4 category.
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Affiliation(s)
- Tarek K. Al-Hussaini
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | | | - Ayman Askar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Ahmed A. Abden
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Yousra M. Othman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Reda S. Hussein
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Asyut, Egypt
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108
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Noli SA, Ferrari S, Ricci E, Reschini M, Cipriani S, Dallagiovanna C, Parazzini F, Somigliana E. Adherence to the Mediterranean diet and the risk of unexpected poor response to ovarian stimulation in IVF cycles. Reprod Biomed Online 2023; 47:77-83. [PMID: 37150703 DOI: 10.1016/j.rbmo.2023.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
RESEARCH QUESTION Can preconception adherence to a Mediterranean diet influence the rate of poor response to ovarian stimulation in IVF cycles? DESIGN The impact of dietary habits on the success of IVF is controversial. Inconsistencies may be explained by confounders associated with the use of pregnancy as an outcome as well as by a reductionist view of diet that focuses on single components rather than on food patterns. This cross-sectional study analysed adherence to a Mediterranean diet in women with unexpected poor response to ovarian stimulation. Main inclusion criteria were: age 18-39 years, normal weight, preserved ovarian reserve and starting dose of gonadotrophins of 150-225 IU/day. Adherence to the Mediterranean diet was assessed through a Mediterranean diet score (MDS). Unexpected poor ovarian response was defined as the retrieval of ≤3 suitable oocytes. RESULTS A total of 296 women were included, of whom 47 (15.9%) showed an unexpected poor response. A clear dose-related association with tertiles of MDS was not observed in the univariate analysis. However, in the multivariate analysis, the risk of unexpected poor response was significantly lower for women in the second tertile of MDS compared with the first tertile (adjusted odds ratio [OR] 0.29, 95% confidence interval [CI] 0.11-0.76) and for women in the second and third tertiles, grouped together, compared with the first tertile (adjusted OR 0.34, 95% CI 0.14-0.82). CONCLUSIONS Low adherence to a Mediterranean diet could be a risk factor for unexpected poor ovarian response.
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Affiliation(s)
- Stefania Antonia Noli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Stefania Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Ricci
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Marco Reschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonia Cipriani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Donato R, Bessow C, Genro V, Chapon R, Oliveira de Souza T, Cunha-Filho JSLD. Corifollitropin alpha was not detrimental to follicular ovarian responsiveness measured by follicular output rate (FORT). HUM FERTIL 2023; 26:557-563. [PMID: 34412562 DOI: 10.1080/14647273.2021.1968044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Corifollitropin alpha has been demonstrated to be non-inferior to other gonadotropins in reproductive outcomes. However, its impact on follicular ovarian responsiveness has never been evaluated. Follicular Output Rate (FORT) is an option for objective assessment of the follicular responsiveness. A prospective study was conducted with 306 infertile patients undergoing in vitro fertilisation. Ovarian stimulation protocol was performed with a single dose of 100 μg (<60kg) or 150 μg (≥60kg) corifollitropin alpha in group 1 (n = 147), and 150-300 IU/day human menopausal gonadotropin in group 2 (n = 150). Comparing ovarian stimulation between corifollitropin alpha and human menopausal gonadotropin, no differences regarding FORT were found (40.0% for group 1 versus 40.83% for group 2; p = 0.930). Patients treated with corifollitropin alpha had a higher number of embryos when compared with human menopausal gonadotropin group (3.0 for group 1 versus 2.0 for group 2; p = 0.04). Other secondary outcomes preset were similar between groups. Therefore, corifollitropin alpha can be an excellent option to simplify in vitro fertilisation treatment due to the "patient-friendly" protocol.
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Affiliation(s)
- Rafaela Donato
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Camila Bessow
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Vanessa Genro
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Rita Chapon
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | | | - João Sabino Lahorgue da Cunha-Filho
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
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110
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Zhou XY, Yang YZ, Zhang J, Zhang XF, Liu YD, Wang Z, Chen SL. Elevated cell-free mitochondria DNA level of patients with premature ovarian insufficiency. BMC Pregnancy Childbirth 2023; 23:462. [PMID: 37349693 DOI: 10.1186/s12884-023-05769-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Premature ovarian insufficiency (POI) patients present with a chronic inflammatory state. Cell-free mitochondria DNA (cf-mtDNA) has been explored as a reliable biomarker for estimating the inflammation-related disorders, however, the cf-mtDNA levels in POI patients have never been measured. Therefore, in the presenting study, we aimed to evaluate the levels of cf-mtDNA in plasma and follicular fluid (FF) of POI patients and to determine a potential role of cf-mtDNA in predicting the disease progress and pregnancy outcomes. METHODS We collected plasma and FF samples from POI patients, biochemical POI (bPOI) patients and control women. Quantitative real-time PCR was used to measure the ratio of mitochondrial genome to nuclear genome of cf-DNAs extracted from the plasma and FF samples. RESULTS The plasma cf-mtDNA levels, including COX3, CYB, ND1 and mtDNA79, were significantly higher in overt POI patients than those in bPOI patients or control women. The plasma cf-mtDNA levels were weakly correlated with ovarian reserve, and could not be improved by regular hormone replacement therapy. The levels of cf-mtDNA in FF, rather than those in plasma, exhibited the potential to predict the pregnancy outcomes, although they were comparable among overt POI, bPOI and control groups. CONCLUSIONS The increased plasma cf-mtDNA levels in overt POI patients indicated its role in the progress of POI and the FF cf-mtDNA content may hold the value in predicting pregnancy outcomes of POI patients.
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Affiliation(s)
- Xing-Yu Zhou
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Northern Road, Guangzhou, 510515, Guangdong, China
| | - Yi-Zhen Yang
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Northern Road, Guangzhou, 510515, Guangdong, China
| | - Jun Zhang
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Northern Road, Guangzhou, 510515, Guangdong, China
| | - Xiao-Fei Zhang
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Northern Road, Guangzhou, 510515, Guangdong, China
| | - Yu-Dong Liu
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Northern Road, Guangzhou, 510515, Guangdong, China
| | - Zhe Wang
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Northern Road, Guangzhou, 510515, Guangdong, China
| | - Shi-Ling Chen
- Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Northern Road, Guangzhou, 510515, Guangdong, China.
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111
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Walker ZW, Lanes A, Srouji SS, Hornstein MD, Ginsburg ES. Ultra-low-dose and very-low-dose Lupron downregulation protocols for poor responders based on POSEIDON group 3 and 4 classifications. J Assist Reprod Genet 2023:10.1007/s10815-023-02842-8. [PMID: 37326893 PMCID: PMC10371969 DOI: 10.1007/s10815-023-02842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE The objective of this study was to assess if very-low-dose Lupron (VLDL) and ultra-low-dose Lupron (ULDL) protocols can have comparable cycle outcomes when compared to other "poor responder" stimulation protocols based on POSEIDON classification groups 3 (PG3) and 4 (PG4). METHODS A retrospective cohort study at a single, large academic center was performed. Women in PG3 (age < 35, AMH < 1.2 ng/mL) or PG4 (age ≥ 35, AMH < 1.2 ng/mL) undergoing in vitro fertilization using an ULDL (Lupron 0.1 to 0.05 mg daily), VLDL (Lupron 0.2 to 0.1 mg daily), microflare (Lupron 0.05 mg twice a day), estradiol priming/antagonist, antagonist, or minimal stimulation protocols from 2012 to 2021 were included. The primary outcome was the number of mature oocytes (MII) obtained. The secondary outcome was live birth rate (LBR). RESULTS The cohort included 3601 cycles. The mean age was 38.1 ± 3.8 years. In the PG3 group, ULDL and VLDL protocols produced a comparable number of MIIs (5.8 ± 4.3 and 5.9 ± 5.4, respectively) and live births (33.3% and 33.3%, respectively) when compared to other protocols. In the PG4 group, ULDL and VLDL protocols resulted in a higher percentage of MIIs when compared to microflare or minimal stimulation (Microflare/ULDL: adjusted relative risk (aRR) 0.78 (95% CI 0.65, 0.95); min stim/ULDL: aRR 0.47 (95% CI 0.38, 0.58); microflare/VLDL: aRR 0.77 (95% CI 0.63, 0.95); min stim/VLDL: aRR 0.47 (95% CI 0.38, 0.95)). There were no significant differences in LBR. CONCLUSION Dilute Lupron downregulation protocols have comparable outcomes to other poor responder protocols and are reasonable to use.
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Affiliation(s)
- Zachary W Walker
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Andrea Lanes
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Serene S Srouji
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Mark D Hornstein
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Elizabeth S Ginsburg
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
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112
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Zhang J, Jia H, Diao F, Ma X, Liu J, Cui Y. Efficacy of dehydroepiandrosterone priming in women with poor ovarian response undergoing IVF/ICSI: a meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1156280. [PMID: 37361534 PMCID: PMC10288189 DOI: 10.3389/fendo.2023.1156280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background Dehydroepiandrosterone (DHEA) may improve the outcomes of patients with poor ovarian response (POR) or diminished ovarian reserve (DOR) undergoing IVF/ICSI. However, the evidence remains inconsistent. This study aimed to investigate the efficacy of DHEA supplementation in patients with POR/DOR undergoing IVF/ICSI. Methods PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) were searched up to October 2022. Results A total of 32 studies were retrieved, including 14 RCTs, 11 self-controlled studies and 7 case-controlled studies. In the subgroup analysis of only RCTs, DHEA treatment significantly increased the number of antral follicle count (AFC) (weighted mean difference : WMD 1.18, 95% confidence interval(CI): 0.17 to 2.19, P=0.022), while reduced the level of bFSH (WMD -1.99, 95% CI: -2.52 to -1.46, P<0.001), the need of gonadotropin (Gn) doses (WMD -382.29, 95% CI: -644.82 to -119.76, P=0.004), the days of stimulation (WMD -0.90, 95% CI: -1.34 to -0.47, P <0.001) and miscarriage rate (relative risk : RR 0.46, 95% CI: 0.29 to 0.73, P=0.001). The higher clinical pregnancy and live birth rates were found in the analysis of non-RCTs. However, there were no significant differences in the number of retrieved oocytes, the number of transferred embryos, and the clinical pregnancy and live birth rates in the subgroup analysis of only RCTs. Moreover, meta-regression analyses showed that women with lower basal FSH had more increase in serum FSH levels (b=-0.94, 95% CI: -1.62 to -0.25, P=0.014), and women with higher baseline AMH levels had more increase in serum AMH levels (b=-0.60, 95% CI: -1.15 to -0.06, P=0.035) after DHEA supplementation. In addition, the number of retrieved oocytes was higher in the studies on relatively younger women (b=-0.21, 95% CI: -0.39 to -0.03, P=0.023) and small sample sizes (b=-0.003, 95% CI: -0.006 to -0.0003, P=0.032). Conclusions DHEA treatment didn't significantly improve the live birth rate of women with DOR or POR undergoing IVF/ICSI in the subgroup analysis of only RCTs. The higher clinical pregnancy and live birth rates in those non-RCTs should be interpreted with caution because of potential bias. Further studies using more explicit criteria to subjects are needed. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD 42022384393.
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Affiliation(s)
- Jie Zhang
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongyan Jia
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Clinical Centre of Reproductive Medicine, Lianyungang Maternal and Child Health Hospital Kangda College of Nanjing Medical University, Lianyungang, China
| | - Feiyang Diao
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Ma
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yugui Cui
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Viardot-Foucault V, Zhou J, Bi D, Takinami Y, Chan JKY, Lee YH. Dehydroepiandrosterone supplementation and the impact of follicular fluid metabolome and cytokinome profiles in poor ovarian responders. J Ovarian Res 2023; 16:107. [PMID: 37268990 PMCID: PMC10239139 DOI: 10.1186/s13048-023-01166-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Poor ovarian responders (POR) are women undergoing in-vitro fertilization who respond poorly to ovarian stimulation, resulting in the retrieval of lower number of oocytes, and subsequently lower pregnancy rates. The follicular fluid (FF) provides a crucial microenvironment for the proper development of follicles and oocytes through tightly controlled metabolism and cell signaling. Androgens such as dehydroepiandrosterone (DHEA) have been proposed to alter the POR follicular microenvironment, but the impact DHEA imposes on the FF metabolome and cytokine profiles is unknown. Therefore, the objective of this study is to profile and identify metabolomic changes in the FF with DHEA supplementation in POR patients. METHODS FF samples collected from 52 POR patients who underwent IVF with DHEA supplementation (DHEA +) and without (DHEA-; controls) were analyzed using untargeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomics and a large-scale multiplex suspension immunoassay covering 65 cytokines, chemokines and growth factors. Multivariate statistical modelling by partial least squares-discriminant regression (PLSR) analysis was performed for revealing metabolome-scale differences. Further, differential metabolite analysis between the two groups was performed by PLSR β-coefficient regression analysis and Student's t-test. RESULTS Untargeted metabolomics identified 118 FF metabolites of diverse chemistries and concentrations which spanned three orders of magnitude. They include metabolic products highly associated with ovarian function - amino acids for regulating pH and osmolarity, lipids such fatty acids and cholesterols for oocyte maturation, and glucocorticoids for ovarian steroidogenesis. Four metabolites, namely, glycerophosphocholine, linoleic acid, progesterone, and valine were significantly lower in DHEA + relative to DHEA- (p < 0.05-0.005). The area under the curves of progesterone glycerophosphocholine, linoleic acid and valine are 0.711, 0.730, 0.785 and 0.818 (p < 0.05-0.01). In DHEA + patients, progesterone positively correlated with IGF-1 (Pearson r: 0.6757, p < 0.01); glycerophosphocholine negatively correlated with AMH (Pearson r: -0.5815; p < 0.05); linoleic acid correlated with estradiol and IGF-1 (Pearson r: 0.7016 and 0.8203, respectively; p < 0.01 for both). In DHEA- patients, valine negatively correlated with serum-free testosterone (Pearson r: -0.8774; p < 0.0001). Using the large-scale immunoassay of 45 cytokines, we observed significantly lower MCP1, IFNγ, LIF and VEGF-D levels in DHEA + relative to DHEA. CONCLUSIONS In POR patients, DHEA supplementation altered the FF metabolome and cytokine profile. The identified four FF metabolites that significantly changed with DHEA may provide information for titrating and monitoring individual DHEA supplementation.
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Affiliation(s)
- Veronique Viardot-Foucault
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Jieliang Zhou
- Translational ‘Omics and Biomarkers Group, KK Research Centre, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Dexi Bi
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072 China
| | - Yoshihiko Takinami
- Bruker Japan, 3-9 Yokohama City, Kanagawa, 220-0022 Japan
- Present Address: Kanomax Analytical Incorportated, Shimizu Suita City, Osaka Japan
| | - Jerry. K. Y. Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
- Obstetrics and Gynaecology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Yie Hou Lee
- Translational ‘Omics and Biomarkers Group, KK Research Centre, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
- Obstetrics and Gynaecology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore-MIT Alliance for Research and Technoology, 1 CREATE Way, Singapore, 138602 Singapore
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114
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Sahin GN, Yildirim RM, Seli E. Embryonic arrest: causes and implications. Curr Opin Obstet Gynecol 2023; 35:184-192. [PMID: 37039141 DOI: 10.1097/gco.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
PURPOSE OF REVIEW Embryonic arrest is a key determinant of the number of euploid blastocysts obtained after IVF. Here, we review factors that are implicated in the developmental arrest of preimplantation embryos and their relevance for assisted reproduction outcomes. RECENT FINDINGS Among the treatment options available to infertile women, IVF is the one associated with most favorable outcomes. The cumulative pregnancy rates in women undergoing IVF are determined by aneuploidy rate (age), ovarian response to stimulation (ovarian reserve), and the rate of embryo developmental arrest. Mutations in maternal effect genes, especially those encoding for subcortical maternal complex, have been implicated in human embryo developmental arrest. In addition, perturbation of biological processes, such as mitochondrial unfolded protein response and long noncoding RNA regulatory pathways, may play a role. However, how each of these factors contributes to embryos' arrest in different cohorts and age groups has not been determined. SUMMARY Arrest of human embryos during preimplantation development is a common occurrence and is partly responsible for the limited number of euploid blastocysts obtained in assisted reproduction cycles. Although genetic and metabolic causes have been implicated, the mechanisms responsible for human embryo developmental arrest remain poorly characterized.
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Affiliation(s)
- Gizem N Sahin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Raziye M Yildirim
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Emre Seli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- IVIRMA New Jersey, Basking Ridge, New Jersey, USA
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115
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Mitsunami M, Mínguez-Alarcón L, Florio AA, Wang S, Attaman JA, Souter I, Hauser R, Chavarro JE. Intake of soy products and soy isoflavones in relation to ovarian reserve. Fertil Steril 2023; 119:1017-1029. [PMID: 36871859 PMCID: PMC10225319 DOI: 10.1016/j.fertnstert.2023.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 02/18/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE To investigate the association between intake of soy food and isoflavone with ovarian reserve. Previous studies suggest on the relationship between soy intake and human fertility are inconsistent. Some clinical studies suggest that soy and phytoestrogens may not be deleterious to reproduction and may even be beneficial in couples undergoing infertility treatment. However, no studies have evaluated the relationship between soy or isoflavone intake with markers of ovarian reserve other than follicle-stimulating hormone (FSH). DESIGN Cross-sectional study. SETTING An academic fertility center. PATIENT(S) Patients presenting to an academic fertility center between 2007 and 2019 were invited to participate in the Environment and Reproductive Health Study. INTERVENTION(S) Six hundred and sixty seven participants reported their soy food intake and had an antral follicle count (AFC) assessment. Intake of 15 soy-based foods during the previous 3 months was obtained at baseline and intake of isoflavone was estimated. Participants were divided into 5 groups based on soy food and isoflavone intake considering those who did not consume soy as the reference group. MAIN OUTCOME MEASURE(S) Ovarian reserve was assessed using AFC as the primary outcome measure, with antimüllerian hormone (AMH) and FSH as secondary outcome measures. The AFC was measured on the third day of the menstrual cycle. Moreover, FSH and AMH levels were measured in blood samples obtained on the third day and the follicular phase of the menstrual cycle. To evaluate the association between soy intake and ovarian reserve, we used Poisson regression models for AFC and quantile regression models for AMH and day 3 FSH levels by adjusting for confounders. RESULT(S) Participants had a median age of 35.0 years. The median intake of soy was 0.09 servings/day and isoflavones was 1.78 mg/day. Moreover, AFC, AMH, and FSH were unrelated to soy intake in crude analyses. We found no association between soy food intake with AFC or day 3 FSH level in multivariable models. However, participants in the highest category of soy food intake had significantly low AMH levels (-1.16, 95% confidence interval: -1.92, -0.41). Soy intake had no association with AFC, AMH, or FSH in sensitivity analyses that included using different cutoff points of soy intake, excluding participants in the highest 2.5 percentile of intake, and additional statistical adjustment for dietary patterns. CONCLUSION(S) The results of this study are not consistent with a strong positive or inverse association of soy or isoflavone intakes within the observed range of intake, which substantially overlaps with that in the general population of the United States as well as the ovarian reserve among individuals presenting to fertility centers.
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Affiliation(s)
- Makiko Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrea A Florio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jill A Attaman
- Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Souter
- Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Russ Hauser
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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116
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Yuan WS, Abu MA, Ahmad MF, Elias MH, Abdul Karim AK. Effects of Dehydroepiandrosterone (DHEA) Supplementation on Ovarian Cumulus Cells following In Vitro Fertilization (IVF)/Intra-Cytoplasmic Sperm Injection (ICSI) Treatment-A Systematic Review. Life (Basel) 2023; 13:1237. [PMID: 37374020 DOI: 10.3390/life13061237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/29/2023] Open
Abstract
Despite many studies exploring the effects of DHEA supplementation, its application in IVF procedure continues to be a subject of debate owing to the inconsistent findings and the lack of rigorously designed, large-scale, randomized trials. Our review aims to explore the effectiveness of DHEA supplementation in ovarian cumulus cells following IVF/ICSI treatment. We conducted a literature search of Pub-Med, Ovid MEDLINE, and SCOPUS (inception to June 2022) for all relevant articles, including the keywords of "dehydroepiandrosterone/DHEA", "oocyte", and "cumulus cells". From the preliminary search, 69 publications were identified, and following a thorough screening process, seven studies were ultimately incorporated into the final review. Four hundred twenty-four women were enrolled in these studies, with DHEA supplementation being administered exclusively to women exhibiting poor ovarian response/diminished ovarian reserve or belonging to an older age demographic. The intervention in the studies was DHEA 75-90 mg daily for at least 8-12 weeks. The only randomized controlled trial showed no difference in clinical or cumulus cell-related outcomes between the control and treatment groups. However, the remaining six studies (two cohorts, four case-controls) showed significant beneficial effects of DHEA in cumulus cell-related outcomes compared to the group (older age or POR/DOR) without DHEA supplementation. All studies revealed no significant difference in stimulation and pregnancy outcomes. Our review concludes that DHEA supplementation did show beneficial effect on ovarian cumulus cells in improving oocyte quality for women of advanced age or with poor ovarian responders.
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Affiliation(s)
- Woon Shu Yuan
- Advanced Reproductive Center, Department of Obstetrics and Gynaecology, UKM Medical Centre, Kuala Lumpur 56000, Malaysia
| | - Muhammad Azrai Abu
- Advanced Reproductive Center, Department of Obstetrics and Gynaecology, UKM Medical Centre, Kuala Lumpur 56000, Malaysia
| | - Mohd Faizal Ahmad
- Advanced Reproductive Center, Department of Obstetrics and Gynaecology, UKM Medical Centre, Kuala Lumpur 56000, Malaysia
| | - Marjanu Hikmah Elias
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai 71800, Malaysia
| | - Abdul Kadir Abdul Karim
- Advanced Reproductive Center, Department of Obstetrics and Gynaecology, UKM Medical Centre, Kuala Lumpur 56000, Malaysia
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117
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Dong X, Xue X. Live birth rate following a failed first in vitro fertilization cycle with no embryos for transfer. Sci Rep 2023; 13:8343. [PMID: 37221255 DOI: 10.1038/s41598-023-35221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
After a failed in vitro fertilization (IVF) procedure in which no transferable embryo was obtained, the possibility of a subsequent pregnancy for the patient is unknown. We conducted a cohort retrospective study evaluating the live birth rate in the subsequent cycles of the patients with no embryo for transfer in their first IVF attempt between 2017and 2020. The first cycle variables of patients who conceived in subsequent cycles were compared to those who did not. Additionally, for patients who conceived at last, variables related to ovarian stimulation were compared between the first cycle and the conceiving cycle. In accordance with the inclusion criteria, 529 were enrolled during the study period, of which 230 had successful pregnancies and 192 gave birth to a live infant. Cumulative live birth rates (CLBR) per cycle and patient were 26% and 36% respectively. Moreover, 99% of the live births were obtained within the first three attempts, beyond six cycles, there was no pregnancy. Stimulating variables in the first cycle were not effective in predicting the likelihood of a patient's subsequent pregnancy. Overall, patients who did not have embryos available for transfer in the first cycle had a 36% chance of getting a live birth in subsequent attempts, and the cause of failure should be considered.
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Affiliation(s)
- Xiaohui Dong
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Xia Xue
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China.
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118
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Salmeri N, Gennarelli G, Vanni VS, Ferrari S, Ruffa A, Rovere-Querini P, Pagliardini L, Candiani M, Papaleo E. Concomitant Autoimmunity in Endometriosis Impairs Endometrium-Embryo Crosstalk at the Implantation Site: A Multicenter Case-Control Study. J Clin Med 2023; 12:jcm12103557. [PMID: 37240662 DOI: 10.3390/jcm12103557] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Endometriosis and autoimmune diseases share a hyper-inflammatory state that might negatively impact the embryo-endometrium crosstalk. Inflammatory and immune deregulatory mechanisms have been shown to impair both endometrial receptivity and embryo competence at the implantation site. The aim of this study was to investigate the potential additional impact of co-existing autoimmunity in women affected by endometriosis on the early stages of reproduction. This was a retrospective, multicenter case-control study enrolling N = 600 women with endometriosis who underwent in vitro fertilization-embryo transfer cycles between 2007 and 2021. Cases were women with endometriosis and concomitant autoimmunity matched based on age and body mass index to controls with endometriosis only in a 1:3 ratio. The primary outcome was the cumulative clinical pregnancy rate (cCPR). The study found significantly lower cleavage (p = 0.042) and implantation (p = 0.029) rates among cases. Autoimmunity (p = 0.018), age (p = 0.007), and expected poor response (p = 0.014) were significant negative predictors of cCPR, with an adjusted odds ratio of 0.54 (95% CI, 0.33-0.90) for autoimmunity. These results suggest that the presence of concomitant autoimmunity in endometriosis has a significant additive negative impact on embryo implantation. This effect might be due to several immunological and inflammatory mechanisms that interfere with both endometrial receptivity and embryo development and deserves further consideration.
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Affiliation(s)
- Noemi Salmeri
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gianluca Gennarelli
- Obstetrics and Gynecology, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Valeria Stella Vanni
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Stefano Ferrari
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandro Ruffa
- Obstetrics and Gynecology, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Luca Pagliardini
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Massimo Candiani
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Enrico Papaleo
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Boogaerts M, Mengels A, Lie Fong S, Peeraer K, Tomasseti C, Vanhie A. Impact of Indication for Oocyte and Embryo Reception on Reproductive and Obstetric Outcomes. Gynecol Obstet Invest 2023; 88:267-277. [PMID: 37231826 DOI: 10.1159/000530885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES This study aimed to assess if the indication for oocyte reception (OR) or embryo reception (ER) impacts the reproductive and obstetric outcomes by evaluating our experience at a tertiary fertility centre and by performing a literature review on this subject. Several previous studies have reported that, in contrast to other types of fertility treatment, the indication for OR/ER seems to have little impact on the outcomes. However, the compared indication groups vary considerably between these studies, and some data indicates worse outcomes in patients who developed premature ovarian insufficiency (POI) due to Turner syndrome or treatment with chemotherapy/radiotherapy. DESIGN A retrospective analysis of all cases of OR/ER at a tertiary fertility centre from 2001 until 2020 was conducted. We analysed 584 cycles from 194 individual patients. A literature review on the impact of indication on reproductive or obstetric outcomes of OR/ER was performed using the following databases: PubMed/MEDLINE, Embase, and the Cochrane Library. A total of 27 studies were included and analysed. PARTICIPANTS, SETTING, METHODS For the retrospective analysis, patients were divided into three major indication groups: failure of autologous assisted reproductive technology, POI, and genetic disease carrier. To assess reproductive outcomes, we determined pregnancy rate, implantation rate, miscarriage rate, and live birth rate. For comparing obstetric outcomes, we reviewed the term of birth, mode of delivery, and birthweight. Outcomes were compared using Fisher's exact test, χ2 test, and one-way ANOVA utilizing the GraphPad tool. RESULTS There were no significant differences in reproductive and obstetric outcomes between the three major indication groups in our population, in line with the findings reported by existing literature. Data on impaired reproductive outcomes in patients with POI after chemotherapy/radiotherapy are conflicting. Obstetrically, these patients are at higher risk of preterm birth and possibly also low birthweight, especially after abdomino-pelvic or total body irradiation. For patients with POI due to Turner syndrome, most data suggest similar pregnancy rates but a higher rate of pregnancy loss, and obstetrically an increased risk of hypertensive disorders and caesarean section. LIMITATIONS The small number of patients in the retrospective analysis resulted in low statistical power when evaluating differences between smaller subgroups. There were some missing data on the occurrence of complications during pregnancy. Our analysis covers a period of 20 years, during which several technological innovations have also been made. CONCLUSIONS Our study shows that the important heterogeneity in couples treated with OR/ER does not significantly impact their reproductive or obstetric outcomes, except for POI due to Turner syndrome or treatment with chemotherapy/radiotherapy, where there seems to be an important uterine/endometrial component that cannot be entirely overcome by providing a healthy oocyte.
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Affiliation(s)
- Matthias Boogaerts
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Annemie Mengels
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Sharon Lie Fong
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Karen Peeraer
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Carla Tomasseti
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Arne Vanhie
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Bielfeld AP, Schwarze JE, Verpillat P, Lispi M, Fischer R, Hayward B, Chuderland D, D'Hooghe T, Krussel JS. Effectiveness of recombinant human follicle-stimulating hormone (r-hFSH): recombinant human luteinizing hormone versus r-hFSH alone in assisted reproductive technology treatment cycles among women aged 35-40 years: A German database study. Best Pract Res Clin Obstet Gynaecol 2023; 89:102350. [PMID: 37320996 DOI: 10.1016/j.bpobgyn.2023.102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/21/2023] [Accepted: 05/07/2023] [Indexed: 06/17/2023]
Abstract
This non-interventional study compared the effectiveness of recombinant human follicle-stimulating hormone (r-hFSH) and recombinant human luteinizing hormone (r-hLH) (2:1 ratio) versus r-hFSH alone for ovarian stimulation (OS) during assisted reproductive technology treatment in women aged 35-40 years, using real-world data from the Deutsches IVF-Register (D·I·R). Numerically higher clinical pregnancy (29.8% [95% CI 28.2, 31.6] vs. 27.8% [26.5, 29.2]) and live birth (20.3% [18.7, 21.8] vs. 18.0% [16.6, 19.4]) rates were observed with r-hFSH:r-hLH versus r-hFSH alone. The treatment effect was consistently higher for r-hFSH:r-hLH compared with r-hFSH alone in terms of clinical pregnancy (relative risk [RR] 1.16 [1.05, 1.26]) and live birth (RR 1.16 [1.02, 1.31]) in a post-hoc analysis of women with 5-14 oocytes retrieved (used as a surrogate for normal ovarian reserve), highlighting the potential benefits of r-hFSH:r-hLH for OS in women aged 35-40 years with normal ovarian reserve.
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Affiliation(s)
- A P Bielfeld
- Department of Obstetrics/Gynecology and Reproductive Medicine, UniKiD Center for Reproductive Medicine (UniKiD), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Universitätsstraße 1, 40225, Duesseldorf, Germany.
| | - J E Schwarze
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany.
| | - P Verpillat
- Global Epidemiology, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany.
| | - M Lispi
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany; PhD School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Viale A. Allegri 9. 42121, Emilia-Romagna, Italy.
| | - R Fischer
- Fertility Centre Hamburg, 20095, Hamburg, Germany.
| | - B Hayward
- EMD Serono, One Technology Place, Rockland, MA 02370, USA, and affiliate of Merck KGaA, Darmstadt, Germany.
| | - D Chuderland
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany.
| | - T D'Hooghe
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU 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.
| | - J S Krussel
- Department of Obstetrics/Gynecology and Reproductive Medicine, UniKiD Center for Reproductive Medicine (UniKiD), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Universitätsstraße 1, 40225, Duesseldorf, Germany.
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121
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Li Y, Xiao N, Liu M, Liu Y, He A, Wang L, Luo H, Yao Y, Sun H. Dysregulation of steroid metabolome in follicular fluid links phthalate exposure to diminished ovarian reserve of childbearing-age women. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 330:121730. [PMID: 37116568 DOI: 10.1016/j.envpol.2023.121730] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
The widespread use of phthalates (PAEs) has drawn increasing attention due to their endocrine disruption and reproductive toxicity, while the steroid metabolome is essential for follicular development. However, the mechanism by which PAE exposure affects ovarian reserve through the steroid metabolome remains unclear. This study recruited 264 childbearing-age women in Tianjin (China) from April 2019 to August 2020 in a cross-sectional design. Target metabolome analysis of 16 steroids was performed in follicular fluid (FF) to compare diminished ovarian reserve (DOR) against normal ovarian reserve (NOR) women and differential steroids were identified using binary logistic analyses. Further analysis of eleven PAE metabolites (mPAEs) in FF was conducted, and the retrieved oocyte number (RON) representing ovarian reserve was counted. Multiple linear regression and quantile-based g-computation (qgcomp) models were used to associate individual mPAEs and mPAE mixture with the DOR-related differential steroids in FF. Mediation analysis was used to discuss the mediating effect of DOR-related steroids on the association between mPAEs and RON. Androstenedione (A4), corticosterone (CORT), cortisol (COR) and cortisone were significantly down-regulated in FF from women with DOR. Nine mPAEs with detection frequencies greater than 60% and median concentrations of 0.02-4.86 ng/mL were incorporated into statistical models. Negative associations with COR and CORT were found for mono-ethyl phthalate (mEP), mono-(2-ethyl-5-oxohexyl) phthalate (mEOHP), and mono-2-ethylhexyl phthalate (mEHP). A positive association with cortisone was found for mEOHP, mEHP, monobutyl phthalate (mBP), and mono (2-isobutyl) phthalate (miBP). The qgcomp and mediation analyses revealed that mEP and mEOHP not only significantly contributed to the decline of COR and CORT in the mixed exposure but also indirectly reduced RON through the mediating effects of COR and CORT. In conclusion, PAE exposure may decrease ovarian reserve by downregulating COR and CORT.
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Affiliation(s)
- Yongcheng Li
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - Nan Xiao
- Department of Center for Reproductive Medicine, Tianjin Central Hospital of Obstetrics and Gynecology/Nankai University Affiliated Maternity Hospital/ Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, 300100, China
| | - Min Liu
- Department of Gynecology and Obstetrics, Capital Medical University Affiliated Shijitan Hospital, No. 10, Tieyi Road, Yangfangdian Street, Haidian District, Beijing, China
| | - Yarui Liu
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - Ana He
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - Lei Wang
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - Haining Luo
- Department of Center for Reproductive Medicine, Tianjin Central Hospital of Obstetrics and Gynecology/Nankai University Affiliated Maternity Hospital/ Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, 300100, China
| | - Yiming Yao
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China.
| | - Hongwen Sun
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China
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122
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Liu DQ, Wei CF, Zhang X, Xiang S, Lian F. MicroRNA profiling reveals effects of Erzhi Tiangui granules on kidney deficiency diminished ovarian reserve: A randomized trial. Medicine (Baltimore) 2023; 102:e33652. [PMID: 37115053 PMCID: PMC10145740 DOI: 10.1097/md.0000000000033652] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Diminished ovarian reserve (DOR) is a danger signal of reduced fertility. The clinical incidence is increasing yearly, exhibiting a gradual low-age trend. Traditional Chinese medicine theory suggests that kidney deficiency is the basic pathogenesis. Erzhi Tiangui granules (ETG), a kidney-tonifying prescription, have been clinically shown to improve ovarian reserve function. The purpose of this study was to investigate the microRNA (miRNA) markers of kidney deficiency DOR and the potential mechanism of ETG on in vitro fertilization outcomes in DOR patients. METHODS Experiment 1: Granulosa cells from 5 normal ovarian reserves and 5 kidney deficiency DOR patients were subjected to miRNA sequencing. Experiment 2: Eighty DOR patients were randomly divided into treatment and control groups (40 subjects each), then treated with ETG and placebo, respectively. granulosa cells were collected and subjected to quantitative polymerase chain reaction for analyzing the expression of specific miRNA found in experiment 1. We also compared fertilization rates, high-quality embryos, and clinical pregnancy rates between the 2 groups. RESULTS miRNA sequencing revealed differential expression of 81 miRNAs, of which 39 were downregulated, specially miR-214-3p and miR-193a-5p, whereas 42 were upregulated, specially let-7e-5p and miR-140-3p. In the second experiment, we found that miR-214-3p was significantly upregulated whereas let-7e-5p and miR-140-3p were significantly downregulated in the treatment group, relative to the control group (P < .05). Patients in the ETG treatment group exhibited a significantly higher fertilization rate than those in the control group (P < .05). CONCLUSION ETG significantly increased fertilization rates in DOR patients with kidney deficiency syndrome and affected the expression of miR-214-3p, let-7e-5p, and miR-140-3p, the potential biomarkers.
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Affiliation(s)
- Dan-Qi Liu
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Chao-Feng Wei
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xing Zhang
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Shan Xiang
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Fang Lian
- Integrative Medicine Research Centre of Reproduction and Heredity, Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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123
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Sun N, Sun PP, Bian J, Zhang YM, Ma HG. Effectiveness of letrozole in pituitary downregulated normogonadotrophic young women with an initial poor response. Medicine (Baltimore) 2023; 102:e33510. [PMID: 37058071 PMCID: PMC10101312 DOI: 10.1097/md.0000000000033510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
It has been reported that 10 to 15% of young normogonadotrophic women show suboptimal response to standard long protocols. Letrozole (LE), an aromatase inhibitor, was shown to improve ovarian sensitivity to follicle stimulating hormone (FSH) and follicular response to gonadotrophin treatment in poor ovarian response patients. We reasoned that it might be possible to utilize LE in young normogonadotrophic patients with unexpected hypo-response in standard gonadotropin-releasing hormone agonist long protocol. A total of 652 patients defined as normogonadotrophic patients with unexpected hypo-response were divided into 2 groups, the +LE group and the +Gn group. +LE group: A fixed daily dose of 2.5 mg of LE was added on day 8 of stimulation. +Gn group: A fixed daily dose of 75 U of human menopausal gonadotrophin was added on day 8 of stimulation. The primary outcome measures were the number of oocytes obtained, fertilization rate, days of stimulation, and total FSH dosage. The secondary outcome measures were the implantation rate and ongoing pregnancy rate. There were no significant differences in the clinical and hormonal characteristics between the 2 groups. A shorter duration of stimulation and a lower dosage of recombinant FSH consumption on the day of human chorionic gonadotropin administration were all observed in the +LE group. Patients who received LE therapy showed a higher number of oocytes obtained and significantly higher fertilization rates. The implantation rate and ongoing pregnancy rate were comparable in both groups. LE significantly improves the number of oocytes obtained in patients with suboptimal response to standard gonadotropin-releasing hormone agonist long protocol.
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Affiliation(s)
- Na Sun
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Ping-Ping Sun
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Jiang Bian
- The Reproductive Medicine Centre of Shanghai Sixth People’s Hospital, Shanghai, China
| | - Yue-Min Zhang
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Hua-Gang Ma
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
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Messinis IE, Messini CI, Papanikolaou EG, Makrakis E, Loutradis D, Christoforidis N, Arkoulis T, Anifandis G, Daponte A, Siristatidis C. Ovarian Stimulation with FSH Alone versus FSH plus a GnRH Antagonist for Elective Freezing in an Oocyte Donor/Recipient Programme: A Protocol for a Pilot Multicenter Observational Study. J Clin Med 2023; 12:jcm12072743. [PMID: 37048828 PMCID: PMC10095010 DOI: 10.3390/jcm12072743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023] Open
Abstract
Preliminary data have shown that it is possible to attempt in vitro fertilization (IVF) treatment in fresh cycles without the use of a gonadotropin-releasing hormone (GnRH) antagonist or any other medication to prevent the luteinizing hormone (LH) surge during ovarian stimulation. To date, there is no information on this topic in the context of a prospective controlled trial. However, as prevention of the LH surge is an established procedure in fresh cycles, the question is whether such a study can be performed in frozen cycles. We aim to perform a pilot study in order to compare the efficacy of a protocol using FSH alone with that of a protocol using follicle-stimulating hormone (FSH) plus a GnRH antagonist for controlled ovarian hyperstimulation (COH) in cycles of elective freezing in the context of a donor/recipient program. This is a seven-center, two-arm prospective pilot cohort study conducted at the respective Assisted Reproductive Units in Greece. The hypothesis to be tested is that an ovarian stimulation protocol that includes FSH alone without any LH surge prevention regimens is not inferior to a protocol including FSH plus a GnRH antagonist in terms of the clinical outcome in a donor/recipient model. The results of the present study are expected to show whether the addition of the GnRH antagonist is necessary in terms of the frequency of LH secretory peaks and progesterone elevations >1 ng/mL during the administration of the GnRH antagonist according to the adopted frequency of blood sampling in all Units.
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Affiliation(s)
- Ioannis E Messinis
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 415 00 Larissa, Greece
| | - Christina I Messini
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 415 00 Larissa, Greece
| | | | | | | | | | | | - Georgios Anifandis
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 415 00 Larissa, Greece
| | - Alexandros Daponte
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 415 00 Larissa, Greece
| | - Charalampos Siristatidis
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vas. Sofias Av., 115 28 Athens, Greece
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125
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Huang LJ, Wan Q, Li T, Lv XY, Geng LH, He QQ, Zhong ZH, Li Y, Tang XJ. Effect of serum progesterone on human chorionic gonadotropin trigger day / metaphase II oocyte ratio on pregnancy and neonatal outcomes in women undergoing ICSI cycle. BMC Pregnancy Childbirth 2023; 23:224. [PMID: 37016365 PMCID: PMC10071741 DOI: 10.1186/s12884-023-05549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/26/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The serum progesterone on human chorionic gonadotropin trigger day / metaphase II oocyte (P/MII) ratio might be a more predictable indicator of pregnancy and neonatal outcomes as compare to P/estradiol (E2) or P alone. Hence, we conducted a larger population study to compare the pregnancy and neonatal outcomes in the low and high P/MII ratio. METHODS A retrospective, single-center, larger population cohort study between January 2015 and August 2021. Calculate the threshold effect of P/MII ratio on clinical pregnancy rate according to the construct smooth curve fitting. Divide data into two groups by threshold for comparison. RESULTS 3566 fresh ICSI-ET cycles were included, in which 929 singleton delivery and 676 twin deliveries. Compare to P/MII ≤ 0.367 group, it indicated that the P/MII > 0.367 group had a lower clinical pregnancy rate and live birth rate, furthermore, a significantly higher rate of LBW and SGA were observed in the singleton and twin deliveries. No deleterious impact of high P/MII ratio on embryo quality and undesirable pregnancy outcomes was shown. CONCLUSIONS When P/MII is higher than 0.367, may have adverse impacts on pregnancy and neonatal outcomes for ICSI cycle.
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Affiliation(s)
- Li-Juan Huang
- Research Center for Medical and Social Development, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Qi Wan
- Xinan Gynecological Hospital, Chengdu, 610011, China
| | - Tian Li
- The Department of Reproductive Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xing-Yu Lv
- Xinan Gynecological Hospital, Chengdu, 610011, China
| | - Li-Hong Geng
- Xinan Gynecological Hospital, Chengdu, 610011, China
| | - Qi-Qi He
- Xinan Gynecological Hospital, Chengdu, 610011, China
| | - Zhao-Hui Zhong
- Research Center for Medical and Social Development, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Yuan Li
- Xinan Gynecological Hospital, Chengdu, 610011, China.
| | - Xiao-Jun Tang
- Research Center for Medical and Social Development, School of Public Health, Chongqing Medical University, Chongqing, 400016, China.
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Hazarika S, Dasari P, Chanu SM, Basu S. Factors Associated with Poor Ovarian Reserve in Young Infertile Women: A Hospital-based Cohort Study. J Hum Reprod Sci 2023; 16:140-147. [PMID: 37547093 PMCID: PMC10404012 DOI: 10.4103/jhrs.jhrs_28_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 08/08/2023] Open
Abstract
Background In practice, we encounter many young infertile women with poor ovarian reserve though ovarian reserve starts to decline after 35 years of age. One of the established risk factors for poor ovarian reserve in young women is endometriosis. There are other conditions that are reported to be associated which require further research. Aims We aimed to study the prevalence of poor ovarian reserve and to find out the associated factors in women who are <35 years of age. Settings and Design This was a prospective observational cohort study conducted in a tertiary care setting. Materials and Methods Women aged more than 21 years and <35 years without Polycystic Ovarian Syndrome (PCOS) or ovarian dysgenesis with normal male factor were included after ethical approval. The sample size was 166 and serum anti-Mullerian hormone (AMH) was estimated by immunoenzymatic assay and expressed in ng/ml. AMH ≤0.99 ng/ml was considered poor ovarian reserve. Apart from established risk factors, the proposed risk factors studied were age 31-35 years, presence of medical disorders, gynaecological pathology and history of repeated ovulation induction (OI). Statistical Analysis Used Data were analysed by SPSS version 25. Chi-square test and Fisher's exact test were used to compare the variables between normal ovarian reserve and poor ovarian reserve. Risk estimation was done by logistic regression and was expressed in odds ratio (OR). Results Poor ovarian reserve was diagnosed in 40% of this cohort, and 62% were between 31 and 35 years. After adjusting for age >30 years, women with endometrioma, hypothyroidism and prior history of ≥3 cycles of OI were found to be having poor ovarian reserve (OR was 5.7, 2.5 and 2.3, respectively). Conclusion Poor ovarian reserve was present in 40% of young women, and significantly associated factors were hypothyroidism and history of repeated multiple OI. This could be a confounder for other underlying mechanisms driving early exhaustion of ovarian reserve in certain young women. Hence, along with established risk factors, these women should undergo AMH testing irrespective of age.
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Affiliation(s)
| | - Paapa Dasari
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
| | | | - Sharbari Basu
- Department of Biochemistry, JIPMER, Puducherry, India
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Morcel K, Merviel P, Pertuisel D, James P, Bouée S, Le Guillou M, Chabaud JJ, Roche S, Drapier H, Perrin A, Beauvillard D. Live Birth Rates in Women Under 38 Years Old with AMH Level < 1.2 ng/ml in the First In Vitro Fertilization + / - Intracytoplasmic Sperm Injection: Retrospective Study and Arguments for Care. Reprod Sci 2023; 30:1133-1142. [PMID: 36175614 DOI: 10.1007/s43032-022-01091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/16/2022] [Indexed: 10/14/2022]
Abstract
Many studies failed to show a predictive impact of AMH levels on the chances of pregnancy; however, acceptable pregnancy rates for young women with low AMH levels were observed in IVF + / - ICSI. The objectives of this retrospective study were to evaluate the clinical pregnancy and live birth rates in the first IVF + / - ICSI cycle in women under 38 years old with AMH level < 1.2 ng/ml and to determine the arguments for care. We classified the women into three groups: group A: AMH < 0.4 ng/ml (n: 86); group B: AMH: 0.4 to 0.8 ng/ml (n: 90); and group C: AMH > 0.8 to < 1.2 ng/ml (n: 92). We recorded data on the patients' characteristics, stimulation cycles, embryo cultures, and ongoing pregnancies. No difference was observed between the three groups for the number of embryos transferred, the clinical pregnancy, and the live birth rates (LBR) per embryo transfer (LBR/transfer: 24.1% in group A, 25.9% in group B, and 28.1% in group C). The young age of the women reassures about the oocyte quality, but a low level of AMH may raise concerns about a lower quantitative oocyte yield, leading to accelerated management of the couple in IVF + / - ICSI.
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Affiliation(s)
- Karine Morcel
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Philippe Merviel
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France.
| | - Diane Pertuisel
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Pandora James
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Sarah Bouée
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Mathilde Le Guillou
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Jean-Jacques Chabaud
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Sylvie Roche
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Hortense Drapier
- Department of Reproductive Biology, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Aurore Perrin
- Department of Reproductive Biology, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Damien Beauvillard
- Department of Reproductive Biology, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
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Huang X, Yu Q. Bioinformatic analysis confirms differences in circular RNA expression profiles of cumulus cells between patients with ovarian and peritoneal endometriosis-associated infertility. Front Endocrinol (Lausanne) 2023; 14:1137235. [PMID: 37008951 PMCID: PMC10050890 DOI: 10.3389/fendo.2023.1137235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
Endometriosis has a detrimental effect on oocyte quality, and ovarian endometriosis (OEM) and peritoneal endometriosis (PEM) may have different effects on female fertility. Therefore, we conducted a study to explore the circular RNA (circRNA) expression profiles of cumulus cells (CCs) in patients with OEM (n = 3), PEM (n = 3), and tubal factor infertility (TFI, n = 3) using high-throughput sequencing techniques and attempted to identify common and unique circRNAs in the OEM and PEM groups. The CIRCexplorer2 program was used to identify circRNAs. Seven candidate circRNAs were validated in 30 samples using quantitative real-time polymerase chain reaction (qRT-PCR). Finally, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to annotate the function of circRNA-targeted genes, which were verified by sequencing results and constructed circRNA-miRNA-mRNA networks. A total of 11833 circRNAs were identified in nine samples. The numbers of differentially expressed circRNAs between the OEM and TFI groups, PEM and TFI groups, and OEM and PEM groups were 130, 71, and 191, respectively. After taking intersections, 11 circRNAs were considered common circRNAs in the OEM and PEM groups; 39 circRNAs in the OEM group and 17 circRNAs in the PEM group were identified as unique key circRNAs. During qRT-PCR validation, hsa_circ_0003638 was significantly upregulated in the PEM group compared to that in the OEM and TFI groups. Functional analysis of circRNA-targeted genes revealed that apoptosis, PI3K-AKT, and p53 signaling pathways were enriched in the PEM-TFI comparison groups, whereas the functions of target genes involved in the JAK-STAT and TGF-β signaling pathways were enriched in the PEM-OEM comparison groups. Our findings confirmed differences in circRNA expression profiles of CCs between patients with OEM and PEM infertility and provide new insights into the different effects of various endometriosis phenotypes on oocytes.
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Affiliation(s)
| | - Qi Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China
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Clinical Application of Double Ovulation Stimulation in Patients with Diminished Ovarian Reserve and Asynchronous Follicular Development Undergoing Assisted Reproduction Technology. Curr Med Sci 2023; 43:304-312. [PMID: 36913110 DOI: 10.1007/s11596-022-2687-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/17/2022] [Indexed: 03/14/2023]
Abstract
OBJECTIVE This study aimed to compare the clinical effects of double ovulation stimulation (DouStim) applied during the follicular and luteal phases with the antagonist protocol in patients with diminished ovarian reserve (DOR) and asynchronous follicular development undergoing assisted reproductive technology (ART). METHODS The clinical data of patients with DOR and asynchronous follicular development receiving ART from January 2020 to December 2021 were retrospectively analyzed. The patients were divided into two groups according to their ovulation stimulation protocol: DouStim group (n=30) and antagonist group (n=62). Assisted reproduction and clinical pregnancy outcomes were compared between the two groups. RESULTS In the DouStim group, the number of oocytes retrieved, metaphase II (MII) oocytes, two-pronuclei (2PN), day 3 (D3) embryos, D3 high-quality embryos as well as blastocyst formation, implantation, and human chorionic gonadotropin-positive rates were significantly greater than those in the antagonist group (all P<0.05). No significant differences were found in MII, fertilization, or continued pregnancy rates at the first frozen embryo transfer (FET), in-vitro fertilization (IVF) cancellation, or early medical abortion rates between the groups (all P>0.05). Except for the early medical abortion rate, the DouStim group generally had favorable outcomes. In the DouStim group, the dosage and duration of gonadotropin and the fertilization rate were significantly greater in the first ovulation stimulation induction than in the second ovulation stimulation induction (P<0.05). CONCLUSION The DouStim protocol efficiently and economically obtained more mature oocytes and high-quality embryos for patients with DOR and asynchronous follicular development.
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130
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Effectiveness, Flexibility and Safety of Switching IVF to IVM as a Rescue Strategy in Unexpected Poor Ovarian Response for PCOS Infertility Patients. J Clin Med 2023; 12:jcm12051978. [PMID: 36902766 PMCID: PMC10003962 DOI: 10.3390/jcm12051978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND According to the latest practice committee document, in vitro maturation (IVM) is a simple and safe procedure, especially in patients with polycystic ovary syndrome (PCOS). Does switching from in vitro fertilization (IVF) to IVM (IVF/M) help as a rescue infertility treatment for PCOS patients with an unexpected poor ovarian response (UPOR) tendency? METHODS This retrospective cohort study included 531 women with PCOS who had undergone 588 natural IVM cycles or had switched to IVF/M cycles from 2008 to 2017. Natural IVM was performed in 377 cycles, and switching IVF/M was performed in 211 cycles. The primary outcome measure was the cumulative live birth rates (cLBRs), and the secondary outcomes included laboratory and clinical outcomes, maternal safety, and obstetric and perinatal complications. RESULTS No significant difference was found in the cLBRs between the natural IVM and switching IVF/M groups (23.6% vs. 17.4%, p = 0.05). Meanwhile, the natural IVM group had a higher cumulative clinical pregnancy rate (36.0% vs. 26.0%, p = 0.01), and a decrease in the number of oocytes was obtained in the switching IVF/M group (13.5 vs. 12.0, p < 0.01). The number of good quality embryos in the natural IVM group was 2.2 ± 2.5, and 2.1 ± 2.3 (p = 0.64) in the switching IVF/M group. No statistically significant differences were observed in the number of 2 pronuclear (2PN) and available embryos. Ovarian hyperstimulation syndrome (OHSS) did not occur in the switching IVF/M and natural IVM groups, indicating a highly favorable outcome. CONCLUSION In PCOS infertile women with UPOR, timely switching IVF/M is a viable option that markedly reduces the canceled cycle, results in reasonable oocyte retrieval, and leads to live births.
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131
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Laqqan MM, Yassin MM. Investigation of the Predictive Factors of Diminished Ovarian Reserve in Women Aged Less Than 40 Years and Undergoing ICSI Cycle. Reprod Sci 2023; 30:873-882. [PMID: 36002711 DOI: 10.1007/s43032-022-01055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Abstract
Diminished ovarian reserve (DOR) is one of the primary causes of poor ICSI outcomes. Therefore, this study was performed to speculate which of the following parameters: AMH, AFC, and women's age can be used as a predictor factor of the DOR in women aged < 40 years. This prospective study enrolled 500 women suffering from idiopathic infertility problems and who underwent GnRH antagonist multiple-dose stimulation protocol. The women were divided into two groups: normal fertility (FSH ≤ 10 mIU/mL, n = 300) and DOR (FSH > 10 mIU/mL, n = 200). At the time of the study, the average of women age was 29.3 ± 5.7 years. A significant reduction was found in AMH level, AFC, number of mature, immature oocytes, fertilized oocytes, embryos transferred, and β-hCG level in the DOR group compared to the normal fertility group (P < 0.001). Conversely, a significant increase was shown in the age of the DOR group compared to the normal fertility group (30.8 ± 5.8 vs. 28.2 ± 5.4, respectively; P < 0.001). A significant negative association was found between the AFC, the number of mature oocytes, fertilized oocytes, embryos transferred, and the basal level of FSH in the DOR group (P < 0.01). The receiver operating characteristics (ROC) demonstrated that AMH level and AFC had the highest accuracy, followed by age in the prediction of DOR (P < 0.001) with a cut-off value of ≤ 1.2 ng/mL, ≤ 4.5, and > 29.5 years, respectively. This study exhibited that the levels of AMH and AFC are the best biomarkers, followed by age for the prediction of DOR in women < 40 years old. Furthermore, AMH is the only independent factor that is significantly related to DOR in women.
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Affiliation(s)
- Mohammed M Laqqan
- Faculty of Health Sciences, Department of Medical Laboratory Sciences, Islamic University, P.O. Box 108, Gaza, Palestine.
| | - Maged M Yassin
- Faculty of Medicine, Department of Human Physiology, Islamic University, P.O. Box 108, Gaza, Palestine
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Huang TH, Chen FR, Zhang YN, Chen SQ, Long FY, Wei JJ, Zhang K, Zeng JZ, Zhu QY, Li-Ling J, Gong Y. Decreased GDF9 and BMP15 in follicle fluid and granulosa cells and outcomes of IVF-ET among young patients with low prognosis. J Assist Reprod Genet 2023; 40:567-576. [PMID: 36689045 PMCID: PMC10033789 DOI: 10.1007/s10815-023-02723-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To analyze the level of growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15) in follicle fluid (FF) and granulosa cells (GCs) derived from young patients with low prognosis for in vitro fertilization and embryo transfer (IVF-ET) treatment. METHODS A prospective cohort study was carried out by enrolling 52 young patients with low prognosis according to the POSEIDON classification group 3 (low prognosis group) and 51 young patients with normal ovarian reserve (control group). The concentration of the GDF9 and BMP15 proteins in FF was determined by enzyme-linked immunosorbent assay. The mRNA level of the GDF9 and BMP15 in the GCs was measured by quantitative real-time PCR. RESULTS The concentration of GDF9 (1026.72 ± 159.12 pg/mL vs. 1298.06 ± 185.41 pg/mL) and BMP15 (685.23 ± 143.91 pg/mL vs. 794.37 ± 81.79 pg/mL) in FF and the mRNA level of GDF9 and BMP15 in the GCs and the live birth rate per treatment cycle started (30.77% vs. 50.98%) and oocytes retrieved (4.25 ± 1.91 vs.12.04 ± 4.24) were significantly lower, whereas the canceled cycle rate was significantly higher (9.62% vs. 0) in the low prognosis group compared with the control group (P < 0.05). The expression of GDF9 and BMP15 in the ovary was positively correlated with live birth (P < 0.05). CONCLUSION The expression of GDF9 and BMP15 in the ovary was decreased in young patients with low prognosis accompanied by a poorer outcome of IVF-ET treatment. TRIAL REGISTRATION ChiCTR1800016107 (Chinese Clinical Trial Registry), May 11, 2018. ( http://www.chictr.org.cn/edit.aspx?pid=27216&htm=4 ).
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Affiliation(s)
- Tian-Hong Huang
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China
| | - Fu-Rui Chen
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China
| | - Ya-Nan Zhang
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China
| | - Shi-Qi Chen
- Women and Children's Health Management Department, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China
| | - Fang-Yi Long
- Department of Pharmacy, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China
| | - Jia-Jing Wei
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China
| | - Kun Zhang
- Department of Genetics, School of Bioscience and Technology, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Jiu-Zhi Zeng
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China
| | - Qiao-Ying Zhu
- Laboratory Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China
| | - Jesse Li-Ling
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Yan Gong
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China.
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Monge-Ochoa B, Montoro L, Montoya J, Ruiz-Pesini E, López-Pérez MJ, de Castro F, Díez-Sánchez C. m.4216 T > C polymorphism in JT cluster determines a lower pregnancy rate in response to controlled ovarian stimulation treatment. J Assist Reprod Genet 2023; 40:671-682. [PMID: 36701026 PMCID: PMC10033795 DOI: 10.1007/s10815-023-02721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To analyze the influence of Caucasian mitochondrial haplogroups on controlled ovarian stimulation outcome (COS), embryo (E), and pregnancy success. METHODS In a Caucasian population (n = 517) undergoing COS, mitochondrial haplogroups and physiological parameters were determined. Patients were classified, according to Bologna criteria, as good (>3)/poor ≤3) responder, on dependence of recruited oocytes (RO), and in pregnancy/non-pregnancy groups. Haplogroups were determined by sequencing mitochondrial hypervariable sequence I and confirmed by polymerase chain reaction (PCR), followed by restriction fragment length polymorphisms (RFLP). RESULTS The rank of total dose of FSH (TD FSH) was similar in all clusters/haplogroups, except in JT, which is narrower (950-3,650 IU), particularly in T (1,350-3,650 IU). The statistical analysis showed higher RO and E in JT when compared to U, although it was only Uk which accumulated significantly in pregnancy respect to JT. Pearson's correlations between TD FSH and RO showed negative statistical significance in all population (P = 0.001), H (P = 0.03), JT (P = 0.01), and T (P = 0.03). The percentage of contribution of TD FSH on RO was almost nine times in the JT cluster as compared to all population one. CONCLUSIONS JT cluster shows a different influence of TD FSH on RO. JT cluster shows higher RO and E than U, but it is Uk which exhibits a significant higher pregnancy rate than JT. The negative influence of the JT cluster on pregnancy success strongly suggests that the m.4216 T > C polymorphism could be responsible.
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Affiliation(s)
- Belén Monge-Ochoa
- Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain
| | - Luis Montoro
- Unidad de Reproducción Asistida, Hospital Universitario Príncipe de Asturias, Universidad Complutense de Madrid, Alcalá de Henares, Madrid, Spain
| | - Julio Montoya
- Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, Spain
| | - Eduardo Ruiz-Pesini
- Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, Spain
| | - Manuel J López-Pérez
- Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain
| | - Francisco de Castro
- Unidad de Reproducción Asistida, Hospital Universitario Príncipe de Asturias, Universidad Complutense de Madrid, Alcalá de Henares, Madrid, Spain
| | - Carmen Díez-Sánchez
- Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain.
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Stovezky YR, Romanski PA, Bortoletto P, Spandorfer SD. Antimüllerian hormone is not associated with embryo ploidy in patients with and without infertility undergoing in vitro fertilization with preimplantation genetic testing. Fertil Steril 2023; 119:444-453. [PMID: 36423663 DOI: 10.1016/j.fertnstert.2022.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the association between antimüllerian hormone (AMH) and embryo ploidy rates in 2 cohorts of patients undergoing in vitro fertilization (IVF) with trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A): the general population of women pursuing IVF with PGT-A (Infertile cohort) and women pursuing IVF with preimplantation genetic testing for monogenic disorders (PGT-M) owing to the risk of hereditary monogenic diseases (Non-infertile cohort). DESIGN Retrospective cohort study. SETTING Academic center. PATIENT(S) Patients undergoing their first cycle of IVF with trophectoderm biopsy and PGT-A or PGT-A and PGT-M in our center between March 2012 and June 2020. Patients of advanced maternal age according to the Bologna criteria (age ≥40 years) and patients who underwent fresh embryo transfers were excluded. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Proportion of euploid, mosaic, and aneuploid embryos per cycle. RESULT(S) "Infertile" (n = 926) and "Non-infertile" (n = 214) patients were stratified on the basis of AMH levels, with low-AMH defined as <1.1 ng/mL in accordance with the Bologna criteria. Age-adjusted regression models showed no relationship between AMH classification and proportion of euploid, mosaic, and aneuploid embryos in the Infertile or Non-infertile cohorts. In the Infertile cohort, no association between AMH classification and embryo ploidy rates was identified in a subgroup analysis of patients aged <35 years, 35-37 years, and 38-39 years. These findings persisted in a sensitivity analysis of infertile patients stratified into AMH (ng/mL) quartile categories. CONCLUSION(S) No association was found between AMH and the proportion of euploid, mosaic, or aneuploid embryos in 2 large cohorts of patients undergoing IVF with PGT-A (Infertile patients) or PGT-A and PGT-M (Non-infertile patients), suggesting that a quantitative depletion of ovarian reserve does not predict the ploidy status of the embryo cohort.
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Affiliation(s)
- Yael R Stovezky
- Weill Medical College of Cornell University, New York, New York.
| | - Phillip A Romanski
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York
| | - Steven D Spandorfer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York
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Pellicer N, Cozzolino M, Diaz-García C, Galliano D, Cobo A, Pellicer A, Herraiz S. Ovarian rescue in women with premature ovarian insufficiency: facts and fiction. Reprod Biomed Online 2023; 46:543-565. [PMID: 36710157 DOI: 10.1016/j.rbmo.2022.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
The ovary has a comparatively short functional lifespan compared with other organs, and genetic and pathological injuries can further shorten its functional life. Thus, preserving ovarian function should be considered in the context of women with threats to ovarian reserve, such as ageing, premature ovarian insufficiency (POI) and diminished ovarian reserve (DOR). Indeed, one-third of women with POI retain resting follicles that can be reactivated to produce competent oocytes, as proved by the in-vitro activation of dormant follicles. This paper discusses mechanisms and clinical data relating to new therapeutic strategies using ovarian fragmentation, stem cells or platelet-rich plasma to regain ovarian function in women of older age (>38 years) or with POI or DOR. Follicle reactivation techniques show promising experimental outcomes and have been successful in some cases, when POI is established or DOR diagnosed; however, there is scarce clinical evidence to warrant their widespread clinical use. Beyond these contexts, also discussed is how new insights into the biological mechanisms governing follicular dynamics and oocyte competence may play a role in reversing ovarian damage, as no technique modifies oocyte quality. Additional studies should focus on increasing follicle number and quality. Finally, there is a small but important subgroup of women lacking residual follicles and requiring oocyte generation from stem cells.
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Affiliation(s)
| | | | - César Diaz-García
- IVI London, EGA Institute for Women's Health, UCL, London, UK; IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | | | - Ana Cobo
- IVI RMA Valencia, Valencia, Spain
| | - Antonio Pellicer
- IVI RMA Rome, Rome, Italy; IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Sonia Herraiz
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
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136
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Moro F, Scavello I, Maseroli E, Rastrelli G, Baima Poma C, Bonin C, Dassie F, Federici S, Fiengo S, Guccione L, Villani M, Gambineri A, Mioni R, Moghetti P, Moretti C, Persani L, Scambia G, Giorgino F, Vignozzi L. The physiological sonographic features of the ovary in healthy subjects: a joint systematic review and meta-analysis by the Italian Society of Gynecology and Obstetrics (SIGO) and the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2023; 46:439-456. [PMID: 36422829 PMCID: PMC9938076 DOI: 10.1007/s40618-022-01939-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE There is a lack of uniformity in the definition of normal ovary ultrasound parameters. Our aim was to summarize and meta-analyze the evidence on the topic. Full-text English articles published through December 31, 2020 were retrieved via MEDLINE and Embase. Data available for meta-analysis included: ovarian follicular count, ovarian volume, and ovarian Pulsatility Index (PI) assessed by Doppler ultrasound. METHODS Cohort, cross-sectional, prospective studies with a single or double arm were considered eligible. Interventional studies were included when providing baseline data. Both studies on pre- and post-menopausal women were screened; however, data on menopausal women were not sufficient to perform a meta-analysis. Studies on pre-pubertal girls were considered separately. Eighty-one papers were included in the meta-analysis. RESULTS The mean ovarian volume was 6.11 [5.81-6.42] ml in healthy women in reproductive age (5.81-6.42) and 1.67 ml [1.02-2.32] in pre-pubertal girls. In reproductive age, the mean follicular count was 8.04 [7.26-8.82] when calculated in the whole ovary and 5.88 [5.20-6.56] in an ovarian section, and the mean ovarian PI was 1.86 [1.35-2.37]. Age and the frequency of the transducers partly modulated these values. In particular, the 25-30-year group showed the higher mean follicular count (9.27 [7.71-10.82]), followed by a progressive age-related reduction (5.67 [2.23-9.12] in fertile women > 35 years). A significant difference in follicular count was also found according to the transducer's upper MHz limit. CONCLUSION Our findings provide a significant input to improve the interpretation and diagnostic accuracy of ovarian ultrasound parameters in different physiological and pathological settings.
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Affiliation(s)
- F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - I Scavello
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - E Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - G Rastrelli
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - C Baima Poma
- Consultorio Familiare ASL Città di Torino, Turin, Italy
| | - C Bonin
- Unit of Obstetrics and Gynecology B, Department of Women and Children's Health, AOUI Verona, Verona, Italy
| | - F Dassie
- Department of Medicine, Clinica Medica 3-Azienda Ospedaliera, University of Padua, Padua, Italy
| | - S Federici
- Unit of Andrology and Reproductive Endocrinology, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
| | - S Fiengo
- Department of Obstetrics and Gynaecology, ARNAS Civico Hospital, Palermo, Italy
| | - L Guccione
- Department of Systems' Medicine, University of Tor Vergata, Rome, Italy
| | - M Villani
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - A Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - R Mioni
- Department of Medicine, Clinica Medica 3-Azienda Ospedaliera, University of Padua, Padua, Italy
| | - P Moghetti
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - C Moretti
- Department of Systems' Medicine, University of Tor Vergata, Rome, Italy
| | - L Persani
- Unit of Andrology and Reproductive Endocrinology, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20121, Milan, Italy
| | - G Scambia
- Istituto Di Clinica Ostetrica E Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - L Vignozzi
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy.
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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137
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Effects of Zishen Yutai Pills on in vitro Fertilization-Embryo Transfer Outcomes in Patients with Diminished Ovarian Reserve: A Prospective, Open-Labeled, Randomized and Controlled Study. Chin J Integr Med 2023; 29:291-298. [PMID: 36809499 DOI: 10.1007/s11655-023-3546-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To explore the effects of Zishen Yutai Pills (ZYPs) on the quality of oocytes and embryos, as well as pregnancy outcomes in patients with diminished ovarian reserve (DOR) receiving in vitro fertilization-embryo transfer (IVF-ET). The possible mechanisms, involving the regulation of bone morphogenetic protein 15 (BMP15) and growth differentiation factor 9 (GDF9), were also investigated. METHODS A total of 120 patients with DOR who underwent their IVF-ET cycle were randomly allocated to 2 groups in a 1:1 ratio. The patients in the treatment group (60 cases) received ZYPs from the mid-luteal phase of the former menstrual cycle by using gonadotropin-releasing hormone (GnRH) antagonist protocol. The patients in the control group (60 cases) received the same protocol but without ZYPs. The primary outcomes were the number of oocytes retrieved and high-quality embryos. Secondary outcomes included other oocyte or embryo indices as well as pregnancy outcomes. Adverse events were assessed by comparison of the incidence of ectopic pregnancy, pregnancy complications, pregnancy loss, and preterm birth. Contents of BMP15 and GDF9 in the follicle fluids (FF) were also quantified with enzyme-linked immunosorbent assay. RESULTS Compared with the control group, the numbers of oocytes retrieved and high-quality embryos were significantly increased in the ZYPs group (both P<0.05). After treatment with ZYPs, a significant regulation of serum sex hormones was observed, including progesterone and estradiol. Both hormones were up-regulated compared with the control group (P=0.014 and 0.008), respectively. No significant differences were observed with regard to pregnancy outcomes including implantation rates, biochemical pregnancy rates, clinical pregnancy rates, live birth rates, and pregnancy loss rates (all P>0.05). The administration of ZYPs did not increase the incidence of adverse events. The expressions of BMP15 and GDF9 in the ZYPs group were significantly up-regulated compared with the control group (both P<0.05). CONCLUSIONS ZYPs exhibited beneficial effects in DOR patients undergoing IVF-ET, resulting in increments of oocytes and embryos, and up-regulation of BMP15 and GDF9 expressions in the FF. However, the effects of ZYPs on pregnancy outcomes should be assessed in clinical trials with larger sample sizes (Trial reqistration No. ChiCTR2100048441).
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138
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Effectiveness of GnRH Agonist Short Protocol Versus GnRH Antagonist Protocol in POSEIDON Groups 3 and 4: a Retrospective Cohort Study. Reprod Sci 2023:10.1007/s43032-023-01196-x. [PMID: 36808612 DOI: 10.1007/s43032-023-01196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/05/2023] [Indexed: 02/19/2023]
Abstract
The aim of this study is to compare the ART (assisted reproductive technology) outcomes and cancellation rates between GnRH antagonist protocol and GnRH agonist short protocol in POSEIDON (Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number) groups 3 and 4. It is a retrospective cohort study conducted in the Department of Reproductive Medicine and Surgery of a tertiary-level hospital. Women who underwent ART treatment with either GnRH antagonist or GnRH agonist short protocol with fresh embryo transfer, between January 2012 and December 2019 belonging to POSEIDON 3 and 4 groups, were included. Among the 295 women who belonged to the POSEIDON groups 3 or 4, 138 women received GnRH antagonist and 157 women received GnRH agonist short protocol. The median total dose of gonadotropin in the GnRH antagonist protocol was not significantly different from GnRH agonist short protocol [3000, IQR (2481-3675) vs. 3175, IQR (2643-3993), p = 0.370]. There was a significant difference in the duration of stimulation between the GnRH antagonist and GnRH agonist short protocol [10, IQR (9-12) vs. 10, IQR (8-11), p = 0.002]. The median number of mature oocytes retrieved was significantly different in the cohort of women receiving GnRH antagonist protocol compared to GnRH agonist short protocol [3, IQR (2-5) vs. 3, IQR (2-4), p = 0.029]. There was no significant difference in the clinical pregnancy rate (24% vs. 20%, p = 0.503) and cycle cancellation rate (29.7% vs. 36.3%, p = 0.290) between the GnRH antagonist and agonist short protocols respectively. Live birth rate was not significantly different between the GnRH antagonist protocol (16.7%) and GnRH agonist short protocol (14.0%) [OR 1.23, 95% CI (0.56-2.68), p = 0.604]. After adjusting for the significant confounding factors, the live birth rate was not significantly associated with the antagonist protocol compared with the short protocol [aOR 1.08, 95% CI (0.44-2.63), p = 0.870]. Though GnRH antagonist protocol results in higher mature oocyte yield when compared with GnRH agonist short protocol, it does not translate into an increase in live birth in POSEIDON groups 3 and 4.
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139
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Hu YL, Wang Y, Geng LH, Meng XQ, Xu HJ, Adu-Gyamfi EA, Zhong ZH, Wan Q, Ding YB. Effects of sequential cleavage and blastocyst embryo transfer on pregnancy outcomes in patients with poor ovarian response. J Reprod Immunol 2023; 155:103780. [PMID: 36481385 DOI: 10.1016/j.jri.2022.103780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
The management of patients with poor ovarian response (POR) remains a major challenge for fertility specialists in in vitro fertilization-embryo transfer (IVF-ET). In this retrospective cohort study, we aimed to evaluate the clinical effect of sequential transfer on pregnancy outcomes in patients with POR. A total of 3579 POR patients who underwent the first frozen embryo transfer (FET) cycle were enrolled from January 2018 to April 2021. The patients were divided into three groups according to the embryo transfer (ET) strategy adopted: a study group that included POR patients in whom a cleavage-stage embryo (day 3) and a blastocyst (day 5/6) were transferred (sequential transfer group), and two control groups in whom two cleavage-stage embryos (D3-dET group) or two blastocysts (D5/6-dET group) were transferred. The study group was matched with the control groups at a ratio of 1:4 by propensity score matching (PSM). The main pregnancy outcomes measured were the live birth rate and multiple pregnancy rate. After PSM, the live birth rate in the sequential transfer group was significantly higher than that in the D3-dET group (44.2% vs. 34.3%, P = 0.019), and was similar to that in the D5/6-dET group (44.2% vs. 45.3%; P = 0.90). In addition, there was no increase in the risk of multiple pregnancy among POR patients undergoing sequential transfer compared with both D3-dET (26.7% vs. 25.6%, P = 0.85) and D5/6-dET (26.7% vs. 28.4%, P = 0.97) groups. These findings imply that sequential transfer is an effective option for POR patients and could be utilized after careful consideration.
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Affiliation(s)
- Yu-Ling Hu
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China
| | - Yue Wang
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Li-Hong Geng
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China
| | - Xiang-Qian Meng
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China
| | - Hai-Jiao Xu
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China
| | - Enoch Appiah Adu-Gyamfi
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Zhao-Hui Zhong
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
| | - Qi Wan
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu 610011, China.
| | - Yu-Bin Ding
- Department of Obstetrics and Gynecology, Women and Childrens' Hospital of Chongqing Medical University, Chongqing 400000, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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140
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Kaleli S, Kervancıoğlu ME, Erol N, Alakbarova U, Akşahin E, Öçer İF. Evaluating the efficacy of ovulation stimulation with intrauterine insemination in women with diminished ovarian reserve compared to women with normal ovarian reserve. Int J Gynaecol Obstet 2023; 160:620-627. [PMID: 35780472 DOI: 10.1002/ijgo.14325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/14/2022] [Accepted: 07/01/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the efficacy of ovulation induction and intrauterine insemination (IUI) in couples with diminished ovarian reserve (DOR). METHODS Women aged 20-39 years and men younger than 50 years were included. Four "ovarian reserve groups" were created according to anti-Müllerian hormone (AMH) and the partner's age. Gestational sac finding on ultrasound examination was the primary outcome measure. RESULTS The study was carried out on a total of 770 cycles of 362 women in an infertility cohort that consisted of 75 women with DOR treated by 153 cycles and 287 women without DOR treated by 617 cycles. The pregnancy rate was similar in the four ovarian reserve groups in terms of first, second, third plus fourth, and total attempts of IUI cycles. Moreover, the pregnancy rate, miscarriage rate, and multiple pregnancy rate were similar. We found no difference in the cumulative pregnancy rate among the groups after four IUI cycles. Multivariate logistic regression analysis of the entire cohort revealed that infertility duration, post-wash sperm count, and follicle number greater than 11 mm on the day of human chorionic gonadotropin trigger were independent predictors of pregnancy (P < 0.001). Neither age nor AMH predicted pregnancy after ovulation stimulation and IUI. CONCLUSIONS Ovulation stimulation and IUI are equally effective in women with DOR and in women with normal ovarian reserve in terms of pregnancy rate, multiple pregnancy rate, and miscarriage rate per IUI cycle or cumulative pregnancy rate after four cycles of IUI.
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Affiliation(s)
- Semih Kaleli
- Istanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology and Assisted Reproduction Unit, İstanbul, Turkey
| | - Mehmet E Kervancıoğlu
- Istanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology and Assisted Reproduction Unit, İstanbul, Turkey
| | - Naciye Erol
- Istanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology and Assisted Reproduction Unit, İstanbul, Turkey
| | - Ulviyya Alakbarova
- Istanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology and Assisted Reproduction Unit, İstanbul, Turkey
| | - Elif Akşahin
- Istanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology and Assisted Reproduction Unit, İstanbul, Turkey
| | - İsmail F Öçer
- Istanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology and Assisted Reproduction Unit, İstanbul, Turkey
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141
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Greco E, Yakovlev P, Kornilov N, Vyatkina S, Bogdanova D, Ermakova M, Tarasova Y, Tikhonov A, Pendina A, Biricik A, Sessa MT, Listorti I, Ronsini C, Greco PF, Victor A, Barnes F, Zouves C, Spinella F, Viotti M. Two clinical case reports of embryonic mosaicism identified with PGT-A persisting during pregnancy as true fetal mosaicism. Hum Reprod 2023; 38:315-323. [PMID: 36610460 DOI: 10.1093/humrep/deac263] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/31/2022] [Indexed: 01/09/2023] Open
Abstract
The health risks associated with transferring embryos classified as mosaic by preimplantation genetic testing for aneuploidies (PGT-A) are currently unknown. Such embryos produce PGT-A results indicating the presence of both euploid and aneuploid cells and have historically been deselected from transfer and grouped with uniformly aneuploid embryos as 'abnormal'. In recent years, numerous groups have reported the intentional transfer of mosaic embryos in the absence of uniformly euploid embryos, largely observing births of seemingly healthy babies. However, it remains to be understood whether the embryonic mosaicism invariably becomes resolved during the ensuing pregnancy, or whether the placenta and/or fetal tissues retain aneuploid cells, and if so to what potential clinical effect. Here, we report two cases of mosaicism persisting from the embryonic stage to the established pregnancy. Case 1 involved an embryonic low-level segmental mosaic loss in Chromosome (Chr) 1, which was confirmed in amniocentesis as well as in brain tissue of the products of conception. This pregnancy was terminated due to the chromosomal pathologies associated with 1p36 deletion syndrome, such as severe intellectual disability. Case 2 involved a low-level mosaic Chr 21 trisomy, which was confirmed with chorionic villus sampling and amniocentesis. The ensuing pregnancy was terminated after ultrasound identification of severe abnormalities in the placenta and fetus. Together, these two cases should be taken into account for risk-benefit assessments of prospective mosaic embryo transfers.
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Affiliation(s)
- Ermanno Greco
- Villa Mafalda, Centre For Reproductive Medicine, Rome, Italy.,Department of Obstetrics and Gynecology, UniCamillus International University, Rome, Italy
| | - Pavel Yakovlev
- Next Generation Clinic, Centre For Reproductive Medicine, Moscow, Russia
| | - Nikolay Kornilov
- Next Generation Clinic, Centre For Reproductive Medicine, Moscow, Russia.,Next Generation Clinic, Centre For Reproductive Medicine, St. Petersburg, Russia
| | - Svetlana Vyatkina
- Next Generation Clinic, Centre For Reproductive Medicine, St. Petersburg, Russia
| | - Daria Bogdanova
- Next Generation Clinic, Centre For Reproductive Medicine, Moscow, Russia
| | - Marina Ermakova
- Medical Genetic Center of the Group of companies "Mother and Child", Moscow, Russia
| | - Yulia Tarasova
- Medical Genetic Center of the Group of companies "Mother and Child", Moscow, Russia
| | - Andrei Tikhonov
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproduction, Saint Petersburg, Russia
| | - Anna Pendina
- D.O. Ott Research Institute of Obstetrics, Gynecology and Reproduction, Saint Petersburg, Russia
| | - Anil Biricik
- Eurofins Genoma Group, Molecular Genetics Laboratories, Rome, Italy
| | | | - Ilaria Listorti
- Villa Mafalda, Centre For Reproductive Medicine, Rome, Italy
| | - Carlo Ronsini
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | | | | | | | - Manuel Viotti
- Zouves Fertility Center, Foster City, CA, USA.,Zouves Foundation for Reproductive Medicine, Foster City, CA, USA
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142
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Shen H, Gao M, Li Q, Sun H, Jiang Y, Liu L, Wu J, Yu X, Jia T, Xin Y, Han S, Wang Y, Zhang X. Effect of PFOA exposure on diminished ovarian reserve and its metabolism. Reprod Biol Endocrinol 2023; 21:16. [PMID: 36726108 PMCID: PMC9890749 DOI: 10.1186/s12958-023-01056-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/05/2023] [Indexed: 02/03/2023] Open
Abstract
Owing to its difficulty in degrading and ease of accumulation in the body, perfluorooctanoic acid (PFOA) has a detrimental effect on reproduction. This study aimed to examine the effect of PFOA concentration in follicular fluid during ovulation stimulation on embryo quality and the impact of PFOA exposure on the metabolic components of follicular fluid. This was a single-center prospective study that included 25 patients with diminished ovarian reserve (DOR), 25 with normal ovarian reserve (NOR), and 25 with polycystic ovary syndrome (PCOS). Follicular fluid samples were analyzed using ultra-high performance liquid chromatography-tandem mass spectrometry. We demonstrated that the PFOA levels of follicular fluid in the DOR group were higher than those in the NOR group and PCOS group (P < 0.05). PFOA concentration in the PCOS group was negatively correlated with high-quality embryos (P < 0.05). To gain more insight into the impact of PFOA on the metabolic composition of follicular fluid, we classified the DOR group based on the PFOA concentration, for which metabolomic analysis was performed. In the high-concentration PFOA group, there was an increase and a decrease in three and nine metabolites, respectively, compared to that in the low-concentration group. These results suggest that PFOA may alter the metabolic composition of follicular fluid, thus, affecting ovarian reserve function.
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Affiliation(s)
- Haofei Shen
- Lanzhou University, Lanzhou, 730000, Gansu, China
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Reproductive Medicine Transformation Application, Lanzhou, 730030, Gansu, China
| | - Min Gao
- Lanzhou University, Lanzhou, 730000, Gansu, China
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China
| | - Qiuyuan Li
- Lanzhou University, Lanzhou, 730000, Gansu, China
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China
| | - Huipeng Sun
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Yingdi Jiang
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China
| | - Lihong Liu
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China
| | - Jingyuan Wu
- Lanzhou University, Lanzhou, 730000, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Reproductive Medicine Transformation Application, Lanzhou, 730030, Gansu, China
| | - Xiao Yu
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China
| | - Tianyu Jia
- Lanzhou University, Lanzhou, 730000, Gansu, China
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China
| | - Yongan Xin
- Linxia Hui Autonomous Prefecture Maternity and Childcare Hospital, Linxia, China
| | - Shiqiang Han
- Linxia Hui Autonomous Prefecture Maternity and Childcare Hospital, Linxia, China.
| | - Yiqing Wang
- Lanzhou University, Lanzhou, 730000, Gansu, China.
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China.
- Gansu International Scientific and Technological Cooperation Base of Reproductive Medicine Transformation Application, Lanzhou, 730030, Gansu, China.
| | - Xuehong Zhang
- Lanzhou University, Lanzhou, 730000, Gansu, China.
- Lanzhou University First Affiliated Hospital, Lanzhou, 730030, Gansu, China.
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143
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Targeted Deletion of Mitofusin 1 and Mitofusin 2 Causes Female Infertility and Loss of Follicular Reserve. Reprod Sci 2023; 30:560-568. [PMID: 35739352 DOI: 10.1007/s43032-022-01014-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
Mitochondria are dynamic organelles that regulate their size, shape, and morphology through mechanisms called fusion and fission, to continually adapt themselves to their bioenergetic environment. These mechanisms play a critical role to maintain the mitochondrial function under metabolic and environmental stress. Mitofusin 1 (MFN1) and mitofusin 2 (MFN2) are transmembrane GTPases that regulate mitochondrial fusion mechanism and are required for the maintenance of cellular homeostasis. In this study, we aimed to determine the role of mitofusins in female reproductive competence and senescence using a mouse model with oocyte-specific double deletion of Mfn1 and Mfn2, eliminating the potential functional redundancy of these two proteins. Oocyte-specific targeted double deletion of Mfn1 and Mfn2 in mice resulted in female infertility associated with impaired follicular development and oocyte maturation. It also resulted in altered mitochondrial dynamics and mitochondrial dysfunction. Lack of Mfn1 and Mfn2 in oocytes resulted in accelerated follicular depletion and impaired oocyte quality which are consistent with phenotype of reproductive aging.
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144
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Follicular Fluid Components in Reduced Ovarian Reserve, Endometriosis, and Idiopathic Infertility. Int J Mol Sci 2023; 24:ijms24032589. [PMID: 36768912 PMCID: PMC9916781 DOI: 10.3390/ijms24032589] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Follicular fluid (FF) molecules, and their increase or decrease, can contribute to appropriate follicular growth and oocyte maturation, thus being related to female infertility conditions. In this paper, we studied the changes and the relationships of some biochemical components, hormones, antioxidant enzymes, F2-Isoprostanes (F2-IsoPs), and resolvin (Rv) D1 in the FF of infertile women with different reproductive conditions such as endometriosis, reduced ovarian reserve, and idiopathic infertility during assisted reproductive techniques (ART). In the whole population, positive correlations between albumin (ALB)/iron (Fe), ALB/beta-2-microglobulin (B2MG), and F2-IsoPs/RvD1 were detected in the FF. In FF from aged women, increased levels of follicle stimulating hormone (FSH) and reduced anti-Müllerian hormone (AMH) levels were associated with a worse oocyte quality. The negative ART outcome was influenced by patient age and AMH, B2MG, and FSH levels. Moreover, the reduced ovarian reserve condition was characterised by a significant decrease in oocyte number and quality, AMH amount, and lactate dehydrogenase (LDH) activity, as well as by an increase in age and FSH levels. In the presence of endometriosis, high levels of MDA and RvD1 were detected in FF, with a decrease in luteinising hormone (LH). Finally, among the molecules examined, none characterised the condition of idiopathic infertility. These data could support the identification of new FF markers in different reproductive disorders, suggesting the need for personalised therapeutic approaches and optimised ART outcomes. In particular, the evaluation of resolvins and lipid mediators in FF could be a promising field of investigation with which to understand the entity of oxidative stress and inflammation in some female infertility conditions.
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145
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İlhan G, Bacanakgil BH, Vuruşkan AK, Eken MK, Karasu AFG, Bilgiç BE, Küçükyurt AK. The effect of individual oocyte matched follicular fluid oxidant, antioxidant status, and pro- and anti-inflammatory cytokines on IVF outcomes of patients with diminished ovarian reserve. Medicine (Baltimore) 2023; 102:e32757. [PMID: 36705378 PMCID: PMC9876021 DOI: 10.1097/md.0000000000032757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Oocyte matched follicular fluid oxidant, antioxidant status, and pro- and anti-inflammatory cytokine levels were assessed to reveal a possible effect of local-intrafollicular levels of these markers on the individual oocyte with its quality, ability to achieve fertilization, further embryo development, and pregnancy. A cross-sectional study of infertile women with diminished ovarian reserve undergoing antagonist protocol in vitro fertilization (IVF); in the form of ICSI, and fresh single embryo transfer were included. When follicular fluid was collected, each ovarian follicle was aspirated independently, and each follicular fluid was collected into a separate test tube to match it with a single cumulus-oocyte complex obtained from the same follicle. Oocyte matched follicular fluid samples and blood specimens were taken from the participants. Relationships of total antioxidant status, total oxidant status, oxidative stress index, total thiol, interleukin (IL)-6, IL-8, and IL-10 levels of each follicle with oocyte grade, grade of transferred embryos, and pregnancy rate of a given follicle were assessed. A total of 23 infertile women with diminished ovarian reserve and 79 individual follicles of these women were assessed. Serum total oxidant status level of metaphase II (MII) group was significantly lower than non-MII group (P < .001). Follicular fluid IL-6 level of MII group was significantly lower than non-MII group (P = .005). Follicular fluid IL-8 value was significantly low with positive pregnancy results (P < .001). Serum oxidative stress status and follicular fluid pro-inflammatory cytokines were associated with IVF outcomes. This unique study might guide IVF practice with the aim of developing and establishing more effective therapeutic strategies and choosing embryos with more potential for success.
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Affiliation(s)
- Gülşah İlhan
- Health Sciences University, Istanbul Research and Education Hospital, Obstetrics and Gynecology, IVF Unit, İstanbul, Turkey
- * Correspondence: Gulsah İlhan, Health Sciences University, Istanbul Research and Education Hospital, Obstetrics and Gynecology, IVF Unit, Telsiz mah. Balikli Street, Zeytinburnu, İstanbul, Turkey (e-mail: )
| | - Besim Haluk Bacanakgil
- Health Sciences University, Istanbul Research and Education Hospital, Obstetrics and Gynecology, IVF Unit, İstanbul, Turkey
| | - Ayşe Köse Vuruşkan
- Health Sciences University, Istanbul Research and Education Hospital, Embryology, IVF Unit, İstanbul, Turkey
| | - Meryem Kürek Eken
- Hisar Hospital, Obstetrics and Gynecology, IVF Unit, İstanbul, Turkey
| | | | - Bülent Emre Bilgiç
- Health Sciences University, Istanbul Research and Education Hospital, Embryology, IVF Unit, İstanbul, Turkey
| | - Ayça Kubat Küçükyurt
- Health Sciences University, Istanbul Research and Education Hospital, Obstetrics and Gynecology, IVF Unit, İstanbul, Turkey
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146
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Di Guardo F, Pluchino N, Drakopoulos P. Treatment modalities for poor ovarian responders. Ther Adv Reprod Health 2023; 17:26334941221147464. [PMID: 36713768 PMCID: PMC9880576 DOI: 10.1177/26334941221147464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Nicola Pluchino
- Department of Obstetrics and Gynecology,
University Hospitals of Geneva, Geneva, Switzerland
| | - Panagiotis Drakopoulos
- Centre for Reproductive Medicine, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium,Department of Obstetrics and Gynaecology,
Alexandria University, Alexandria, Egypt,IVF Athens, Athens, Greece
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Diminished ovarian reserve is a risk factor for preeclampsia and placental malperfusion lesions. Fertil Steril 2023; 119:794-801. [PMID: 36702344 DOI: 10.1016/j.fertnstert.2023.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess obstetric outcomes and placental findings in pregnancies attained by in vitro fertilization (IVF) in patients with diminished ovarian reserve (DOR). DESIGN Retrospective cohort study. SETTING University-affiliated tertiary hospital. INTERVENTIONS DOR, defined as an antral follicle count (AFC) of 6 or less (DOR group), compared with patients with no DOR and an antral count above 6 (control group). PATIENTS Live singleton births after IVF between 2009 and 2017. MAIN OUTCOME MEASURES Primary outcomes were placental findings, including anatomic, inflammatory, vascular malperfusion, and villous maturation lesions, as categorized according to the Amsterdam Placental Workshop Group Consensus. Secondary outcomes included obstetric and perinatal outcomes. RESULTS A total of 110 deliveries of patients with DOR were compared with 772 controls. Maternal age was higher in the DOR group than in the control group (36.3 ± 4.4 years vs. 35.3 ± 4.1 years, P=.02). Patients with DOR were more likely to have a diagnosis of endometriosis (P=.02) and less likely to have a diagnosis of male factor (P<.001), ovulation disorder (P<.001), or tubal factor (P=.04), or a transfer of a blastocyte (P=.007). After adjustment for confounders, pregnancies in the DOR group were notable for a significantly higher rate of preeclampsia (8.1% vs. 2.7%, adjusted odds ratio: 3.05, 95% confidence interval: 1.33-6.97). On placental examination, DOR was associated with a higher rate of fetal vasculopathy (P=.01) and multiple fetal vascular malperfusion lesions (P=.03), and a lower rate of circummarginate insertion (P=.01) and intervillous thrombosis (P=.02). CONCLUSION DOR, specifically defined as an AFC of 6 or less, is associated with a higher incidence of preeclampsia and multiple placental fetal vascular lesions.
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The Polymorphism Asn680Ser on the FSH Receptor and Abnormal Ovarian Response in Patients with Normal Values of AMH and AFC. Int J Mol Sci 2023; 24:ijms24021080. [PMID: 36674596 PMCID: PMC9865618 DOI: 10.3390/ijms24021080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/09/2023] Open
Abstract
After the controlled ovarian stimulation (COS), the number of cumulus oocyte complexes collected is lower than predicted. The aim of this study is to understand if there is a possible reason for that deficient ovarian response. It was hypothesized that this is associated with the SNP (single-nucleotide polymorphism) of the FSH receptor (FSHr), specifically c.2039A > G, resulting in Asn680Ser. Two groups of patients were enrolled for this purpose: the normal (n = 36) and abnormal responses (n = 31). To predict the number of retrievable oocytes, according to the anti-Mũllerian hormone (AMH) and the antral follicle count (AFC), the following formula was applied in a log scale: the number of oocytes retrieved = 2.584 − 0.015 × (age) − 0.035 × (FSH) + 0.038 × (AMH) + 0.026 × (AFC). Then, when the number of oocytes collected was less than 50% of the calculated value, it was proposed that the patients result in an abnormal response. DNA sample blood was collected from the women, and then the genetic assessment for the Asn680Ser of the FSHr was evaluated in both groups. The differences between the two categories were statistically analyzed with an independent samples t test, a Mann−Whitney U test and a Chi-squared test. In a patient with an abnormal response, a significant prevalence of the amino acid serine at position 680 of the FSHr compared to the counterpart group (p < 0.05) was detected. In conclusion, according to the results, the genetic evaluation of the FSHr could represent an accurate and predictive feature for patients undergoing assisted reproductive technology treatment.
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Sperduti S, Paradiso E, Anzivino C, Lazzaretti C, Limoncella S, D'Alessandro S, Roy N, Reggianini F, Ferrari T, Melli B, La Sala GB, Nicoli A, Daolio J, Villani MT, Tagliavini S, Trenti T, Potì F, Sandhowe R, Centonze C, Lispi M, Simoni M, Casarini L. LH increases the response to FSH in granulosa-lutein cells from sub/poor-responder patients in vitro. Hum Reprod 2023; 38:103-112. [PMID: 36367827 DOI: 10.1093/humrep/deac246] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does LH addition to FSH in vitro recover the human primary granulosa lutein cell (hGLC) sub/poor-response? SUMMARY ANSWER A picomolar concentration of LH may recover the FSH-induced cAMP and progesterone production of hGLC from sub/poor-responder women. WHAT IS KNOWN ALREADY Clinical studies suggested that FSH and LH co-treatment may be beneficial for the ovarian response of sub/poor-responders undergoing ovarian stimulation during ART. STUDY DESIGN, SIZE, DURATION hGLC samples from 286 anonymous women undergoing oocyte retrieval for ART were collected from October 2017 to February 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS hGLCs from women undergoing ovarian stimulation during ART were blindly purified, cultured, genotyped and treated in vitro by increasing concentrations of FSH (nM) ±0.5 nM LH. cAMP and progesterone levels produced after 3 and 24 h, respectively, were measured. In vitro data were stratified a posteriori, according to the donors' ovarian response, into normo-, sub- and poor-responder groups and statistically compared. The effects of LH addition to FSH were compared with those obtained by FSH alone in all the groups as well. MAIN RESULTS AND THE ROLE OF CHANCE hGLCs from normo-responders were shown to have higher sensitivity to FSH treatment than sub-/poor-responders in vitro. Equimolar FSH concentrations induced higher cAMP (about 2.5- to 4.2-fold), and progesterone plateau levels (1.2- to 2.1-fold), in cells from normo-responder women than those from sub-/poor-responders (ANOVA; P < 0.05). The addition of LH to the cell treatment significantly increased overall FSH efficacy, indicated by cAMP and progesterone levels, within all groups (P > 0.05). Interestingly, these in vitro endpoints, collected from the normo-responder group treated with FSH alone, were similar to those obtained in the sub-/poor-responder group under FSH + LH treatment. No different allele frequencies and FSH receptor (FSHR) gene expression levels between groups were found, excluding genetics of gonadotropin and their receptors as a factor linked to the normo-, sub- and poor-response. In conclusion, FSH elicits phenotype-specific ovarian lutein cell response. Most importantly, LH addition may fill the gap between cAMP and steroid production patterns between normo- and sub/poor-responders. LIMITATIONS, REASONS FOR CAUTION Although the number of experimental replicates is overall high for an in vitro study, clinical trials are required to demonstrate if the endpoints evaluated herein reflect parameters of successful ART. hGLC retrieved after ovarian stimulation may not fully reproduce the response to hormones of granulosa cells from the antral follicular stage. WIDER IMPLICATIONS OF THE FINDINGS This in vitro assay may describe the individual response to personalize ART stimulation protocol, according to the normo-, sub- and poor-responder status. Moreover, this in vitro study supports the need to conduct optimally designed, randomized clinical trials exploring the personalized use of LH in assisted reproduction. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by Merck KGaA. M.L. and C.C. are employees of Merck KGaA or of the affiliate Merck Serono SpA. Other authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Samantha Sperduti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Elia Paradiso
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Anzivino
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Clara Lazzaretti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Limoncella
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara D'Alessandro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,International Ph.D. School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Neena Roy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Reggianini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Ferrari
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Beatrice Melli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Battista La Sala
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessia Nicoli
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jessica Daolio
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Teresa Villani
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simonetta Tagliavini
- Department of Laboratory Medicine and Pathological Anatomy, Azienda USL/Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Tommaso Trenti
- Department of Laboratory Medicine and Pathological Anatomy, Azienda USL/Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesco Potì
- Department of Medicine and Surgery, Unit of Neurosciences, University of Parma, Parma, Italy
| | - Reinhild Sandhowe
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Chiara Centonze
- Medical Affair, Merck Serono SpA (Rome, Italy), An Affiliate of Merck KGaA, Darmstadt, Germany
| | - Monica Lispi
- International Ph.D. School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy.,Global Medical Affair, Merck KGaA, Darmstadt, Germany
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
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150
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Gong X, Zhang Y, Zhu Y, Wang P, Wang Z, Liu C, Zhang M, La X. Development and validation of a live birth prediction model for expected poor ovarian response patients during IVF/ICSI. Front Endocrinol (Lausanne) 2023; 14:1027805. [PMID: 36798666 PMCID: PMC9927003 DOI: 10.3389/fendo.2023.1027805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A number of live birth predictive model during assisted reproductive technology treatment have been available in recent years, but few targeted evaluating the chances of live birth in poor ovarian response(POR) patients. The aim of this study was to develop a nomogram based on POSEIDON criteria to predict live birth in patients with expected POR. METHODS This retrospective cohort study using clinical data from 657 patients in POSEIDON Groups 3 and 4 (antral follicle count [AFC] ≤5 and AMH <1.2 ng/ml) in the Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, and Construction a nomogram model t. RESULTS Among 657 expected POR patients, 111 (16.89%) had live births, and 546 (83.11%) did not have live births. These were divided into a training set(n=438) and a validation set (n=219). Multivariate logistic regression analysis showed that the age (OR = 0.91, 95% CI: 0.86-0.97), BMI (OR = 1.98, 95% CI: 1.09-3.67), AMH (OR = 3.48, 95% CI: 1.45-8.51), normal fertilized oocytes (OR = 1.40, 95% CI: 1.21-1.63), and the basal FSH (OR = 0.89, 95% CI: 0.80-0.98) of the female were independent factors predicting live birth in patients with expected POR. Then, an individualized nomogram prediction model was built from these five factors. The area under the ROC curve of the live birth prediction model was 0.820 in the training set and 0.879 in the validation set. CONCLUSION We have developed a nomogram combining clinical and laboratory factors to predict the probability of live birth in patients with an expected POR during IVF/ICSI, which can helpful for clinician in decision-making. However, the data comes from the same center, needs a prospective multicenter study for further in-depth evaluation and validation of this prediction model.
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Affiliation(s)
- Xiaoyun Gong
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China
| | - Yunian Zhang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Basic Medical College of Xinjiang Medical University, Urumqi, China
| | - Yuejie Zhu
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Peng Wang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhihui Wang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chen Liu
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Manli Zhang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaolin La
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China
- *Correspondence: Xiaolin La,
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