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Li Y, Xia L, Li Z, Zhang Z, Jiang R. Factors affecting cumulative live birth rate after the 1st oocyte retrieved in polycystic ovary syndrome patients in women during IVF/ICSI-ET. J Ovarian Res 2023; 16:201. [PMID: 37833722 PMCID: PMC10571446 DOI: 10.1186/s13048-023-01290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The factors affecting the cumulative live birth rate (CLBR) of PCOS (Polycystic ovary syndrom) patients who received in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) needs more research for a better outcome. METHODS Here we carried out a retrospective analysis of 1380 PCOS patients who received IVF/ICSI-ET for the first time from January 2014 to December 2016. We divided them into cumulative live birth group (group A) and non-cumulative live birth group (group B) according to whether there were live births. RESULTS The conservative cumulative live birth rate was 63.48%. There were 876 cumulative live births (group A) and 504 non-cumulative live births (group B) according to whether the patients had live births or not. Competition analysis showed that duration of infertility, primary/secondary type of infertility, stimulation protocols, starting dose of gonadotrophins and oocyte retrieved numbers were significantly correlated with CLBR. The Cox proportional risk regression model of PCOS patients showed that stimulation protocols had a significant impact on CLBR. Patients in the GnRH (Gonadotropin-releasing hormone)-antagonist protocol group and the mild stimulation protocol had lower CLBR than those in the prolonged GnRH-agonist protocol, which was statistically significant. PCOS patients with the starting dose of gonadotrophins greater than 112.5u had lower CLBR than those with less than 100u, which was statistically significant. Women with 11-15 oocytes and 16-20 oocytes had higher CLBR than women with 1-9 oocytes, which was statistically significant. CONCLUSIONS When we used Prolonged GnRH-agonist protocol, or the first starting dose of gonadotrophins was 100u-112.5u, or the number of oocytes obtained was 11-15 and 16-20, the CLBR of PCOS patients increased significantly after the 1st oocyte collection.
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Affiliation(s)
- You Li
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P. R. China
| | - Leizhen Xia
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P. R. China
| | - Zengming Li
- The Subcenter of National Clinical Research Center for Obstetrics and Gynecology, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi Province, China
- Clinical Research Center for Obstetrics and Gynecology of Jiangxi province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P. R. China
| | - Ziyu Zhang
- The Subcenter of National Clinical Research Center for Obstetrics and Gynecology, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi Province, China.
- Clinical Research Center for Obstetrics and Gynecology of Jiangxi province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P. R. China.
- Department of pathology, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P. R. China.
| | - Ru Jiang
- Department of gynecology and obstetrics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China.
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Grynberg M, Cedrin-Durnerin I, Raguideau F, Herquelot E, Luciani L, Porte F, Verpillat P, Helwig C, Schwarze JE, Paillet S, Castello-Bridoux C, D'Hooghe T, Benchaïb M. Comparative effectiveness of gonadotropins used for ovarian stimulation during assisted reproductive technologies (ART) in France: A real-world observational study from the French nationwide claims database (SNDS). Best Pract Res Clin Obstet Gynaecol 2023; 88:102308. [PMID: 36707343 DOI: 10.1016/j.bpobgyn.2022.102308] [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: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
This comparative non-interventional study using data from the French National Health Database (Système National des Données de Santé) investigated real-world (cumulative) live birth outcomes following ovarian stimulation, leading to oocyte pickup with either originator recombinant human follicle-stimulating hormone (r-hFSH) products (alfa or beta), r-hFSH alfa biosimilars, or urinaries including mainly HP-hMG (menotropins), and marginally u-hFSH-HP (urofollitropin). Using data from 245,534 stimulations (153,600 women), biosimilars resulted in a 19% lower live birth (adjusted odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76-0.86) and a 14% lower cumulative live birth (adjusted hazard ratio (HR) 0.86, 95% CI 0.82-0.89); and urinaries resulted in a 7% lower live birth (adjusted OR 0.93, 95% CI 0.90-0.96) and an 11% lower cumulative live birth (adjusted HR 0.89, 95% CI 0.87-0.91) versus originator r-hFSH alfa. Results were consistent across strata (age and ART strategy), sensitivity analysis using propensity score matching, and with r-hFSH alfa and beta as the reference group.
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Affiliation(s)
- M Grynberg
- Hôpital Antoine Béclère, Service de Médecine de La Reproduction et Préservation de La Fertilité, 92140, Clamart, France; Hôpital Jean Verdier, Service de Médecine de La Reproduction et Préservation de La Fertilité, 93140, Bondy, France.
| | - I Cedrin-Durnerin
- Hôpital Jean Verdier, Service de Médecine de La Reproduction et Préservation de La Fertilité, 93140, Bondy, France.
| | | | | | - L Luciani
- Direction des Affaires Médicales - Real-World Evidence, Merck Santé, 69008, Lyon, France.
| | - F Porte
- Direction des Affaires économiques - Market Access, Merck Santé, 69008, Lyon, France.
| | | | - C Helwig
- Merck Healthcare KGaA, Darmstadt, Germany.
| | | | - S Paillet
- Direction des Affaires Médicales - Fertilité, Merck Santé, 69008, Lyon, France.
| | - C Castello-Bridoux
- Direction des Affaires Médicales - Fertilité, Merck Santé, 69008, Lyon, France.
| | - Thomas D'Hooghe
- Merck Healthcare KGaA, Darmstadt, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Herestraat 49 - Box 805 | B-3000, Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, CT, 06510, USA.
| | - M Benchaïb
- Hôpital Mère Enfant, Service de Médecine de La Reproduction et Préservation de La Fertilité, 69500, Bron, France.
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Neves AR, Montoya-Botero P, Sachs-Guedj N, Polyzos NP. Association between the number of oocytes and cumulative live birth rate: A systematic review. Best Pract Res Clin Obstet Gynaecol 2023; 87:102307. [PMID: 36707342 DOI: 10.1016/j.bpobgyn.2022.102307] [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: 08/02/2022] [Revised: 11/24/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
The available literature is controversial regarding the association between the number of oocytes retrieved and the cumulative live birth rate (CLBR). Although some authors report a continuous increase in the CLBR with the number of oocytes retrieved, others have found a plateau. A systematic review was conducted, including all eligible studies published until June 2022, to determine the optimal number of oocytes retrieved to maximize the CLBR. We found a positive association between the number of oocytes and the CLBR. However, this association varies according to patients' age. While in patients younger than 35 years, little benefit is derived from increasing the number of oocytes above 25-30, in patients older than 35 years, the number of oocytes seems to improve the CLBR until the extreme of reproductive age is reached. In women aged 44 years or older, the CLBR will be consistently low, independent of the number of oocytes retrieved.
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Affiliation(s)
- Ana Raquel Neves
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, 08028 Barcelona, Spain; IVI-RMA Lisboa, Portugal; Autonomous University of Barcelona, 08193, Cerdanyola del Vallès, Barcelona, Spain.
| | | | - Noemie Sachs-Guedj
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, 08028 Barcelona, Spain
| | - Nikolaos P Polyzos
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, 08028 Barcelona, Spain; Faculty of Medicine and Health Sciences, Ghent University (UZ Gent), 9000 Gent, Belgium
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Impact of the number of retrieved oocytes on IVF outcomes: oocyte maturation, fertilization, embryo quality and implantation rate. ZYGOTE 2023; 31:91-96. [PMID: 36533391 DOI: 10.1017/s096719942200065x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The process of oocyte retrieval represents a key phase during the cycles of in vitro fertilization (IVF). It involves controlled ovarian stimulation to retrieve the highest number of oocytes possible. According to many previous studies, the higher the number of oocytes the higher the chances of obtaining embryos for multiple transfers. In this study, in total, 1987 patients were retrospectively reviewed to investigate the correlations between the number of retrieved oocytes and the subsequent IVF outcomes. Patients were divided into three groups according to the number of retrieved oocytes (Group 1: ≤5 oocytes; Group 2: 6-15 oocytes; Group 3: ≥15 oocytes). The results showed a significant negative correlation between oocyte number and maturation rate as well as fertilization rate. However, a significant positive correlation was found between oocyte number and the blastulation rate. The implantation rate after fresh embryo transfers was higher in group 2 (6-15 oocytes) compared with group 1 (≤5 oocytes). According to our findings, we conclude that oocyte numbers between 6 and 15 oocytes can result in the highest chances of positive IVF outcomes in terms of embryo quality and fresh embryo transfers with lower risks of ovarian hyperstimulation.
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Zhang Y, Qiao Y, Li L, Gao DD, Song JY, Sun ZG. Efficacy of Qizi Yusi Pill on Pregnancy Outcomes in Women of Advanced Reproductive Age: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Chin J Integr Med 2022; 28:675-682. [PMID: 35648305 DOI: 10.1007/s11655-022-3515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evalvate efficacy of Qizi Yusi Pills (QYP), a Chinese medicine compound preparation, on in vitro fertilization-embryo transfer (IVF-ET) in women of advanced reproductive age. METHODS This multicenter, randomized, double-blind, placebo-controlled trial was conducted from June 2018 to October 2019. A total of 124 patients were randomly allocated to either the QYP group or the placebo group using a stratified block randomization design, with 62 patients in each group. All patients completed controlled ovarian stimulation using a standard gonadotropin-releasing hormone agonist (GnRH-a) long protocol. As the QYP group, QYP was administered while the control group received placebo. QYP and placebo were administered for a total of 24 to 30 days from the day of GnRH-a pituitary downregulation to transvaginal oocyte retrieval. Both medications were taken orally at doses of 10 g three times each day. The primary outcome was cumulative pregnancy rate, and the secondary outcomes were periodic medication, follicular status, serum hormone and endometrial receptivity. Follow-up continued until 4 weeks after delivery. Maternal and neonatal complications, such as gestational diabetes, were also observed. RESULTS Overall, 119 patients completed the study, 60 in the QYP group and 59 in the placebo group. Per protocol (PP) analysis revealed that 6-month cumulative pregnancy rate in the QYP group was significantly higher than that in the placebo group [43.33% (26/60) vs. 25.42% (15/59), P=0.040). Additionally, more oocytes were retrieved from the QYP group than those from the placebo group (8.95 ± 3.12 vs. 7.85 ± 1.91, P=0.022). Moreover, the endometrial thickness of HCG day in the QYP group was significantly higher than that in the placebo group (11.78 ± 2.27 mm vs. 10.68 ± 2.07 mm, P=0.012). Maternal and neonatal complications between the two groups were not significantly different (P>0.05). Intention-to-treat analysis was in line with PP results. CONCLUSIONS QYP can enhance ovarian reserve capacity and ovarian response, and possibly promote endometrial receptivity. QYP effectively improves cumulative pregnancy rates in older patients (⩾35 years) undergoing IVF-ET. (Registration No. ChiCTR1800014427).
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Affiliation(s)
- Yi Zhang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Yan Qiao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Li Li
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Dan-Dan Gao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Zhen-Gao Sun
- Reproductive and Genetic Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China.
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Time to pregnancy in women with previous ectopic pregnancy undergoing in vitro fertilization treatment: a retrospective cohort study. Sci Rep 2022; 12:8820. [PMID: 35614336 PMCID: PMC9133082 DOI: 10.1038/s41598-022-13027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
We aimed to investigate the difference in the time to pregnancy (TTP) between women with previous ectopic pregnancy (EP) and control women following in vitro fertilization (IVF) treatment and the association between TTP and the number of oocytes retrieved and embryos available. A retrospective study involving 1097 women, 547 of which had previous EP and 550 were control women whose previous pregnancy were abortion, was conducted. Women in the EP group had significantly longer median TTP than those in the control group (36; range, 12–252 vs 28; range, 12–220; P = 0.019). For women with previous EP, > 48 months TTP was most likely associated with low numbers of oocytes retrieved and embryos available compared to TTP of ≤ 24 months or 25–48 months, and women with younger age had a shorter TTP, higher numbers of oocytes retrieved and embryos available. A Cox proportional hazards model showed that maternal age was significantly related to the pregnancy over the TTP (adjusted hazard ratio, 0.934; P < 0.001). In conclusion, women with previous EP have a significantly increased TTP than control women with previous abortion. For women with previous EP, TTP is negatively associated with the numbers of oocytes retrieved and embryos available.
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Jia R, Liu Y, Jiang R, Zhu X, Zhou L, Chen P, Cao M, Zhao Z. The Optimal Number of Oocytes Retrieved From PCOS Patients Receiving IVF to Obtain Associated With Maximum Cumulative Live Birth Rate and Live Birth After Fresh Embryo Transfer. Front Endocrinol (Lausanne) 2022; 13:878214. [PMID: 35813639 PMCID: PMC9259927 DOI: 10.3389/fendo.2022.878214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
AIMS This study aims to determine the optimal number of oocytes retrieved so that patients with polycystic ovary syndrome (PCOS) receiving in vitro fertilization (IVF) can obtain the best cumulative live birth rate (CLBR) and live birth after fresh embryo transfer. METHODS This is a retrospective study of 1,419 patients with PCOS who underwent their first IVF cycle at the Second Hospital of Hebei Medical University from January 2014 to December 2021. Multivariable regression analysis was performed to adjust for factors known to independently affect cumulative live birth aspiration. The number of oocytes retrieved to obtain the best cumulative live birth rate was explored through curve fitting and threshold effect analysis. The decision tree method was used to explore the best number of oocytes retrieved to achieve live birth in the shortest time. RESULTS (1) The number of oocytes retrieved was found to be an independent protective factor for the cumulative live birth rate (OR = 1.09 (95% CI: 1.06, 1.12)). When the number of oocytes retrieved was less than 15, CLBR increased by 16% with each increase in the number of oocytes retrieved (OR = 1.16 (95% CI: 1.11, 1.22)); and when more than 15, CLBR tended to be stable. (2) Live birth after the first fresh embryo transfer was analyzed through a classification decision tree. For patients younger than 35 years old, those with less than 6 oocytes and those with 7-16 oocytes had a similar proportion of live births with fresh embryo transfer but higher than 16 oocytes (53.7% vs. 53.8% vs. 18.4%). Patients older than 35 years old had a similar proportion of live births with fresh embryo transfer (35.7% vs. 39.0%) to those younger than 35 years old, but the proportion of no live births after using up all embryos was higher than those younger than 35 years old (39.3% vs. 19.2%). CONCLUSIONS In PCOS patients, high CLBR can be obtained when the number of oocytes retrieved was 15 or more. The number of oocytes retrieved from 7 to 16 could achieve more chance of live birth after fresh embryo transfer.
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Ebid AHIM, Motaleb SMA, Mostafa MI, Soliman MMA. Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: A modeling approach. Clin Exp Reprod Med 2021; 48:163-173. [PMID: 34024083 PMCID: PMC8176155 DOI: 10.5653/cerm.2020.03909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. METHODS This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. RESULTS The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women's age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. CONCLUSION Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.
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Wang Y, Zhang M, Shi H, Yi S, Li Q, Su Y, Guo Y, Hu L, Sun J, Sun YP. Causes and Effects of Oocyte Retrieval Difficulties: A Retrospective Study of 10,624 Cycles. Front Endocrinol (Lausanne) 2021; 12:564344. [PMID: 35046887 PMCID: PMC8761769 DOI: 10.3389/fendo.2021.564344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Oocyte retrieval is a routine procedure during the application of assisted reproduction technology. However, technical difficulties experienced during oocyte retrieval and the subsequent unsatisfactory number of oocytes obtained are rarely reported. The current study included 10,624 oocyte retrieval cycles from April 2015 to June 2018, and patients were followed up until February 2019. Patients were divided into two groups depending on whether the oocyte number obtained reached the >14-mm follicle number on the day of hCG administration. In the oocyte retrieval not satisfactory (ORNS) group, there were 1,294 cycles, and in the oocyte retrieval satisfactory (ORS) group, there were 9,330 cycles. ORNS patients were older, had a longer duration of infertility, had higher follicle-stimulating hormone, and were more likely to have endometriosis. The ORS group had a higher rate of the use of a follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long ovarian stimulation protocol and a lower rate of the use of a luteal phase short-acting GnRH agonist long protocol. The ORNS group had fewer total number of days of FSH stimulation. On human chorionic gonadotropin day, the ORNS group had higher luteinizing hormone (LH), lower estradiol, and lower progesterone levels. After oocyte retrieval, the oocyte quality and fresh cycle transplantation rate were higher in the ORNS group. An unsatisfactory oocyte retrieval number did not influence the clinical pregnancy rate, miscarriage rate, or live birth rate during the fresh cycles. The cumulative pregnancy rate and the live birth rate were lower in the ORNS group. In conclusion, with a similar number of matured follicles, ORNS was more likely to occur in ovarian dysfunction patients. The follicular phase long-acting GnRH agonist long protocol had lower oocyte retrieval difficulty during IVF/ICSI. ORNS does not affect embryo quality or the fresh cycle pregnancy rate, but it significantly reduces the cumulative pregnancy rate and the live birth rate.
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Affiliation(s)
- Yang Wang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meixiang Zhang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Shi
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shiqi Yi
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingchun Su
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yihong Guo
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linli Hu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-pu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Ying-pu Sun,
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Law YJ, Zhang N, Kolibianakis EM, Costello MF, Keller E, Chambers GM, Venetis CA. Is there an optimal number of oocytes retrieved at which live birth rates or cumulative live birth rates per aspiration are maximized after ART? A systematic review. Reprod Biomed Online 2020; 42:83-104. [PMID: 33390313 DOI: 10.1016/j.rbmo.2020.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Abstract
The association between the number of oocytes retrieved and fresh live birth rate (LBR) or cumulative LBR (CLBR), and whether an optimal number of oocytes are retrieved when LBR or CLBR are maximized, are highly relevant clinical questions; however published results are conflicting. A systematic review of all eligible studies (n = 16) published until January 2020 on MEDLINE, Embase, Scopus, CINAHL and Web of Science was conducted. Five studies evaluated only LBR from fresh cycles, five studies evaluated only CLBR from stimulated cycles and six evaluated both. A marked difference was observed between the oocyte yields at which LBR and CLBR were reportedly maximized in the individual studies. On the basis of nine studies, the optimal number of oocytes at which fresh LBR seems to be maximized is proposed to be between 12 and 18 oocytes (15 oocytes was the most common suggestion). On the other hand, CLBR continues to increase with the number of oocytes retrieved. This is the first systematic review on the topic, and it suggests that the retrieval of 12-18 oocytes is associated with maximal fresh LBR, whereas a continuing positive association is present between the number of oocytes retrieved and CLBR.
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Affiliation(s)
- Yin Jun Law
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia
| | - Ning Zhang
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia
| | | | - Michael F Costello
- School of Women's and Children's Health, UNSW Medicine, Sydney NSW, Australia; IVFAustralia, Sydney NSW, Australia
| | - Elena Keller
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia
| | - Christos A Venetis
- National Perinatal Epidemiology and Statistics Unit, School of Women and Children's Health and Centre for Big Data Research in Health, UNSW Medicine, Level 2, AGSM Building (G27), UNSW Australia, UNSW Sydney NSW 2052, Sydney NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney NSW, Australia; IVFAustralia, Sydney NSW, Australia.
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Tarazona AM, Ceballos MC, Broom DM. Human Relationships with Domestic and Other Animals: One Health, One Welfare, One Biology. Animals (Basel) 2019; 10:E43. [PMID: 31878310 PMCID: PMC7022888 DOI: 10.3390/ani10010043] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/02/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022] Open
Abstract
Excessive human population growth, uncontrolled use of natural resources, including deforestation, mining, wasteful systems, biodiversity reduction by agriculture, and damaging climate change affect the existence of all animals, including humans. This discussion is now urgent and people are rethinking their links with the animals we use for clothing, food, work, companionship, entertainment, and research. The concepts of one health, one welfare, and one biology are discussed as a background to driving global change. Nothing should be exploited without considering the ethics of the action and the consequences. This review concerns domesticated animals, including those used for human consumption of meat, eggs, and milk; horses kept for work; and dogs kept for company. Animal welfare includes health, emotional state, and comfort while moving and resting, and is affected by possibilities to show behavior and relationships with others of the same species or with humans. We show some examples of the relations between humans and domesticated animals in the environmental context, including zoonotic diseases, and consider the consequences and the new paradigms resulting from current awareness.
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Affiliation(s)
- Ariel M Tarazona
- Facultad de Ciencias Agrarias, Departamento de Producción Animal Medellín, Universidad Nacional de Colombia, Antioquia 050034, Colombia
| | - Maria C Ceballos
- Grupo ETCO, Group of Studies and Research in Animal Ethology and Ecology, Jaboticabal-SP 14884-900, Brazil;
- Swine Teaching and Research Center, Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348, USA
| | - Donald M Broom
- St Catharine’s College and Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK;
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Lunenfeld B, Bilger W, Longobardi S, Kirsten J, D'Hooghe T, Sunkara SK. Decision points for individualized hormonal stimulation with recombinant gonadotropins for treatment of women with infertility. Gynecol Endocrinol 2019; 35:1027-1036. [PMID: 31392906 DOI: 10.1080/09513590.2019.1650345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
It is essential that fertility treatment is individualized based on a thorough diagnostic work-up, with treatment tailored to the patients' requirements. This individualization should be kept in mind during the main decision points that occur before and during treatment. Treatment customization must include consideration of both the woman and her partner involved in the process together, including their collective treatment goals. Once treatment goals have been agreed and diagnostic evaluations performed, personalization based on patient characteristics, together with an understanding of treatment goals and patient preferences, enables the selection of appropriate treatments, protocols, products and their dosing. Following treatment initiation, monitoring and adaptation of product and dose can then ensure optimal outcomes. Currently, it is not possible to base treatment decisions on every characteristic of the patient and personalization is based on biomarkers that have been identified as the most relevant. However, in the future, the use of artificial intelligence coupled with continuous monitoring should enable greater individualization and improve outcomes. This review considers the current state-of-the-art related to decision points during individualized treatment of female infertility, before looking at future developments that might further assist in making individualized treatment decisions, including the use of computer-assisted decision making.
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Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Wilma Bilger
- Medical Affairs Fertility, Endocrinology & General Medicine, Merck Serono GmbH, Darmstadt, Germany
| | | | - Jan Kirsten
- Business Franchise Fertility, Merck KGaA, Darmstadt, Germany
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Merck KGaA, Darmstadt, Germany
- Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Sesh K Sunkara
- Assisted Conception Unit, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Vermey BG, Chua SJ, Zafarmand MH, Wang R, Longobardi S, Cottell E, Beckers F, Mol BW, Venetis CA, D'Hooghe T. Is there an association between oocyte number and embryo quality? A systematic review and meta-analysis. Reprod Biomed Online 2019; 39:751-763. [PMID: 31540848 DOI: 10.1016/j.rbmo.2019.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 11/28/2022]
Abstract
This systematic review and meta-analysis determined the association between aspirated after ovarian stimulation and top/good quality embryos obtained in women undergoing ovarian stimulation for IVF/intracytoplasmic sperm injection (ICSI). MEDLINE, EMBASE, Scopus, CINAHL and Web of Science were searched for English-language publications on top/good-quality embryos at cleavage (day 2/3) and/or blastocyst (day 5/6) developmental stages, up to 18 November 2017. Twenty-eight studies (three prospective and 25 retrospective) reporting data on 291,752 assisted reproductive technology (ART) cycles were considered eligible. We confirmed a strong positive association between oocytes retrieved and top/good-quality day 2/3 embryos (weighted correlation coefficient [rw] = 0.791), day 5/6 embryos (rw = 0.901), metaphase II oocytes (rw = 0.988), oocytes exhibiting two pronuclei (rw = 0.987) and euploid embryos (rw = 0.851); P < 0.001 for all correlations (evaluated in subsets of the 17 studies). Data from 5657 cycles showed that the group with the most oocytes aspirated had the most top/good-quality day 2/3 embryos (pooled standardized mean differences (high [>15] versus low [<4] 1.91, 95% confidence interval [CI] 1.05-2.77, P < 0.0001; high versus medium [4-15] 1.15, 95% CI 0.74-1.55, P < 0.0001; medium versus low 1.41, 95% CI 0.79-2.03, P < 0.0001). Individual participant meta-analysis would enable accurate determination of these associations and other outcomes.
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Affiliation(s)
- Belinda G Vermey
- School of Women's and Children's Health, University of New South Wales NSW, Australia.
| | - Su Jen Chua
- Robinson Research Institute and Adelaide Medical School, University of Adelaide SA, Australia
| | - Mohammad Hadi Zafarmand
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Rui Wang
- Robinson Research Institute and Adelaide Medical School, University of Adelaide SA, Australia
| | | | | | | | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton Victoria, Australia
| | - Christos A Venetis
- School of Women's and Children's Health, University of New South Wales NSW, Australia; Centre for Big Data Research in Health, University of New South Wales NSW, Australia
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Use of Cumulative Live Birth Rate per Total Number of Embryos to Calculate the Success of IVF in Consecutive IVF Cycles in Women Aged ≥35 Years. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6159793. [PMID: 31346521 PMCID: PMC6617928 DOI: 10.1155/2019/6159793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/28/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Abstract
Objective The use of cumulative live birth rate (CLBR) per ovarian stimulation cycle is proving to be an accurate method to calculate the success of IVF; however, the cycle outcome is closely associated with the number of embryos transferred (ET). Our aim was to report CLBR after IVF according to the number of embryos required to achieve a live birth in women aged ≥35 years, considering age, body mass index (BMI), and ethnicity. Methods We conducted a retrospective cohort study including 1344 patients who underwent IVF between January 2013 and June 2016 at the First Affiliated Hospital of Xinjiang Medical University. The cumulative probability of live birth for each couple was estimated using the Kaplan–Meier method, and survival curves were compared according to age, BMI, and ethnicity using the log-rank test. Results CLBR increased rapidly from 1 to 5 ETs, moderately from 6 to 10 ETs, and slowly thereafter. CLBR was significantly different across 4 categories based on BMI as well as across those based on age; low CLBR was significantly associated with the age of ≥42 years and obesity. Conclusion The association between CLBR and number of ET provides realistic and precise information regarding the success of IVF and can be applied to guide clinicians and patients.
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Zeng C, Shang J, Jin AM, Wu PL, Li X, Xue Q. The effect of luteal GnRH antagonist on moderate and severe early ovarian hyperstimulation syndrome during in vitro fertilization treatment: a prospective cohort study. Arch Gynecol Obstet 2019; 300:223-233. [PMID: 31004220 DOI: 10.1007/s00404-019-05163-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/12/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Ovarian hyperstimulation syndrome (OHSS) is a serious complication of assisted reproductive technology (ART) treatment. However, there are limited data regarding the ability of the luteal GnRH antagonist cetrorelix to reduce the incidence of moderate and severe OHSS, and the mechanism remains unclear. Thus, we designed a study to assess the effectiveness of cetrorelix to prevent early moderate and severe OHSS in high-risk patients undergoing controlled ovarian stimulation for IVF/ICSI. METHODS In this prospective cohort study, 105 patients with high-risk OHSS undergoing cryopreservation of all embryos were divided into two groups according to their personal choice. The cetrorelix group (n = 65) received 0.25 mg of cetrorelix by subcutaneous injection daily, from days 3 to 5 post-oocyte retrieval (POR); the control group (n = 40) received no drug. The primary outcome measures were the incidence and severity of early moderate and severe OHSS. Secondary measures included serum estradiol levels, ovarian volume, ascites volume, hematocrit values, and WBC count on days 3, 6, and 9 POR. VEGF and EGR-1 levels were assessed, and binary logistic regression analysis was applied to predict associations between clinical variables and OHSS. RESULTS Ninety-six patients were examined. The incidence of moderate and severe OHSS was significantly lower in the cetrorelix group than in the control group (18.03% and 37.14%, respectively; P = 0.037). Serum estradiol (P = 0.013), white blood cell count (P = 0.031), ascites volume (P = 0.036), EGR-1 (P = 0.025), and VEGF levels (P = 0.015) were significantly higher in the control group on day 6 POR than on day 3 POR, while no increase was observed between day 3 POR and day 6 POR in the cetrorelix group, indicating a faster regression of OHSS symptoms. Cetrorelix intervention was associated with the incidence and severity of OHSS (OR 0.29, 95% CI 0.11-0.78, P = 0.014). CONCLUSION Cetrorelix effectively reduces the incidence of early moderate and severe OHSS in high-risk women and decreases serum VEGF levels.
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Affiliation(s)
- Cheng Zeng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, People's Republic of China
| | - Jing Shang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, People's Republic of China
| | - Ao-Ming Jin
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, 100191, People's Republic of China
| | - Pei-Li Wu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, People's Republic of China
| | - Xin Li
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, People's Republic of China
| | - Qing Xue
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, People's Republic of China. .,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, People's Republic of China.
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Cai Y, Ding M, Lin F, Diao Z, Zhang N, Sun H, Zhou J. Evaluation of preimplantation genetic testing based on next-generation sequencing for balanced reciprocal translocation carriers. Reprod Biomed Online 2019; 38:669-675. [PMID: 30885668 DOI: 10.1016/j.rbmo.2018.12.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022]
Abstract
RESEARCH QUESTION Can next-generation sequencing (NGS) based on copy number variation sequencing (CNV-Seq) identify normal/balanced embryos in balanced reciprocal translocation carriers and what are their reproductive outcomes? DESIGN One hundred couples with balanced reciprocal translocation who underwent a total of 134 preimplantation genetic testing (PGT) cycles between January 2015 and October 2017 were evaluated. Trophectoderm cells of blastocysts were biopsied for CNV-Seq-based NGS. All the balanced/normal blastocysts were vitrified and cryopreserved. Single balanced/normal blastocysts were warmed and transferred in the subsequent frozen embryo transfer (FET) cycle. RESULTS During the study period, 400 blastocysts were analysed by NGS-PGT, of which 109 (27.25%) were balanced and euploid. A total of 52 blastocysts were transferred in the FET cycle. Clinical pregnancy was confirmed in 34 women (65.38%), with a miscarriage rate of 2.94%; 26 healthy term babies were born, including 24 singletons and one set of twins, while eight couples had ongoing pregnancies. Amniocentesis revealed a fetal chromosome status that was consistent with the NGS-PGT results. Female carriers had a significantly higher blastocyst rate than did the male carriers (37.01% versus 31.27%, P = 0.04). The transferable blastocyst rate was higher in couples treated with gonadotrophin-releasing hormone (GnRH) antagonist than in those treated with GnRH agonist (38.20% versus 24.37%, P = 0.01). However, neither carrier sex nor ovarian stimulation protocol influenced the clinical pregnancy rate. CONCLUSIONS CNV-Seq-based NGS is an efficient and reliable PGT method for balanced reciprocal translocation.
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Affiliation(s)
- Yunni Cai
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing Jiangsu 210008, China
| | - Min Ding
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing Jiangsu 210008, China
| | - Fei Lin
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital, The Affiliated Hospital to Nanjing University Medical School, Nanjing Jiangsu 210008, China
| | - Zhenyu Diao
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital, The Affiliated Hospital to Nanjing University Medical School, Nanjing Jiangsu 210008, China
| | - Ningyuan Zhang
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital, The Affiliated Hospital to Nanjing University Medical School, Nanjing Jiangsu 210008, China
| | - Haixiang Sun
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital, The Affiliated Hospital to Nanjing University Medical School, Nanjing Jiangsu 210008, China
| | - Jianjun Zhou
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing Jiangsu 210008, China; Reproductive Medicine Centre, Nanjing Drum Tower Hospital, The Affiliated Hospital to Nanjing University Medical School, Nanjing Jiangsu 210008, China.
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Shi W, Zhou H, Tian L, Zhao Z, Zhang W, Shi J. Cumulative Live Birth Rates of Good and Low Prognosis Patients According to POSEIDON Criteria: A Single Center Analysis of 18,455 Treatment Cycles. Front Endocrinol (Lausanne) 2019; 10:409. [PMID: 31293519 PMCID: PMC6606694 DOI: 10.3389/fendo.2019.00409] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/07/2019] [Indexed: 12/15/2022] Open
Abstract
Objective: To investigate the characteristics and outcomes of low prognosis patients defined by POSEIDON criteria undergoing IVF treatment. Design: Retrospective cohort analysis. Setting: An IVF clinic in a public hospital. Patients: 18,455 fresh aspirated IVF cycles with subsequently frozen embryo transfer from Jan 2014 to Jan 2017 in a single IVF clinic were included in the analysis. The low prognosis patients were categorized into 4 groups based on POSEIDON criteria: group 1: age < 35, antral follicle count (AFC) ≥ 5, number of oocytes retrieved ≤ 9 in the previous cycle; group 2: age ≥ 35, AFC≥5, number of oocytes retrieved ≤ 9 in the previous cycle; group 3: age < 35, AFC < 5; group 4: age ≥ 35, AFC < 5. The non-low prognosis patients: group 5: AFC ≥ 5, previous number of oocytes retrieved > 9 oocytes; group 6: AFC ≥ 5, no previous ovarian stimulation. Intervention(s): None. Main Outcome Measure: The primary outcome was cumulative live birth rate (CLBR). Result(s): Taking group 1 as reference, the CLBR from young women in group 3 (35.5%, OR 0.9, 95% CI 0.7-1.2) was slightly lower than that in group 1 (44.6%, p = 0.615). The CLBR in group 2 (24.5%, OR 0.6, 95% CI 0.4-0.8, p = 0.004) and group 4 (12.7%, OR 0.4, 95% CI 0.3-0.6, p < 0.001) was significant lower than that in group 1. In non-poor prognosis patients, the CLBR from young women in group 5 (53.5% OR 1.3 95% CI 0.9, 1.7, p = 0.111) was a slight higher than the reference group 1 while the highest CLBR was originated from the first IVF patients with good ovarian reserve in group 6 (66.9%, OR 2.0, 95% CI 1.6, 2.4). Conclusion(s): The CLBRs and implantation rates in the young women (group 3) with diminished ovarian reserve was similar in those young women (group 1), and was significantly higher than in advanced age women with a fair ovarian reserve (group 2). Though patients in group 2 had better ovarian reserve, more oocytes and more embryos, the pregnancy outcome was inferior to that of group 3 patients with poorer ovarian reserve, fewer oocytes and fewer embryos.
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Affiliation(s)
- Wenhao Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Hanying Zhou
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Li Tian
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Zhenghao Zhao
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Wei Zhang
- Department of Respiratory Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
- *Correspondence: Wei Zhang
| | - Juanzi Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
- Juanzi Shi
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Eftekhar M, Mirhashemi ES, Tabibnejad N. Outcome of assisted reproductive technology in different subgroups of poor ovarian responders fulfilling the POSEIDON criteria. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2018.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Merlotti L, Kuohung W, Rinehart J. Current clinical applications of antimullerian hormone. Curr Opin Endocrinol Diabetes Obes 2018; 25:373-376. [PMID: 30299434 DOI: 10.1097/med.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Determine if literature supports the use of anti-Müllerian hormone (AMH) as a useful biomarker of reproductive potential when cumulative live birth rates (CLBRs) per retrieval are used as the outcome variable. RECENT FINDINGS Advances in technology used in in-vitro fertilization (IVF) permit the use of single embryo transfer to achieve expected pregnancy success rates. Many IVF cycles result in the creation of more than a single embryo suitable for transfer per oocyte retrieval. Cryopreservation permits subsequent use of other embryos with no loss in total reproductive potential from single retrievals. Therefore, an emerging concept in IVF is the CLBR per retrieval as an indicator of the patient's reproductive potential. Using the total reproductive potential from a single retrieval may help patients decide on IVF. As such, any predictor of success that relies upon the live birth rate for a single transfer, as opposed to CLBR per retrieval, is inadequate to estimate the true reproductive potential for patient. AMH has been proposed as a biomarker for reproductive potential, but most studies have correlated an AMH value to a single embryo transfer. SUMMARY A more appropriate way to use AMH levels may be to correlate the AMH with CLBR per retrieval. AMH may thus prove to be a useful biomarker when counseling patients about what to expect from their treatment.
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Affiliation(s)
| | - Wendy Kuohung
- Department of Reproductive Endocrinology, Boston, Massachusetts, USA
| | - John Rinehart
- Department of Reproductive Endocrinology, Evanston, Illinois
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Haahr T, Esteves SC, Humaidan P. Individualized controlled ovarian stimulation in expected poor-responders: an update. Reprod Biol Endocrinol 2018; 16:20. [PMID: 29523204 PMCID: PMC5845159 DOI: 10.1186/s12958-018-0342-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/06/2018] [Indexed: 12/29/2022] Open
Abstract
Controlled ovarian stimulation with subsequent multi-follicular development continues to be a keystone in ART. Evidence supports an individualized approach to ovarian stimulation, usually involving combinations of ovarian reserve tests, body mass index and age to tailor the exogenous gonadotropin dose, and potentially adjuvant treatment aiming for high safety and a shortening of time to live birth. While stimulation and trigger concepts have been developed successfully in normo- and hyperresponder patients, the poor responder patient remains difficult to manage. However, recent advances in definition and classification of the expected poor ovarian responder patient might enable a more accurate and clinically useful interpretation of new treatment concepts in a more homogenous study population. In the present review, we discuss the classification of the expected poor ovarian responder patient as well as clinically useful measurements of efficacy for controlled ovarian stimulation, and finally, we discuss the evidence for clinical management of patients with expected poor ovarian response, including adjuvant treatments such as growth hormone, androgens, and LH activity.In conclusion, the best available evidence supports that the treatment of the expected poor ovarian response patient should be individualized in all steps of ART, including the choice of GnRH analogue, the gonadotropin type and dose, ovulation trigger, and the possible use of adjuvant therapies.
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Affiliation(s)
- Thor Haahr
- Department of Clinical Medicine, Aarhus University, Denmark and the Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark
| | - Sandro C Esteves
- Department of Clinical Medicine, Aarhus University, Denmark and the Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Department of Surgery (Division of Urology), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Peter Humaidan
- Department of Clinical Medicine, Aarhus University, Denmark and the Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark.
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