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Boga A, Stapleton F, Chapman M, Golebiowski B. Effects of elevated serum estrogen on dry eye in women undergoing in vitro fertilisation. Ocul Surf 2023; 29:511-520. [PMID: 37422153 DOI: 10.1016/j.jtos.2023.06.015] [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: 06/30/2022] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Sex hormones impact inflammatory and immune-mediated diseases. During IVF (in vitro fertilisation) treatment, circulating estrogen levels increase dramatically (10-50x) alongside changes in other hormones. This study examined changes in dry eye with IVF and its relationship with sex hormones. METHODS A two visit study was conducted on first day of menstruation when estrogen levels are lowest (baseline visit), and on day 9-11 (peak estrogen visit (PO)) of IVF. Symptoms of dry eye and ocular pain and signs of dry eye were examined. Serum hormone levels were assessed using mass spectrometry and immunoassay. Changes in signs and symptoms and associations were explored. Hierarchical multiple regression analysis assessed factors contributing to signs and symptoms. RESULTS 40 women (36.2 ± 4.0 years) completed the study. Baseline and PO oestradiol (E2) levels were 28.9 pg/ml (20) (median (IQR)); 1360 pg/ml (1276) respectively. Ocular pain and dry eye symptoms worsened (p = 0.02 and p < 0.01) and tear break up and tear secretion values decreased (p = 0.005 and 0.01) at PO. Higher E2 and lower luteinizing hormone (LH) were associated with worsening of dry eye symptoms (ρ = 0.34 p = 0.03, ρ = -0.49 p = 0.001). Reduction in LH and increase in progesterone (P4) were associated with increased ocular pain (ρ = 0.45, p = 0.004 and ρ = 0.39, p = 0.01). Dry eye symptoms were predicted by LH and tear break up (p = 0.02; R2 = 0.18). CONCLUSIONS IVF treatment resulted in significantly increased ocular symptoms and tear film alterations although these changes were not clinically significant. Dry eye signs and symptoms were poorly predicted by hormone levels.
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Affiliation(s)
- Archana Boga
- School of Optometry and Vision Science, UNSW Sydney, Australia.
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia.
| | - Michael Chapman
- St.George's Hospital and School of Women's & Children's Health UNSW Sydney, Australia; IVF Australia, Southern Sydney, Australia.
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Zeng R, Chen H, Zeng X, Qin L. The Essential Role of Body Weight in Adjusting Gn Dosage to Prevent High Ovarian Response for Women With PCOS During IVF: A Retrospective Study. Front Endocrinol (Lausanne) 2022; 13:922044. [PMID: 35846308 PMCID: PMC9283682 DOI: 10.3389/fendo.2022.922044] [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: 04/17/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Polycystic ovarian syndrome (PCOS) is the major cause of anovulatory infertility. Since women with PCOS are often accompanied by increased body weight and hyper response to controlled ovarian stimulation, individualized gonadotropin (Gn) dose is required to achieve a therapeutic effect while minimizing the risk of ovarian hyperstimulation simultaneously. We aimed to investigate the essential role of body weight in optimizing initial Gn dosage for PCOS patients during in vitro fertilization (IVF). We retrospectively included 409 infertile PCOS patients who used gonadotropin-releasing hormone (GnRH)-antagonist fixed protocol and underwent their first cycle of IVF in West China Second University Hospital from January 2019 to June 2021. Baseline characteristics controlled ovarian stimulation parameters, and reproductive outcomes were compared between patients with different body weights and different ovarian responses. Multivariable linear regression analyses were adopted to investigate the relationship between body weight and initial Gn dosage. Receiver operating characteristic (ROC) curves were drawn to find the optimal cut-off value of body weight in predicting the starting Gn dosage so as to prevent high ovarian response (HOR). We found that luteinizing hormone (LH) level and Anti-Mullerian hormone (AMH) level were lowest in the group with body weight over 70 kg and was highest in the group with body weight less than 50 kg. Increased body weight was significantly correlated to the rise of initial Gn dosage (Beta = 0.399, t = 8.921, p < 0.001). Normal ovarian response (NOR) patients had significantly less fresh cycle cancel rate and ovarian hyperstimulation syndrome (OHSS) rate which outweighed the fewer embryos compared with HOR patients. Using ROC curves, 53.25 kg (sensitivity, 84.2%; specificity, 53.8%) and 70.5 kg (sensitivity, 58.8%; specificity, 93.0%) were identified as the optimal cut-off values to predict the initial Gn dosage of no more than 150 IU and 225 IU, respectively. In conclusion, adjusting the initial Gn dosage based on body weight is crucial to preventing ovarian hyperstimulation while not influencing reproductive outcomes for PCOS patients during IVF.
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Affiliation(s)
- Rujun Zeng
- Reproductive Centre, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hanxiao Chen
- Reproductive Centre, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xun Zeng
- Reproductive Centre, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xun Zeng, ; Lang Qin,
| | - Lang Qin
- Reproductive Centre, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xun Zeng, ; Lang Qin,
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Nisal A, Diwekar U, Hobeika E. Personalized medicine for GnRH antagonist protocol in in vitro fertilization procedure using modeling and optimal control. Comput Chem Eng 2022. [DOI: 10.1016/j.compchemeng.2021.107554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Saunders H, Bjärgestad Lamp L, Donat H, Messner M, Reder M, Kendrew H. Risk of dosing errors in ART treatment: user experience of single- vs multi-use follitropin alfa pens. Expert Opin Drug Deliv 2020; 18:643-654. [PMID: 33331185 DOI: 10.1080/17425247.2021.1863944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: This user experience study evaluated the suitability of single-use versus multi-dose follitropin alfa pen injectors for self-administration by women undergoing fertility treatment.Methods: Twenty-four fertility patients and 19 specialist nurses were recruited in four European countries to assess their use of Bemfola (a single-use pen), Gonal-f®, and Ovaleap® (multi-use pens). Participants completed usability tests in which their performance in assembling and administering doses of each pen was assessed against defined critical steps for ensuring safe and correct administration.Results: Critical error rates among nurses were 4%, 40%, and 49% for Bemfola®, Ovaleap®, and Gonal-f®, respectively; and among patients were 7%, 16%, and 38%. The most frequently reported critical errors occurred with the multi-use pens and were incorrect/lack of priming and failure to check the dose window prior to setting a new dose. The need to 'top up' doses from a new pen or cartridge when a pen contained insufficient dose also caused errors. The single-use pens did not cause these errors. Overall, 63% of nurses and 67% of patients had most confidence in Bemfola® for correct dosing and self-administration.Conclusions: Single-use pens require fewer preparation and administration steps than multi-use pens and are associated with fewer critical handling errors.
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Affiliation(s)
- Helen Saunders
- Medical Affairs Department, PregLem/Gedeon Richter, Geneva, Switzerland
| | | | - Hasan Donat
- Medical Affairs Department, PregLem/Gedeon Richter, Geneva, Switzerland
| | - Monja Messner
- Point Blank International Research & Consultancy GmBH, Berlin, Germany
| | - Maren Reder
- Point Blank International Research & Consultancy GmBH, Berlin, Germany
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Gordon C, Ginsburg E. Too much of a good thing? Total gonadotropin dose and in vitro fertilization outcomes. Fertil Steril 2020; 114:1169-1170. [DOI: 10.1016/j.fertnstert.2020.09.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
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Nisal A, Diwekar U, Bhalerao V. Personalized medicine for in vitro fertilization procedure using modeling and optimal control. J Theor Biol 2019; 487:110105. [PMID: 31809718 DOI: 10.1016/j.jtbi.2019.110105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/01/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023]
Abstract
In vitro fertilization (IVF) is the most common technique in assisted reproductive technology and in most cases the last resort for infertility treatment. It has four basic stages: superovulation, egg retrieval, fertilization, and embryo transfer. Superovulation is a drug-induced method to enable multiple ovulation per menstrual cycle and key component towards a successful IVF cycle. Although there are the general guidelines for dosage, the dose is not optimized for each patient, and complications, such as overstimulation, can occur. To overcome the shortcomings of this general system, a mathematical procedure is developed which can provide a customized model of this stage regarding the size distribution of eggs (follicles/ oocytes) obtained per cycle as a function of the chemical interactions of the drugs used and the conditions imposed on the patient during the cycle, which provide a basis for predicting the possible outcome. Uncertainty and risk are modeled and included in optimal drug dosage decisions. This paper describes the theory, model, and the optimal control procedure for improving outcomes of IVF treatment for one of the four protocols used in real practice. The validation of the procedure is performed using clinical data from the patients previously undergone IVF cycles. Customized patient-specific model parameters are obtained by using initial two-day data for each patient. Subsequently, this model is used to predict the FSD for the remaining days of the cycle. This procedure was conducted for 49 patients. The results of the customized models are found to be closely matching with the observed FSD. These results thus validate the modeling approach and consequently its use for predicting the customized optimal drug dosage for each patient. Using the customized model and the optimized dosage, the FSD at the end of the cycle was determined. A small double-blind clinical trial was also conducted in India. The results from the trial show that the dosage predicted by using the model is 40% less than the suggestion made by the IVF clinicians. The testing and monitoring requirements for patients using optimized drug dosage is reduced by 72%. Work on the other three protocols and for patients in the USA is started and is showing promising results.
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Affiliation(s)
- Apoorva Nisal
- Department of Industrial Engineering, University of Illinois, Chicago, IL 60607, United States; Center for Uncertain Systems: Tools for Optimization & Management (CUSTOM), Vishwamitra Research Institute, Crystal Lake, IL 60012, USA
| | - Urmila Diwekar
- Department of Industrial Engineering, University of Illinois, Chicago, IL 60607, United States; Center for Uncertain Systems: Tools for Optimization & Management (CUSTOM), Vishwamitra Research Institute, Crystal Lake, IL 60012, USA.
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Agresta F, Fois R, Garrett C, Rozen G, Polyakov A. Is it possible to apply trial outcomes to a real-world population? A novel approach to External Validity Analysis. Aust N Z J Obstet Gynaecol 2019; 60:284-289. [PMID: 31758541 DOI: 10.1111/ajo.13090] [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: 09/14/2019] [Accepted: 10/13/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Translation of findings from randomised controlled trials (RCT), the foundation of evidence-based medicine, into clinical practice requires an understanding of relationships between patient characteristics, treatment practices and outcomes. We propose a novel technique, External Validity Analysis (EVA), to evaluate applicability of findings from a large RCT, comparing baseline characteristics, interventions and outcomes between the RCT and a large clinical database. AIM To perform EVA of the findings of a randomised controlled trial (ESTHER-1) to a population in an Australian clinic setting. To demonstrate this method, we evaluated the discordance in first cycle follicle-stimulating hormone (FSH) exposure and outcomes between the two populations, to inform clinical practice. MATERIALS AND METHODS In this retrospective, descriptive analysis, we compared practices and outcomes between the follitropin alfa 'conventional' dosing arm of the ESTHER-1 trial and a selected comparable clinic subpopulation of patients who underwent controlled ovarian stimulation using FSH. RESULTS Mean FSH exposure was 34% higher in the clinic subpopulation than in the trial subpopulation, resulting in higher average ovarian response without improving the likelihood of clinical pregnancy or live birth. CONCLUSIONS EVA allowed for the comparison of a trial population with a selected clinic population with similar characteristics. With respect to FSH consumption, this analysis revealed higher exposure to FSH in the clinic setting without a corresponding benefit. The comparison reveals population differences as well as the potential to improve clinical outcomes through a reappraisal of current practices and objectives in gonadotropin dose selection.
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Affiliation(s)
| | - Romano Fois
- Ferring Pharmaceuticals Pty Ltd, Sydney, New South Wales, Australia
| | | | - Genia Rozen
- Melbourne IVF, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Alex Polyakov
- Melbourne IVF, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Barakhoeva Z, Vovk L, Fetisova Y, Marilova N, Ovchinnikova M, Tischenko M, Scherbatyuk Y, Kolotovkina A, Miskun A, Kasyanova G, Teterina T, Zorina I, Belousova N, Morozova E, Yakovenko S, Apryshko V, Sichinava L, Shalinа R, Polzikov M. A multicenter, randomized, phase III study comparing the efficacy and safety of follitropin alpha biosimilar and the original follitropin alpha. Eur J Obstet Gynecol Reprod Biol 2019; 241:6-12. [PMID: 31400644 DOI: 10.1016/j.ejogrb.2019.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/15/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the therapeutic equivalence between the follitropin alpha biosimilar and the reference medication in women undergoing assisted reproductive technologies (ART). STUDY DESIGN This multicenter, randomized (1:1), embryologist-blinded, parallel-group, comparative phase III study involved 110 women aged 20-35 years old with tubal and/or male factors of infertility. All of the subjects underwent controlled ovarian hyperstimulation (COH) using a gonadotropin-releasing hormone antagonist (GnRH-ant) protocol. Over the 5-day fixed-dose regimen, the women received 150 IU/day of follitropin alpha biosimilar (n = 55) or original follitropin alpha (n = 55), followed by dose adaptation. The primary endpoint for assessing the therapeutic equivalence was the number of retrieved oocytes using a pre-determined clinical equivalence margin of ± 3.4 oocytes. RESULTS Similar numbers of oocytes were retrieved in both groups: 12.16 ± 7.28 in the follitropin alpha biosimilar group and 11.62 ± 6.29 in the original follitropin alpha group, with mean difference of 0.546 ± 1.297 oocytes (95% confidence interval [CI]: -2.026, 3.116), p = 0.002 (intention-to-treat [ITT] population). Additionally, no statistically significant differences were found for secondary endpoints: the onset of biochemical (34.7% and 36.7%, p = 0.883), clinical pregnancy (26.5% and 32.7%, p = 0.507), delivery (26.5% and 24.5%, p = 0.817) and take-home baby rate (28.6% and 26.5%, p = 0.816) for the follitropin biosimilar and original follitropin groups (per-protocol [PP] population). Ovarian hyperstimulation syndrome was observed in subjects with a positive pregnancy test in 0% and 3.64% of cases and after triggering ovulation in 7.27% and 3.64% for the follitropin biosimilar and original follitropin groups, respectively. CONCLUSIONS This study demonstrated similar therapeutic equivalence and safety profiles between the follitropin alpha biosimilar and the reference follitropin in women who underwent COH in GnRH-ant cycles. TRIAL REGISTRATION NUMBER 1. Name of the registry: ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT03088137. Date of registration: 02.03.2017, retrospectively registered. Trial conducted between 08.02.2017 and 17.08.2018, the date of enrollment of the first participant - 08.02.2017. 2. Name of the registry: Russian Ministry of Health, grls.rosminzdrav.ru. TRIAL REGISTRATION NUMBER RCT 754. Date of registration: 26.10.2016, prospectively registered.
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Affiliation(s)
| | - Lyudmila Vovk
- Perinatal Medical Center, "Mother and Child" group of companies, Moscow, Russia
| | - Yulia Fetisova
- Perinatal Medical Center, "Mother and Child" group of companies, Moscow, Russia
| | - Nina Marilova
- Perinatal Medical Center, "Mother and Child" group of companies, Moscow, Russia
| | - Maria Ovchinnikova
- Lapino Clinical Hospital, "Mother and Child" group of companies, Moscow, Russia
| | - Marina Tischenko
- Lapino Clinical Hospital, "Mother and Child" group of companies, Moscow, Russia
| | - Yulia Scherbatyuk
- Lapino Clinical Hospital, "Mother and Child" group of companies, Moscow, Russia
| | | | - Anna Miskun
- Lapino Clinical Hospital, "Mother and Child" group of companies, Moscow, Russia
| | - Galina Kasyanova
- Lapino Clinical Hospital, "Mother and Child" group of companies, Moscow, Russia
| | | | - Irina Zorina
- "AltraVita" Human Reproduction Clinic, Moscow, Russia
| | | | - Ekaterina Morozova
- Perinatal Medical Center, "Mother and Child" group of companies, Moscow, Russia
| | - Sergey Yakovenko
- "AltraVita" Human Reproduction Clinic, Moscow, Russia; Lomonosov Moscow State University, Moscow, Russia
| | | | - Lali Sichinava
- Perinatal Medical Center, "Mother and Child" group of companies, Moscow, Russia; Russian National Research Medical University named after N.I. Pirogov, Health Ministry of the Russian Federation, Moscow, Russia; Moscow Center for Family Planning and Reproduction, Moscow Healthcare Department, Moscow, Russia
| | - Raisa Shalinа
- Lapino Clinical Hospital, "Mother and Child" group of companies, Moscow, Russia; Russian National Research Medical University named after N.I. Pirogov, Health Ministry of the Russian Federation, Moscow, Russia; Moscow Center for Family Planning and Reproduction, Moscow Healthcare Department, Moscow, Russia
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Artini PG, Obino ME, Vergine F, Sergiampietri C, Papini F, Cela V. Assisted reproductive technique in women of advanced fertility age. ACTA ACUST UNITED AC 2018; 70:738-749. [DOI: 10.23736/s0026-4784.18.04247-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Drakopoulos P, Santos-Ribeiro S, Bosch E, Garcia-Velasco J, Blockeel C, Romito A, Tournaye H, Polyzos NP. The Effect of Dose Adjustments in a Subsequent Cycle of Women With Suboptimal Response Following Conventional Ovarian Stimulation. Front Endocrinol (Lausanne) 2018; 9:361. [PMID: 30083131 PMCID: PMC6064928 DOI: 10.3389/fendo.2018.00361] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Several infertile patients, who may even represent around 40% of the infertile cohort, may respond "suboptimally" (4-9 oocytes retrieved) following IVF, despite being predicted as normal responders. The aim of our longitudinal study was to evaluate the ovarian response of suboptimal responders in terms of the number of oocytes retrieved, following their second IVF cycle, evaluating exclusively patients who had the same stimulation protocol and used the same or higher initial dose of the same type of gonadotropin compared to their previous failed IVF attempt. Overall, our analysis included 160 patients treated with a fixed antagonist protocol in their second cycle with the same [53 (33.1%)] or higher [107 (66.9%)] starting dose of rFSH. The number of oocytes retrieved was significantly higher in the second IVF cycle [6 (5-8) vs. 9 (6-12), p < 0.001]. According to our results, a dose increment of rFSH remained the only significant predictor of the number of oocytes retrieved in the subsequent IVF cycle (coefficient 0.02, p-value = 0.007) after conducting GEE multivariate regression, while adjusting for relevant confounders. A regression coefficient of 0.02 for the starting dose implies that an increase of 50 IU of the initial rFSH dose would lead to 1 more oocyte.
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Affiliation(s)
- Panagiotis Drakopoulos
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Reproductive Medicine, University of Liège, Liège, Belgium
| | - Samuel Santos-Ribeiro
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
| | - Ernesto Bosch
- Instituto Valenciano de Infertilidad (IVI-RMA), Valencia, Spain
| | - Juan Garcia-Velasco
- Instituto Valenciano de Infertilidad (IVI-RMA), Madrid, Spain
- Department of Obstetrics and Gynecology, Rey Juan Carlos University, Madrid, Spain
| | - Christophe Blockeel
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Obstetrics and Gynaecology, University of Zagreb-School of Medicine, Zagreb, Croatia
| | - Alessia Romito
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Herman Tournaye
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nikolaos P. Polyzos
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- *Correspondence: Nikolaos P. Polyzos ;
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Siristatidis C, Dafopoulos K, Vrantza T, Salamalekis G, Basios G, Vogiatzi P, Pergialiotis V, Papantoniou N. Mild versus conventional antagonist ovarian stimulation protocols in expected normal responders undergoing IVF/ICSI: a case-control study. Gynecol Endocrinol 2017; 33:553-556. [PMID: 28277113 DOI: 10.1080/09513590.2017.1296128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Mild controlled ovarian hyperstimulation (COH) protocols combining clomiphene citrate (CC) or letrozole with gonadotropins were introduced as an effective alternative of conventional COH in normal responders undergoing IVF/ICSI. In this case-control study, we compared 41 participants treated with a mild stimulation protocol receiving gonadotropins combined with either CC (n = 24) or letrozole (n = 17) with 71 subfertile participants with matching baseline characteristics, conforming with the same inclusion criteria and treated with a conventional antagonist protocol. Live birth was determined in reduced rates in the study group compared to the control group, reaching marginal statistical significance [4/41 versus 19/71, p = 0.050], as also in the respective number of clinical pregnancies [6/41 versus 22/71, p = 0.054], although the incidence of miscarriage was similar for both groups [2/41 versus 5/71, p = 0.714]. Most of the secondary parameters examined, favored the conventional antagonist protocol. There was no difference in any of the outcomes reported between the three different stimulation groups in post-hoc analysis. Mild stimulation regimens with the aid of either CC or letrozole employing GnRH antagonists do not seem to constitute an equally effective method as compared to the conventional antagonist protocol to be offered in good prognosis subfertile women seeking an induced cycle toward IVF/ICSI.
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Affiliation(s)
- Charalampos Siristatidis
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece and
| | - Konstantinos Dafopoulos
- b Assisted Reproduction Unit, Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, University of Thessaly , Larissa , Greece
| | - Tereza Vrantza
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece and
| | - George Salamalekis
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece and
| | - George Basios
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece and
| | - Paraskevi Vogiatzi
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece and
| | - Vasileios Pergialiotis
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece and
| | - Nikolaos Papantoniou
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece and
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Bosch E, Nyboe Andersen A, Barri P, García-Velasco JA, de Sutter P, Fernández-Sánchez M, Visnova H, Klein BM, Mannaerts B, Arce JC. Follicular and endocrine dose responses according to anti-Müllerian hormone levels in IVF patients treated with a novel human recombinant FSH (FE 999049). Clin Endocrinol (Oxf) 2015. [PMID: 26202150 DOI: 10.1111/cen.12864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the association between serum anti-Müllerian hormone (AMH) levels and follicular development and endocrine responses induced by increasing doses (5·2-12·1 μg/day) of a novel recombinant human FSH (rhFSH, FE 999049) in patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in a GnRH antagonist protocol. DESIGN Secondary analysis of a randomized controlled trial with stratified randomization according to AMH (lower stratum: 5·0-14·9 pmol/l; higher stratum: 15·0-44·9 pmol/l). PATIENTS Infertile women of good prognosis (n = 265). MEASUREMENTS Follicular development and endocrine parameters during controlled ovarian stimulation (COS) with rhFSH. RESULTS Serum FSH levels increased with increasing rhFSH doses and steady-state levels for each dose were similar in both AMH strata. In the whole study population, significant (P < 0·001) positive dose responses were observed for the number of follicles ≥ 12 mm, and serum levels of oestradiol, inhibin B, inhibin A and progesterone at end of stimulation. In comparison with the higher AMH stratum, patients in the lower AMH stratum had significantly different slopes of the dose-response curves for these hormones, and no clear dose-related increase was observed for the number of follicles in these patients. CONCLUSIONS Dose-response relationships between rhFSH and follicular development and endocrine parameters are significantly different for IVF/ICSI patients with lower and higher serum AMH levels at start of COS.
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Affiliation(s)
| | - Anders Nyboe Andersen
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | | | | | - Bjarke M Klein
- Global Biometrics, Global Clinical & Non-Clinical R&D, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Bernadette Mannaerts
- Reproductive Health, Global Clinical & Non-Clinical R&D, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Joan-Carles Arce
- Reproductive Health, Global Clinical & Non-Clinical R&D, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
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13
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Rombauts L, Lambalk CB, Schultze-Mosgau A, van Kuijk J, Verweij P, Gates D, Gordon K, Griesinger G. Intercycle variability of the ovarian response in patients undergoing repeated stimulation with corifollitropin alfa in a gonadotropin-releasing hormone antagonist protocol. Fertil Steril 2015; 104:884-890.e2. [PMID: 26187300 DOI: 10.1016/j.fertnstert.2015.06.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether individual subject variation in ovarian response between repeated cycles with the same ovarian stimulation protocol can be predicted. DESIGN Retrospective data analysis. SETTING Multicenter, open-label, uncontrolled clinical trial. PATIENT(S) Women aged 18-39 from a phase 3, open-label, uncontrolled trial with complete data across all cycles (n = 176). INTERVENTION(S) Up to three cycles of a single injection of 150 μg corifollitropin alfa for 7 days, then daily recombinant FSH/hMG until three follicles reached ≥17 mm. Gonadotropin-releasing hormone antagonist from stimulation day 5 until day of hCG administration. MAIN OUTCOME MEASURE(S) Numbers of follicles ≥11 mm on day of hCG in cycles 1-3, transition in ovarian response type between cycles from low (0-<6), normal (6-<18), and high (≥18), and serum FSH concentrations and antral follicle count (AFC) at each cycle start. RESULT(S) The mean (SD) numbers of follicles ≥11 mm on day of hCG were 13.4 (6.2), 13.3 (5.4), and 13.8 (6.4) in cycles 1, 2 and 3, respectively. Between cycles 1 and 2, 11.9% switched from normal to low or high response, and 12.5% switched from low or high to normal response; 75.6% remained in the same category. Between cycles 2 and 3, 15.9% switched from normal to low or high response, and 10.2% switched from low or high to normal response; 73.9% remained in the same category. These shifts are symmetrical in nature, in that the percentage of subjects who shift from normal to low or high response is comparable to the percentage of subjects who shift from low or high to normal response. Baseline FSH and AFC did not significantly predict transition in ovarian response. CONCLUSION(S) The variability in ovarian responses between repeated cycles using the same protocol was not explained by baseline FSH and AFC. CLINICAL TRIAL REGISTRATION NUMBER NCT00696878 Protocol P05714.
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Affiliation(s)
- Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Monash IVF, Clayton, Victoria, Australia.
| | - Cornelis B Lambalk
- Department of Obstetrics/Gynecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Askan Schultze-Mosgau
- Department of Reproductive Medicine and Gynecologic Endocrinology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | | | | | | | - Georg Griesinger
- Department of Reproductive Medicine and Gynecologic Endocrinology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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14
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Fernando S, Rombauts L. Melatonin: shedding light on infertility?--A review of the recent literature. J Ovarian Res 2014; 7:98. [PMID: 25330986 PMCID: PMC4209073 DOI: 10.1186/s13048-014-0098-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/11/2014] [Indexed: 12/31/2022] Open
Abstract
In recent years, the negative impact of oxidative stress on fertility has become widely recognised. Several studies have demonstrated its negative effect on the number and quality of retrieved oocytes and embryos following in-vitro fertilisation (IVF). Melatonin, a pineal hormone that regulates circadian rhythms, has also been shown to exhibit unique oxygen scavenging abilities. Some studies have suggested a role for melatonin in gamete biology. Clinical studies also suggest that melatonin supplementation in IVF may lead to better pregnancy rates. Here we present a critical review and summary of the current literature and provide suggestions for future well designed clinical trials.
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Affiliation(s)
- Shavi Fernando
- MIMR-PHI Institute of Medical Research, 246 Clayton Rd, Clayton, 3168, , Victoria, Australia. .,Monash University, Department of Obstetrics and Gynaecology, Level 5 Monash Medical Centre, 246 Clayton Rd, Clayton, 3168, , Victoria, Australia.
| | - Luk Rombauts
- MIMR-PHI Institute of Medical Research, 246 Clayton Rd, Clayton, 3168, , Victoria, Australia. .,Monash IVF, 252 Clayton rd, Clayton, 3168, , Victoria, Australia.
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15
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Tutuncu L, Dundar O. Increasing the Stimulation Dose of rFSH in Unexpected Poor Responders Is Not Associated with Better IVF Outcome. ScientificWorldJournal 2012. [DOI: 10.1100/2012/202804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this retrospective study is to determine whether increasing the stimulation dose of rFSH in unexpected poor responders is associated with better in vitro fertilization (IVF) outcome or not. A total of forty eligible women who fulfilled our definition of poor responders and who did not achieve an ongoing pregnancy in the first cycle and returned for a second higher rFSH dose IVF cycle with a long-agonist protocol were included to the study. The first low-dose cycles and the second high-dose cycles were compared to each other. Main outcome measures of the study were duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos, and E2 level on day of hCG injection. There were no significant differences in duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos, and E2 level on day of hCG injection between the first low- and second high-dose cycles. Daily dose and total dose of rFSH were significantly higher in the second high-dose cycles. Increasing the dose of rFSH in a second stimulation cycle after first unsuccessful treatment cycle will add only to the cost and discomfort of the treatment and might adversely affect pregnancy rates.
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Affiliation(s)
- Levent Tutuncu
- IVF Unit, Department of Obstetrics and Gynecology, Haydarpasa Training Hospital, Gulhane Military Medical Academy, Haydarpasa, 34668 Istanbul, Turkey
| | - Ozgur Dundar
- IVF Unit, Department of Obstetrics and Gynecology, Haydarpasa Training Hospital, Gulhane Military Medical Academy, Haydarpasa, 34668 Istanbul, Turkey
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16
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Griesinger G, Berndt H, Schultz L, Schultze-Mosgau A, Diedrich K, von Otte S. Intensified ovarian stimulation in a GnRH antagonist protocol with agonist triggering: a prospective, clinical feasibility study. Reprod Biomed Online 2010; 22:133-9. [PMID: 21227753 DOI: 10.1016/j.rbmo.2010.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 11/16/2022]
Abstract
The threat of severe ovarian hyperstimulation syndrome (OHSS) and the increase in discomfort for the patient has limited the feasibility of maximizing the oocyte yield per treatment cycle. A gonadotrophin-releasing hormone (GnRH) antagonist protocol with agonist triggering and vitrification of all 2PN oocytes can eliminate the risk of OHSS. This prospective, single-centre, cohort study in 30 good-responder IVF patients ≤ 36 years reports the feasibility of arbitrarily intensifying stimulation in a GnRH antagonist protocol in terms of tolerability, safety and efficacy. Ovarian stimulation was performed with 225-375IU FSH, induction of final oocyte maturation with 0.2mg GnRH agonist followed by vitrification of all 2 pronuclear (2PN) oocytes and repetitive vitrified-warmed embryo transfer cycles. Main outcomes were severe OHSS incidence, tolerability, assessed by a questionnaire, and cumulative live birth rate. On average, 17 oocytes were retrieved (range 4-42) and 8.4 oocytes at the 2PN stage were cryopreserved (range 3-22). No case of severe OHSS was observed (0%, 95 CI 0-11.4%). Tolerability was good. The cumulative live birth rate per patient undergoing at least one vitrified-warmed embryo transfer was 26.9% (7/26, 95% CI 13.7-46.1%). This approach can be explored in future larger-sized controlled studies.
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Affiliation(s)
- Georg Griesinger
- Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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17
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Gleicher N, Weghofer A, Oktay K, Barad DH. Can the FMR1 (Fragile X) Gene Serve As Predictor of Response to Ovarian Stimulation? Reprod Sci 2009; 16:462-7. [DOI: 10.1177/1933719108328617] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Norbert Gleicher
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, Center for Human Reproduction, New York, and the Foundation for Reproductive Medicine, New York,
| | - Andrea Weghofer
- Department of Obstetrics and Gynecology, Vienna University School of Medicine, Vienna, Austria, Center for Human Reproduction, New York, and the Foundation for Reproductive Medicine, New York
| | - Kutluk Oktay
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York, Center for Human Reproduction, New York, and the Foundation for Reproductive Medicine, New York
| | - David H. Barad
- and Departments of Epidemiology and Social Medicine as well as Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, Center for Human Reproduction, New York, and the Foundation for Reproductive Medicine, New York
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18
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Nelson SM, Greer IA. The potential role of heparin in assisted conception. Hum Reprod Update 2008; 14:623-45. [DOI: 10.1093/humupd/dmn031] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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