Oocyte retrieval following continued stimulation five days beyond ovulation yields live birth after frozen embryo transfer

Ovarian stimulation in the luteal phase: systematic review and meta-analysis

PURPOSE

The purpose of this study was to evaluate whether outcomes are different if controlled ovarian stimulation (COS) is started in the luteal phase rather than the follicular phase.

METHODS

A systematic review and meta-analysis was performed. Sixteen studies were included in the qualitative analysis, and eight studies with a total of 338 women were included in the quantitative analysis.

RESULTS

Cycles initiated in the luteal phase were slightly longer (WMD 1.1 days, 95 % CI 0.39-1.9) and utilized more total gonadotropins (WMD 817 IU, 95 % CI 489-1144). However, no differences were noted in peak estradiol levels (WMD -411 pg/ml, 95 % CI -906-84.7) or in the total number of oocytes retrieved (WMD 0.52 oocytes, 95 % CI -0.74-1.7). There were slightly more mature oocytes retrieved in the luteal phase (WMD 0.77 oocytes, 95 % CI 0.21-1.3), and fertilization rates were significantly higher (WMD 10 %, 95 % CI 0.03-0.18). While only three studies reported pregnancy outcomes, no difference was noted in the FET pregnancy rates after COS in the luteal versus follicular phase (RR 0.95, 95 % CI 0.56-1.7). A post hoc power analysis revealed that a sample of this size was sufficient to detect a clinically meaningful difference of 2 oocytes retrieved with 93 % power.

CONCLUSION

Although initiating COS in the luteal phase requires a longer stimulation and a higher dose of total gonadotropin, these differences are not clinically significant. Furthermore, COS initiated in the luteal phase does not compromise the quantity or quality of oocytes retrieved compared to outcomes of traditional stimulation in the follicular phase.

Fertility issues in cancer survivorship

Breakthroughs in cancer diagnosis and treatment have led to dramatic improvements in survival and the need to focus on survivorship issues. Chemotherapy and radiotherapy can be gonadotoxic, resulting in impaired fertility. Techniques to help cancer survivors reproduce have been improving over the past decade. Discussion of the changes to a patient's reproductive health after cancer treatment is essential to providing comprehensive quality care. The purpose of this review is to aid in pre- and posttreatment counseling, focusing on fertility preservation and other strategies that may mitigate risks to the patient's reproductive, sexual, and overall health.

Ovarian stimulation protocols for onco-fertility patients

PURPOSE

To review options for ovarian stimulation before oocyte collection for fertility preservation for women with cancer or related diseases who require potentially sterilizing chemo- or radiotherapy.

METHODS

Narrative review of current practice.

RESULTS

Vitrification of oocytes and embryos has improved chances of pregnancy for this group of patients in recent years, increasing the uptake of fertility preservation before cancer treatment substantially. Strategies for ovarian stimulation for such patients should optimize oocyte yield whilst avoiding risk of ovarian hyperstimulation.

CONCLUSIONS

Best practice in ovarian stimulation can deliver good numbers of oocytes or embryos for cryopreservation with minimal risk of ovarian hyperstimulation for women under 36 years of age. Results are less encouraging for older patients.