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Duarte-Filho OB, Miyadahira EH, Matsumoto L, Yamakami LYS, Tomioka RB, Podgaec S. Follitropin delta combined with menotropin in patients at risk for poor ovarian response during in vitro fertilization cycles: a prospective controlled clinical study. Reprod Biol Endocrinol 2024; 22:7. [PMID: 38166856 PMCID: PMC10759374 DOI: 10.1186/s12958-023-01172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The maximum daily dose of follitropin delta for ovarian stimulation in the first in vitro fertilization cycle is 12 μg (180 IU), according to the algorithm developed by the manufacturer, and based on patient's ovarian reserve and weight. This study aimed to assess whether 150 IU of menotropin combined with follitropin delta improves the response to stimulation in women with serum antimullerian hormone levels less than 2.1 ng/mL. METHODS This study involved a prospective intervention group of 44 women who received 12 μg of follitropin delta combined with 150 IU of menotropin from the beginning of stimulation and a retrospective control group of 297 women who received 12 μg of follitropin delta alone during the phase 3 study of this drug. The inclusion and exclusion criteria and other treatment and follow-up protocols in the two groups were similar. The pituitary suppression was achieved by administering a gonadotropin-releasing hormone (GnRH) antagonist. Ovulation triggering with human chorionic gonadotropin or GnRH agonist and the option of transferring fresh embryos or using freeze-all strategy were made according to the risk of developing ovarian hyperstimulation syndrome. RESULTS Women who received follitropin delta combined with menotropin had higher estradiol levels on trigger day (2150 pg/mL vs. 1373 pg/mL, p < 0.001), more blastocysts (3.1 vs. 2.4, p = 0.003) and more top-quality blastocysts (1.8 vs. 1.3, p = 0.017). No difference was observed in pregnancy, implantation, miscarriage, and live birth rates after the first embryo transfer. The incidence of ovarian hyperstimulation syndrome did not differ between the groups. However, preventive measures for the syndrome were more frequent in the group using both drugs than in the control group (13.6% vs. 0.6%, p < 0.001). CONCLUSIONS In women with serum antimullerian hormone levels less than 2.1 ng/mL, the administration of 150 IU of menotropin combined with 12 μg of follitropin delta improved the ovarian response, making it a valid therapeutic option in situations where ovulation triggering with a GnRH agonist and freeze-all embryos strategy can be used routinely. TRIAL REGISTRATION U1111-1247-3260 (Brazilian Register of Clinical Trials, available at https://ensaiosclinicos.gov.br/rg/RBR-2kmyfm ).
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Affiliation(s)
| | | | | | | | | | - Sergio Podgaec
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Disciplina de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Jones CA, Hawkins L, Friedman C, Hitkari J, McMahon E, Born KB. Choosing Wisely Canada: Canadian fertility and andrology society’s list of top items physicians and patients should question in fertility medicine. Arch Gynecol Obstet 2022; 306:267-275. [PMID: 35278119 PMCID: PMC8917376 DOI: 10.1007/s00404-022-06453-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
Abstract
Purpose To create a Choosing Wisely Canada list of the top 5 diagnostic and therapeutic interventions that should be questioned in Reproductive Endocrinology and Infertility in Canada. Methods The Canadian Fertility and Andrology Society (CFAS) National Working Group developed an initial list of recommendations of diagnostic and therapeutic interventions that are commonly used, but are not supported by evidence, and could expose patients to unnecessary harm. These were chosen based on their prevalence, cost, potential for harm, and quality of supporting evidence. A modified Delphi consensus was used over 5 rounds to generate ideas, review supporting evidence, assess clinical relevance, estimate recommendation impact and narrow the recommendations list to 5 items. Results Fifty unique ideas were first proposed by the working group, and after 5 rounds including a survey of Canadian Fertility and Andrology Society (CFAS) members, the final list of recommendations was created, including topics related to unnecessary investigations and interventions for patients with infertility and recurrent pregnancy loss, and those undergoing IVF. In this article, we describe not only the Delphi process used to determine the list, but also provide a summary of the evidence behind each of the final recommendations. Conclusions The list of five recommendations highlights opportunities to initiate conversations between clinicians and patients about the risks, benefits, harms and costs of unnecessary fertility treatments and procedures in a Canadian context.
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Affiliation(s)
- C A Jones
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, Toronto, ON, M5G 1E2, Canada
- Mount Sinai Fertility, Sinai Health System, 700-250 Dundas Street West, Toronto, ON, M5T 2Z5, Canada
| | - L Hawkins
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, Toronto, ON, M5G 1E2, Canada
- Department of Obstetrics and Gynaecology, Humber River Hospital, 1235 Wilson Ave, North York, ON, M3M 0B2, Canada
| | - Catherine Friedman
- Department of Obstetrics and Gynaecology, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
| | - J Hitkari
- Department of Obstetrics and Gynaecology, University of British Columbia, 930-1125 Howe Street, Vancouver, BC, V6Z 2K8, Canada
- Olive Fertility Centre, 300-East Tower, 555 West 12th Avenue, Vancouver, BC, V5Z 3X7, Canada
| | - E McMahon
- Mount Sinai Fertility, Sinai Health System, 700-250 Dundas Street West, Toronto, ON, M5T 2Z5, Canada
- Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - K B Born
- Institute of Health Policy, Management and Evaluation, Dalla School of Public Health, University of Toronto, 155 College St. 4th Floor, Toronto, ON, M5T 3M6, Canada
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Jones CA, Acharya KS, Acharya CR, Raburn D, Muasher SJ. Patient and in vitro fertilization (IVF) cycle characteristics associated with variable blastulation rates: a retrospective study from the Duke Fertility Center (2013–2017). MIDDLE EAST FERTILITY SOCIETY JOURNAL 2019. [DOI: 10.1186/s43043-019-0004-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract
Background
To evaluate the association of patient and IVF cycle characteristics with blastulation rate and formation of high-quality blastocysts
Results
We analyzed autologous blastocyst cycles from 2013 to 2017. Cycles were subdivided into low (< 33%), intermediate (33–66%), and high (> 66%) blastulation rates. Embryo quality was assigned by embryologists using Gardner Criteria. R statistical package was used, and the blastulation groups were compared using analysis of variance (ANOVA) for continuous variables and chi-squared tests for categorical variables. The Bonferroni correction was used to adjust for multiple comparisons. One hundred seventeen IVF cycles met our inclusion criteria. Of these, 20 (17.1%) had low, 74 (63.2%) had intermediate, and 23 (19.7%) had high blastulation rates. Low blastulation rate was associated with a lower number of blastocysts, including fewer high-quality blastocysts. The mean number of oocytes retrieved was highest (18.1) in the group with the lowest blastulation rate, and lowest (13.4) in those with the highest blastulation rate, although this did not reach statistical significance. There were no significant differences between blastulation rates and age, gravidity, prior live birth, anti-mullerian hormone, estradiol and progesterone levels on the day of ovulation trigger, follicle-stimulating hormone dose, or fertility diagnosis.
Conclusions
High blastulation rate is associated with a greater number of blastocysts, including a greater number of high-quality blastocysts. Higher oocyte yield, however, is not associated with improved blastulation rates. Blastulation rates, blastocyst number, and quality remain difficult to predict based on cycle characteristics alone, and oocyte yield may not be an accurate predictor of either outcome.
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Blumenfeld Z. Corifollitropin-α is useful for low and normal responders, but what about hyperresponders? Fertil Steril 2019; 111:675-676. [PMID: 30853088 DOI: 10.1016/j.fertnstert.2018.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Zeev Blumenfeld
- Reproductive Endocrinology, Obstetrics and Gynaecology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Blumenfeld Z. Depression, assisted reproductive technology/in vitro fertilization and selective serotonin reuptake inhibitors. Fertil Steril 2017; 108:948-949. [DOI: 10.1016/j.fertnstert.2017.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/12/2023]
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Salama KM, Abo Ragab HM, El Sherbiny MF, Morsi AA, Souidan II. Sequential E2 levels not ovarian maximal diameter estimates were correlated with outcome of cetrotide therapy for management of women at high-risk of ovarian hyperstimulation syndrome: a randomized controlled study. BMC WOMENS HEALTH 2017; 17:108. [PMID: 29132339 PMCID: PMC5683329 DOI: 10.1186/s12905-017-0466-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 11/03/2017] [Indexed: 11/12/2022]
Abstract
Background Ovarian hyperstimulation syndrome (OHSS) is an important condition with considerable morbidity and a small risk of mortality and most commonly results as an iatrogenic condition following follicular stimulation of the ovaries. We aimed to evaluate safety and efficacy of 3-day cetrotide therapy started on day of oocyte retrieval (Day-0) in women at high-risk for development of ovarian hyperstimulation syndrome (OHSS) after GnRH agonist induction protocol. Methods Forty-eight women fulfilling inclusion criteria underwent ultrasound scanning for maximal ovarian diameter (MOD) estimation and ascites grading. Patients underwent embryo freezing, but the study group received 3-day Cetrotide sc injection (0.25 mg/day) started on Day-0. Serum E2, pain scores and MOD were checked daily. Hematocrite value (Ht%), total leucocytic count (TLC), gastrointestinal (GI) manifestations and ascites grading were re-evaluated on Day-3, 6 and 8. Results Sequential serum E2 levels decreased significantly in both groups with significantly lower levels in the study group. Sequential MOD estimates showed non-significant difference between the two groups and versus Day-0 estimates. On Day-2, pain scores showed progressive significant decrease compared to Day-0 scores in both groups with significantly lower scores in the study group. On Day-3; four control patients still had vomiting and by Day-6, 6 of the control patients still had GI manifestations with significant difference versus the study group. Compared to Day-0 estimates, Ht% and TLC were significantly lower on Day-3, 6 and 8 in the study group, but only on Day-8 in the control group. Day-3 and Day-8 ascites grading in both groups was significantly lower compared to respective Day-0 grading with significant difference in favor of the study group. Six patients required hospitalization, but without mortalities. Day-3 E2 levels in the study group showed positive significant correlation with clinical and other laboratory data and ascites grading, while the correlation was non-significant with MOD. Conclusion The 3-day cetrotide therapy starting after oocyte retrieval with embryo transfer freezing could be an appropriate management policy for women received GnHR-agonist induction protocol and were at high-risk for OHSS. Sequential E2 serum levels could predict outcome more perfectly than sequential MOD estimates. Trial registration Trial registration (clinicaltrial.gov registration) NCT02823080 (retrospective) Initial Release 21–6-2016 Last Release 3–1-2017 Unique Protocol ID: Benha U Secondary IDs: kmsalama.
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Affiliation(s)
- Khalid M Salama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt.
| | - Hesham M Abo Ragab
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohammed F El Sherbiny
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ali A Morsi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ibrahim I Souidan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
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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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Chen YH, Wang Q, Zhang YN, Han X, Li DH, Zhang CL. Cumulative live birth and surplus embryo incidence after frozen-thaw cycles in PCOS: how many oocytes do we need? J Assist Reprod Genet 2017; 34:1153-1159. [PMID: 28580513 DOI: 10.1007/s10815-017-0959-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/17/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study aimed to evaluate the cumulative live birth rate (CLBR) and surplus embryo rate of polycystic ovarian syndrome (PCOS) patients during in vitro fertilization and embryo transfer (IVF-ET) treatment. METHODS In this retrospective cohort study, we analyzed 1142 PCOS patients who underwent first IVF in our institution between January 2011 and December 2014. All patients were categorized into five groups according to the number of oocytes retrieved. Main outcomes include CLBR and surplus embryo rate. RESULTS A strong correlation was observed between number of oocytes retrieved and CLBR as well as surplus embryo rate in PCOS patients. CLBR was elevated with the increasing number of oocytes and plateaued when oocyte number was up to ten, whereas the surplus embryo rate steadily increased in line with the increase of oocyte number. Patients transferred with frozen embryos showed higher CLBR and LBR during first ET than patients transferred with fresh embryos. CONCLUSIONS For PCOS patients, retrieving more than ten oocytes leads to no significant benefit to CLBR but generates surplus embryos. Thus, moderate ovarian stimulation should be reconsidered during IVF treatment.
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Affiliation(s)
- Yuan-Hui Chen
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Qian Wang
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Ya-Nan Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Xiao Han
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Dong-Han Li
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Cui-Lian Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China. .,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.
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Teh WT, McBain J, Rogers P. What is the contribution of embryo-endometrial asynchrony to implantation failure? J Assist Reprod Genet 2016; 33:1419-1430. [PMID: 27480540 PMCID: PMC5125144 DOI: 10.1007/s10815-016-0773-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/07/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The synchronized development of a viable embryo and a receptive endometrium is critical for successful implantation to take place. The aim of this paper is to review current thinking about the importance of embryo-endometrial synchrony in in vitro fertilization (IVF). METHODS Detailed review of the literature on embryo-endometrial synchrony. RESULTS By convention, the time when the blastocyst first attaches and starts to invade into the endometrium has been defined as the 'window of implantation'. The term window of implantation can be misleading when it is used to imply that there is a single critical window in time that determines whether implantation will be successful or not. Embryo maturation and endometrial development are two independent continuous processes. Implantation occurs when the two tissues fuse and pregnancy is established. A key concept in understanding this event is developmental 'synchrony', defined as when the early embryo and the uterus are both developing at the same rate such that they will be ready to commence and successfully continue implantation at the same time. Many different events, including controlled ovarian hyperstimulation as routinely used in IVF, can potentially disrupt embryo-endometrial synchrony. There is some evidence in humans that implantation rates are significantly reduced when embryo-endometrial development asynchrony is greater than 3 days (±1.5 days). CONCLUSIONS Embryo-endometrial synchrony is critical for successful implantation. There is an unmet need for improved precision in the evaluation of endometrial development to permit better synchronization of the embryo and the endometrium prior to implantation.
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Affiliation(s)
- Wan-Tinn Teh
- Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Road, Parkville, 3052, VIC, Australia.
- Reproductive Services, The Royal Women's Hospital, Parkville, VIC, Australia.
| | - John McBain
- Reproductive Services, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Peter Rogers
- Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Road, Parkville, 3052, VIC, Australia
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Maas K, Galkina E, Thornton K, Penzias AS, Sakkas D. No change in live birthweight of IVF singleton deliveries over an 18-year period despite significant clinical and laboratory changes. Hum Reprod 2016; 31:1987-96. [DOI: 10.1093/humrep/dew173] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/10/2016] [Indexed: 11/14/2022] Open
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Blumenfeld Z. Small follicles may be a promising source of oocytes in modified natural cycle in vitro fertilization-embryo transfer. Fertil Steril 2016; 106:66-67. [PMID: 27059511 DOI: 10.1016/j.fertnstert.2016.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Zeev Blumenfeld
- Reproductive Endocrinology, Department of Obstetrics and Gynecology, RAMBAM Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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