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Alhilali MJ, Parham A, Attaranzadeh A, Amirian M, Azizzadeh M. Prognostic role of follicular fluid tumor necrosis factor alpha in the risk of early ovarian hyperstimulation syndrome. BMC Pregnancy Childbirth 2020; 20:691. [PMID: 33183268 PMCID: PMC7663882 DOI: 10.1186/s12884-020-03379-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition characterized by capillary hyperpermeability which can be predicted by preovulatory ovarian responses such as number of follicles. A variety of cytokines are thought to be involved in pathophysiology of this syndrome. METHODS A prospective cohort study invloving sixty intracytoplasmic sperm injection (ICSI) patients. On the day of hCG injection, we explored the threshold of larger follicles ≥11 mm diameter with a count of ≥18 follicles for the high-risk moderate-to-severe OHSS and 13-18 follicles for the low-risk moderate-to-severe OHSS. Whereas larger follicles count of less than 13 were classified as normoresponders. Pooled follicular fluid (FF) samples of each patient were collected on the day of oocyte retrieval. Magnetic multiplex immunoassay was explored to measure the concentrations of some intrafollicular cytokines including: GM-CSF, INF-γ, TNF-α, IL-10, CXCL8/IL-8, IL-6, IL-5, IL-4, IL-2, and IL-1β. All sixty patients underwent controlled ovarian hyperstimulation (COH) with either GnRH agonist or antagonist protocols. RESULTS Intrafollicular TNF-α concentration was significantly different (p < 0.05) in the high-risk moderate-to-severe OHSS patients compared to low-risk moderate-to-severe OHSS patients and normoresponders. TNF-α in FF had a negative correlation with the chance of high-risk moderate-to-severe OHSS. The differences in the risk of OHSS between patients who received GnRH agonist or antagonist were not significant (p > 0.05). CONCLUSIONS In accordance to the negative correlation of TNF-α and high risk of early OHSS, we did not expect TNF-α to play a role in increasing vascular permeability in ovarian tissues. In addition, the risk of early moderate-to-severe OHSS was not affected by different GnRH superovulation protocols.
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Affiliation(s)
- Miaad Jabbar Alhilali
- Department of Physiology, College of Veterinary Medicine, AlQadisiyiah University, Diwanyiah, Iraq
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Abbas Parham
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran.
- Stem Cell Biology and Regenerative Medicine Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Armin Attaranzadeh
- Milad Center for Infertility Treatment, Mashhad, Iran
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Amirian
- Milad Center for Infertility Treatment, Mashhad, Iran
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Azizzadeh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
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Inoue T, Taguchi S, Hirao K, Tsujimoto Y, Yamamoto S, Uemura M, Miyazaki K, Yamashita Y. Association of follicular fluid volume with membrane stretchability of human metaphase II oocytes following the gonadotropin-releasing hormone agonist protocol during intracytoplasmic sperm injection. Reprod Med Biol 2018; 17:283-288. [PMID: 30013430 PMCID: PMC6046520 DOI: 10.1002/rmb2.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The authors previously revealed the association of the follicular fluid (FF) volume with oolemma stretchability following the gonadotropin-releasing hormone (GnRH) antagonist protocol during intracytoplasmic sperm injection (ICSI). However, the impact of the GnRH agonist protocol on oolemma stretchability remains unclear. METHODS Data that were obtained from 74 ICSI cycles were reviewed retrospectively. Controlled ovarian stimulation was performed in accordance with the short GnRH agonist protocol. Each follicle was individually aspirated and assigned to one of six groups, according to the FF volume. The oolemma stretchability during ICSI was evaluated by using a mechanical stimulus for oolemma penetration; that is, oolemma penetration with or without aspiration (high vs low stretchability, respectively). RESULTS The incidence of low oolemma stretchability was significantly higher in the <1.0 mL group than that in the ≥1.0 mL group. The normal fertilization rate was significantly lower in the <1.0 mL group than that in the 2.0-<3.0 mL group. The rate of blastocyst development was lower in the <1.0 mL group than that in the 3.0-<4.0 mL group. CONCLUSION The FF volume potentially was associated with metaphase II oolemma stretchability, fertilization, and blastocyst development.
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Affiliation(s)
- Taketo Inoue
- Umeda Fertility ClinicOsakaJapan
- Department of Emergency, Disaster and Critical Care MedicineHyogo College of MedicineNishinomiyaJapan
| | | | | | | | | | - Mikiko Uemura
- Faculty of RehabilitationKobe Gakuin UniversityKobeJapan
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Chen Y, Ye B, Yang X, Zheng J, Lin J, Zhao J. Predicting the outcome of different protocols of in vitro fertilization with anti-Muüllerian hormone levels in patients with polycystic ovary syndrome. J Int Med Res 2017; 45:1138-1147. [PMID: 28449632 PMCID: PMC5536432 DOI: 10.1177/0300060517704140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective This study evaluated associations of basal serum and follicular fluid (FF) anti-Muüllerian hormone (AMH) levels with in vitro fertilization (IVF) outcomes in polycystic ovary syndrome (PCOS) patients. Methods This prospective study included 179 consecutive women undergoing IVF, including 59 with PCOS and non-PCOS controls. Thirty PCOS cases had long gona-dotrophin-releasing hormone agonist (GnRH-a) and 29 had antagonist (GnRH-ant) protocols. Controls underwent conventional GnRH-a. Associations of basal serum and FF AMH levels with IVF outcomes were assessed. Results Median serum and FF AMH levels, antral follicle count (AFC), oestradiol human chorionic gonadotropin injection day (peak E2), and retrieved oocyte numbers were higher in PCOS patients than in controls (all P < 0.01). Oocyte maturation and high-quality embryo rates were lower in PCOS patients than in controls (P < 0.01), but both groups had similar fertilization, implantation, clinical pregnancy, and newborn rates. Peak E2 was higher in GnRH-ant than in GnRH-a protocols (16.5 nmol/L vs. 12.1 nmol/L, P < 0.05). AMH levels were correlated with AFC in PCOS patients (P < 0.01). Peak E2 and FF AMH levels were independent predictors of oocyte number. Peak E2 predicted the fertilization rate. Conclusion Serum basal AMH levels are predictive of oocyte quantity, but not oocyte quality or IVF outcomes. Serum AMH, FF AMH, and outcomes are similar among protocols.
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Affiliation(s)
- Ya Chen
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Ya Chen, Reproductive Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China.
| | - Bilv Ye
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaojing Yang
- Gynaecology and Obstetrics Department, The First People’s Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Jiujia Zheng
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinju Lin
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junzhao Zhao
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Kim YY, Tamadon A, Ku SY. Potential Use of Antiapoptotic Proteins and Noncoding RNAs for EfficientIn VitroFollicular Maturation and Ovarian Bioengineering. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:142-158. [DOI: 10.1089/ten.teb.2016.0156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Yoon Young Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Amin Tamadon
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Yup Ku
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
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Al‐Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev 2016; 4:CD001750. [PMID: 27126581 PMCID: PMC8626739 DOI: 10.1002/14651858.cd001750.pub4] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Gonadotrophin-releasing hormone (GnRH) antagonists can be used to prevent a luteinizing hormone (LH) surge during controlled ovarian hyperstimulation (COH) without the hypo-oestrogenic side-effects, flare-up, or long down-regulation period associated with agonists. The antagonists directly and rapidly inhibit gonadotrophin release within several hours through competitive binding to pituitary GnRH receptors. This property allows their use at any time during the follicular phase. Several different regimens have been described including multiple-dose fixed (0.25 mg daily from day six to seven of stimulation), multiple-dose flexible (0.25 mg daily when leading follicle is 14 to 15 mm), and single-dose (single administration of 3 mg on day 7 to 8 of stimulation) protocols, with or without the addition of an oral contraceptive pill. Further, women receiving antagonists have been shown to have a lower incidence of ovarian hyperstimulation syndrome (OHSS). Assuming comparable clinical outcomes for the antagonist and agonist protocols, these benefits would justify a change from the standard long agonist protocol to antagonist regimens. This is an update of a Cochrane review first published in 2001, and previously updated in 2006 and 2011. OBJECTIVES To evaluate the effectiveness and safety of gonadotrophin-releasing hormone (GnRH) antagonists compared with the standard long protocol of GnRH agonists for controlled ovarian hyperstimulation in assisted conception cycles. SEARCH METHODS We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched from inception to May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, inception to 28 April 2015), Ovid MEDLINE (1966 to 28 April 2015), EMBASE (1980 to 28 April 2015), PsycINFO (1806 to 28 April 2015), CINAHL (to 28 April 2015) and trial registers to 28 April 2015, and handsearched bibliographies of relevant publications and reviews, and abstracts of major scientific meetings, for example the European Society of Human Reproduction and Embryology (ESHRE) and American Society for Reproductive Medicine (ASRM). We contacted the authors of eligible studies for missing or unpublished data. The evidence is current to 28 April 2015. SELECTION CRITERIA Two review authors independently screened the relevant citations for randomised controlled trials (RCTs) comparing different GnRH agonist versus GnRH antagonist protocols in women undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and extracted the data. The primary review outcomes were live birth and ovarian hyperstimulation syndrome (OHSS). Other adverse effects (miscarriage and cycle cancellation) were secondary outcomes. We combined data to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for each comparison using GRADE methods. MAIN RESULTS We included 73 RCTs, with 12,212 participants, comparing GnRH antagonist to long-course GnRH agonist protocols. The quality of the evidence was moderate: limitations were poor reporting of study methods.Live birthThere was no conclusive evidence of a difference in live birth rate between GnRH antagonist and long course GnRH agonist (OR 1.02, 95% CI 0.85 to 1.23; 12 RCTs, n = 2303, I(2)= 27%, moderate quality evidence). The evidence suggested that if the chance of live birth following GnRH agonist is assumed to be 29%, the chance following GnRH antagonist would be between 25% and 33%.OHSSGnRH antagonist was associated with lower incidence of any grade of OHSS than GnRH agonist (OR 0.61, 95% C 0.51 to 0.72; 36 RCTs, n = 7944, I(2) = 31%, moderate quality evidence). The evidence suggested that if the risk of OHSS following GnRH agonist is assumed to be 11%, the risk following GnRH antagonist would be between 6% and 9%.Other adverse effectsThere was no evidence of a difference in miscarriage rate per woman randomised between GnRH antagonist group and GnRH agonist group (OR 1.04, 95% CI 0.82 to 1.30; 33 RCTs, n = 7022, I(2) = 0%, moderate quality evidence).With respect to cycle cancellation, GnRH antagonist was associated with a lower incidence of cycle cancellation due to high risk of OHSS (OR 0.47, 95% CI 0.32 to 0.69; 19 RCTs, n = 4256, I(2) = 0%). However cycle cancellation due to poor ovarian response was higher in women who received GnRH antagonist than those who were treated with GnRH agonist (OR 1.32, 95% CI 1.06 to 1.65; 25 RCTs, n = 5230, I(2) = 68%; moderate quality evidence). AUTHORS' CONCLUSIONS There is moderate quality evidence that the use of GnRH antagonist compared with long-course GnRH agonist protocols is associated with a substantial reduction in OHSS without reducing the likelihood of achieving live birth.
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Affiliation(s)
- Hesham G Al‐Inany
- Faculty of Medicine, Cairo UniversityDepartment of Obstetrics & Gynaecology8 Moustapha Hassanin StManialCairoEgypt
| | - Mohamed A Youssef
- Faculty of Medicine, Cairo UniversityDepartment of Obstetrics & Gynaecology8 Moustapha Hassanin StManialCairoEgypt
| | - Reuben Olugbenga Ayeleke
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand
| | - Julie Brown
- The University of AucklandLiggins InstitutePark RdGraftonAucklandNew Zealand1142
| | - Wai Sun Lam
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand
| | - Frank J Broekmans
- University Medical CenterDepartment of Reproductive Medicine and GynecologyUtrechtNetherlands
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Hestiantoro A, Negoro YS, Afrita Y, Wiweko B, Sumapradja K, Natadisastra M. Anti-Müllerian hormone as a predictor of polycystic ovary syndrome treated with clomiphene citrate. Clin Exp Reprod Med 2016; 43:207-214. [PMID: 28090459 PMCID: PMC5234282 DOI: 10.5653/cerm.2016.43.4.207] [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: 02/23/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to determine the threshold of anti-Müllerian hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Methods Fifty female subjects with PCOS were recruited and divided into two groups based on successful and unsuccessful follicular growth. Related variables such as age, infertility duration, cigarette smoking, use of Moslem hijab, sunlight exposure, fiber intake, body mass index, waist circumference, AMH level, 25-hydroxy vitamin D level, and growth of dominant follicles were obtained, assessed, and statistically analyzed. Results The AMH levels of patients with successful follicular growth were significantly lower (p=0.001) than those with unsuccessful follicular growth (6.10±3.52 vs. 10.43±4.78 ng/mL). A higher volume of fiber intake was also observed in the successful follicular growth group compared to unsuccessful follicular growth group (p=0.001). Our study found the probability of successful follicle growth was a function of AMH level and the amount of fiber intake, expressed as Y=–2.35+(–0.312×AMH level)+(0.464×fiber intake) (area under the curve, 0.88; 95% confidence interval, 0.79–0.98; p<0.001). Conclusion The optimal threshold of AMH level in predicting the failure of follicle growth in patients with PCOS treated with CC was 8.58 ng/mL.
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Affiliation(s)
- Andon Hestiantoro
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yuwono Sri Negoro
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yohana Afrita
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Budi Wiweko
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kanadi Sumapradja
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Muharam Natadisastra
- Division of Reproductive Immunoendocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Nastri CO, Teixeira DM, Moroni RM, Leitão VMS, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:377-93. [PMID: 25302750 DOI: 10.1002/uog.14684] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To identify, appraise and summarize the current evidence regarding the pathophysiology, staging, prediction and prevention of ovarian hyperstimulation syndrome (OHSS). METHODS Two comprehensive systematic reviews were carried out: one examined methods of predicting either high ovarian response or OHSS and the other examined interventions aimed at reducing the occurrence of OHSS. Additionally, we describe the related pathophysiology and staging criteria. RESULTS Seven studies examining methods of predicting OHSS and eight more examining methods of predicting high ovarian response to controlled ovarian stimulation were included. Current evidence shows that the best methods of predicting high response are antral follicle count and anti-Müllerian hormone levels, and that a high ovarian response (examined by the number of large follicles, estradiol concentration or the number of retrieved oocytes) is the best method of predicting the occurrence of OHSS. Ninety-seven randomized controlled trials examining the effect of several interventions for reducing the occurrence of OHSS were included. There was high-quality evidence that replacing human chorionic gonadotropin by gonadotropin-releasing hormone agonists or recombinant luteinizing hormone, and moderate-quality evidence that antagonist protocols, dopamine agonists and mild stimulation, reduce the occurrence of OHSS. The evidence for the effect of the other interventions was of low/very low quality. Additionally, we identified and described 12 different staging criteria. CONCLUSIONS There are useful predictive tools and several preventive interventions aimed at reducing the occurrence of OHSS. Acknowledging and understanding them are of crucial importance for planning the treatment of, and, ultimately, eliminating, OHSS while maintaining high pregnancy rates.
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Affiliation(s)
- C O Nastri
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil; School of Health Technology - Ultrasonography School of Ribeirao Preto (FATESA-EURP), Ribeirao Preto, Brazil
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Hasky N, Uri-Belapolsky S, Goldberg K, Miller I, Grossman H, Stemmer SM, Ben-Aharon I, Shalgi R. Gonadotrophin-releasing hormone agonists for fertility preservation: unraveling the enigma? Hum Reprod 2015; 30:1089-101. [PMID: 25796551 DOI: 10.1093/humrep/dev037] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/03/2015] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Can gonadotrophin-releasing hormone agonists (GnRH-a) preserve long-term fertility when administered prior to and concomitantly with chemotherapy? SUMMARY ANSWER GnRH-a display a differential protective effect on fertility, depending upon the specific chemotherapy-induced mechanism of ovarian injury. WHAT IS KNOWN ALREADY The role of GnRH-a in fertility preservation has been constantly debated and their use is considered experimental due to conflicting clinical evidence and paucity of data regarding their mechanism for ovarian protection. STUDY DESIGN, SIZE, DURATION In vivo model: 7-8 weeks old imprinting control region (ICR) mice were injected with GnRH-a (Leuprolide-acetate) or saline prior to and concomitantly with cyclophosphamide, doxorubicin or saline and sacrificed at various time-points on a longitudinal follow-up; 24 h (n = 36), 1 week (n = 40), 1 month (n = 36) and 9 months (n = 66) post chemotherapy treatment. Blood samples were drawn on Day 0 and on a monthly basis after chemotherapy treatment. On the day of sacrifice, blood samples were drawn and ovaries excised and processed for either immunohistochemistry (IHC), protein or RNA extraction. In vitro model: 21-23 days old Wistar-derived rats were sacrificed, their ovaries excised and primary granulosa cells (PGC) were either isolated for in vitro culture, or processed for immunofluorescence (IF) as well as for protein or RNA extraction. MATERIALS, SETTING, METHODS Ovarian reserve was estimated by serial measurements of serum anti-mullerian hormone (AMH), quantified by the AMH Gen II ELISA assay. Ovarian AMH and phosphorylated Akt (pAkt) were detected by immunoblotting. Vascular endothelial growth factor (VEGF) was measured by quantitative PCR. Ovarian GnRH receptor (GnRHR), AMH and CD34 were visualized by IHC, and apoptosis was evaluated using TdT (terminal deoxynucleotidyl transferase)-mediated dUDP nick-end labeling (TUNEL). MAIN RESULTS AND THE ROLE OF CHANCE Cyclophosphamide-induced ovarian injury caused a prompt decrease in AMH level (P < 0.01) and a further long-term decline in serum AMH (P = 0.017), indicating damage to the ovarian reserve. Pretreatment with GnRH-a diminished AMH-decrease (P < 0.05) and maintained serum AMH level in the long run (P < 0.05). Doxorubicin-exerted ovarian-vascular-injury is also displayed by an acute increase in ovarian VEGF level (P < 0.05) and a sustained decrease in serum AMH level (P < 0.001). This was followed by ovarian recovery manifested by increased neovascularization. GnRH-a delayed the recovery in AMH level and decreased the level of VEGF (P < 0.001), thus interfering with the vascular recovery subsequent to doxorubicin-induced vascular damage. LIMITATIONS, REASONS FOR CAUTION To portray the differential mechanism of each chemotherapy, cyclophosphamide and doxorubicin were given separately, whereas most of the clinical protocols include several types of chemotherapies. Thus, future study should explore a prospective evaluation of various chemotherapies, as well as combined chemotherapeutic protocols. WIDER IMPLICATIONS OF THE FINDINGS Our study demonstrates that different chemotherapy agents affect the ovary via diverse mechanisms and thus the administration of GnRH-a concomitantly, could be beneficial to a subpopulation of patients treated with cyclophosphamide-based protocols. STUDY FUNDING/COMPETING INTERESTS This work was partially supported by a grant from the Israel Science Foundation (ISF) to I.B.-A. The authors have no conflict of interest to disclose.
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Affiliation(s)
- Noa Hasky
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Uri-Belapolsky
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Goldberg
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Miller
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Grossman
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salomon M Stemmer
- Institute of Oncology, Davidoff Center and Rabin Medical Center, Petah-Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Ben-Aharon
- Institute of Oncology, Davidoff Center and Rabin Medical Center, Petah-Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Shalgi
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kim JH, Lee JR, Chang HJ, Jee BC, Suh CS, Kim SH. Anti-Müllerian hormone levels in the follicular fluid of the preovulatory follicle: a predictor for oocyte fertilization and quality of embryo. J Korean Med Sci 2014; 29:1266-70. [PMID: 25246746 PMCID: PMC4168181 DOI: 10.3346/jkms.2014.29.9.1266] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/28/2014] [Indexed: 11/20/2022] Open
Abstract
This prospective study investigated the relationship between anti-Müllerian hormone (AMH) level in the follicular fluid (FF) and the quality of the oocyte and embryo. A total of 65 FF samples from 54 women were included in this study. FF was collected from the largest preovulatory follicle sized≥20 mm of mean diameter from each ovary. Samples were divided into 3 groups according to the FF AMH levels: below the 33th percentile (low group, FF AMH<2.1 ng/mL, n=21), between the 33th and the 67th percentile (intermediate group, FF AMH=2.1-3.6 ng/mL, n=22), and above the 67th percentile (high group, FF AMH>3.6 ng/mL, n=22). The quality of the ensuing oocytes and embryos was evaluated by fertilization rate and embryo score. FF AMH levels correlated positively with the matched embryo score on day 3 after fertilization (r=0.331, P=0.015). The normal fertilization rate was significantly lower in the low group than in the intermediate group (61.9% vs. 95.5% vs. 77.3%, respectively, P=0.028). Our results suggest that the FF AMH level could be a predictor of the ensuing oocyte and embryo quality.
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Affiliation(s)
- Jee Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Jin Chang
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Mehde AA, Mehdi WA, Zainulabdeen JA, Abdulbari AS. Correlation of inhibin and several antioxidants in children with acute lymphoblastic leukemia. Asian Pac J Cancer Prev 2014; 15:4843-6. [PMID: 24998550 DOI: 10.7314/apjcp.2014.15.12.4843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is most common in childhood. Inhibin (a non-steroidal glycoprotein hormone of gonadal origin) can be used as marker of fertility. The current study was conducted to evaluate inhibin levels in ALL patients and to estimate its correlation with some antioxidants in these in comparison with control subjects. MATERIALS AND METHODS This study was conducted on sixty patients with ALL and thirty children as controls. Fasting blood samples were taken from each subject and analyzed for haemoglobin, serum protein, vitamin E and C, in addition to glutathione and inhibin. RESULTS The results of the study showed highly significant decreases (p<0.001) in haemoglobin, glutathione and inhibin levels with significant decreases (p<0.05) in serum protein and vitamin E levels for patients group in comparison with controls while there was no significant differences in vitamin C. Moreover, there were significant correlations between inhibin levels and serum protein, glutathione and both vitamins (E and C) in the ALL patient group (r= 0.81, 0.80, 0.77 and 0.69, respectively). CONCLUSIONS The present results indicated infertility in patients with ALL demonstrated by low inhibin level as a consequence of abnormality in anti-oxidative metabolism due to the cancer process. So, it can be suggested the need for routine measurement of inhibin for leukemic patients to estimate the action of hormones of gonadal origin.
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Affiliation(s)
- Atheer Awad Mehde
- Department of Acceptable Analysis, Health and Medical Technical College, university of Baghdad, Baghdad, Iraq E-mail :
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Weintraub A, Margalioth EJ, Chetrit AB, Gal M, Goldberg D, Alerhand S, Eldar-Geva T. The dynamics of serum anti-Mullerian-hormone levels during controlled ovarian hyperstimulation with GnRH-antagonist short protocol in polycystic ovary syndrome and low responders. Eur J Obstet Gynecol Reprod Biol 2014; 176:163-7. [DOI: 10.1016/j.ejogrb.2014.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 01/09/2014] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
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Guvendag Guven ES, Dilbaz S, Duraker R, Mentese A, Cinar O, Ozdegirmenci O. The effect of cabergoline on folicular microenviroment profile in patients with high risk of OHSS. Gynecol Endocrinol 2013; 29:749-53. [PMID: 23741965 DOI: 10.3109/09513590.2013.801440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study to evaluate the effect of cabergoline on follicular microenvironment by measuring follicular fluid (FF) insulin like growth hormone -I (IGF-I), antimullerian hormone (AMH), inhibin B and hepatocyte growth factor (HGF) levels in women with PCOS and high risk of ovarian hyperstimulation syndrome (OHSS). In this prospective cohort study, 41 women with PCOS undergoing controlled ovarian hyperstimulation for assisted reproduction and having the high risk factors for OHSS are included. The women in the study group (n = 15) received cabergoline for OHSS prevention while the women in the control did not received any medications for OHSS prevention. FF samples were collected during oocyte pick-up procedure for all women were determined using commercially available ELISA kits. Concentrations of FF IGF-I, AMH, inhibin B and HGF were assessed. In the study group FF AMH (2.96 ± 1.27 versus 1.91 ± 0.64 ng/mL), Inhibin B (1339.47 ± 198.56 versus 1200.09 ± 133.64 pg/mL), HGF (5623.21 ± 2411.09 versus 3787.42 ± 2269.89 pg/mL) and IGF-I (298.60 ± 37.80 versus 219.90 ± 71.40 pg/mL) concentrations were significantly decreased compared with control group. Cabergolin prevents OHSS in high risk patients by disrupting FF hormone microenvironment.
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Affiliation(s)
- Emine Seda Guvendag Guven
- Department of Obstetrics and Gynecology, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey.
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Kaya A, Atabekoglu CS, Kahraman K, Taskin S, Ozmen B, Berker B, Sonmezer M. Follicular fluid concentrations of IGF-I, IGF-II, IGFBP-3, VEGF, AMH, and inhibin-B in women undergoing controlled ovarian hyperstimulation using GnRH agonist or GnRH antagonist. Eur J Obstet Gynecol Reprod Biol 2012; 164:167-71. [DOI: 10.1016/j.ejogrb.2012.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 03/26/2012] [Accepted: 06/09/2012] [Indexed: 10/28/2022]
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Lee HJ, Ku SY, Kim SH, Choi YM, Kim JG, Moon SY. A comparative study on the impact of fresh variables on the success of frozen-thawed embryo transfer cycles using 2PN sibling embryos in women with/without polycystic ovary syndrome. Gynecol Endocrinol 2012; 28:351-5. [PMID: 22103769 DOI: 10.3109/09513590.2011.633651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of the present study was to identify the fresh variables that influence the frozen-thawed embryo transfer (FET) outcome using sibling two pronuclei (2PN) embryos in women with polycystic ovary syndrome (PCOS) and non-PCOS women. MATERIAL & METHODS Fifty-five FET cycles were performed using sibling embryos randomly cryopreserved at 2PN states and basal/cycle characteristics of fresh variables were compared between PCOS and non-PCOS groups according to the success in FET pregnancy: group A (pregnant PCOS); group B (not pregnant PCOS); group C (pregnant non-PCOS); group D (not pregnant non-PCOS). RESULTS In PCOS patients, higher progesterone level on human chorionic gonadotropin (hCG) day was observed in group A than in group B (0.9 ± 0.0 vs. 0.5 ± 0.3, p = 0.004). In non-PCOS patients who achieved a pregnancy in the fresh cycle, a subsequent FET cycle using sibling 2PN embryos conferred a thirteen times increased chance of achieving pregnancy (OR 13.0; 95% CI, 2.3-74.1). Embryo quality and endometrial maturation were comparable between A and B or C and D. CONCLUSIONS The success of the fresh embryo transfer (ET)was the most important predictor of pregnancy in FET cycles in the non-PCOS group. The relationship between serum progesterone on hCG day in the fresh cycle and the outcome of subsequent FET would benefit further evaluation in PCOS group.
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Affiliation(s)
- Hye Jun Lee
- Department of Obstetrics and Gynecology, College of Medicine, Seoul, Korea
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Polyzos NP, Stoop D, Blockeel C, Adriaensen P, Platteau P, Anckaert E, Smitz J, Devroey P. Anti-Müllerian hormone for the assessment of ovarian response in GnRH-antagonist-treated oocyte donors. Reprod Biomed Online 2012; 24:532-9. [DOI: 10.1016/j.rbmo.2012.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 01/25/2012] [Accepted: 01/26/2012] [Indexed: 10/14/2022]
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Kim H, Ku SY, Suh CS, Kim SH, Choi YM, Kim JG, Moon SY. The effect of intracytoplasmic sperm injection on the early hCG level in twin pregnancies. Gynecol Endocrinol 2012; 28:60-2. [PMID: 21787129 DOI: 10.3109/09513590.2011.588754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Since it has been suggested that intracytoplasmic sperm injection (ICSI) might impair the early development of embryos and twin pregnancies have physiologically different aspects from singleton pregnancies, we aimed to investigate the effect of ICSI on the human chrionic gonadotropin (hCG) levels in twin pregnancies. METHODS A total of 220 clinical pregnancies which underwent controlled ovarian hyperstimulation and in vitro fertilization/ICSI were analyzed retrospectively. RESULTS In twin pregnancies, the mean number of retrieved oocytes and estradiol (E₂) levels on hCG day were significantly higher in ICSI group in spite of lower dose of gonadotropin. The hCG levels according to insemination method did not demonstrate any difference after adjustment for age of patient and partner, BMI, treatment regimens, serum E₂ on hCG day, number of oocytes retrieved and date of sampling. CONCLUSIONS The hCG values according to fertilization methods were not significantly different both in twin pregnancies with adjustment for confounders.
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Affiliation(s)
- Hoon Kim
- Department of Obstetrics and Gynecology, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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OLA SI, SUN QY. Factors Influencing the Biochemical Markers for Predicting Mammalian Oocyte Quality. J Reprod Dev 2012; 58:385-92. [DOI: 10.1262/jrd.11-084h] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Safiriyu Idowu OLA
- Department of Animal Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Qing-Yuan SUN
- State Key Laboratory of Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
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Choe SA, Ku SY, Jee BC, Suh CS, Kim SH, Choi YM, Gu Kim J, Yong Moon S. Symmetry in number of retrieved oocytes between two ovaries: a possible predictor of in vitro fertilization outcome. Gynecol Endocrinol 2011; 27:997-1000. [PMID: 21627556 DOI: 10.3109/09513590.2011.579654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the relationship between the ratio of difference in number of retrieved oocytes from the two ovaries to total number of oocytes (difference ratio, |N(RO) - N(LO)|/N(TOTAL)) and in?vitro fertilization (IVF) outcome. METHODS Retrospective review of medical record for infertility patients with intact two ovaries who had undertaken controlled ovarian stimulation (COS) and IVF cycles in Seoul National University Hospital was conducted. Characteristics and IVF outcomes were compared according to the difference ratio (|N(RO) - N(LO)|/N(TOTAL)) using student t-test and χ² test. To adjust for the effect of confounding factors, binary logistic regression test was performed. RESULTS When the study population was divided according to the difference ratio by cut-off value of 0.4, patients with difference ratio less than 0.4 showed significantly higher pregnancy rate (25.7% vs. 17.1%, p = 0.021). A significant correlation was noted between the difference ratio and achievement of pregnancy after adjustment for patient's age and total number of top quality embryos transferred (adjusted OR = 0.40, 95% CI 0.19-0.83, p = 0.014). CONCLUSIONS The difference ratio of retrieved oocytes in patients with intact two ovaries was observed to have prognostic value in IVF cycles.
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Affiliation(s)
- Seung Ah Choe
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine
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Kim YJ, Ku SY, Jee BC, Suh CS, Kim SH, Choi YM, Kim JG, Moon SY. Tri-pronucleated zygotes may occur less frequently in luteinizing hormone activity-added cycles. Gynecol Endocrinol 2011; 27:458-63. [PMID: 20642378 DOI: 10.3109/09513590.2010.501878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was performed to evaluate the association between adding luteinizing hormone (LH) activity and the incidence of tripronuclear (3PN) zygotes occurrence. METHODS The incidence of 3PN and cycle outcomes was compared between recombinant follicle stimulating hormone (rFSH)-only and rFSH with exogenous LH activity groups. These comparisons were performed in gonadotropin releasing hormone (GnRHa, n = 196) and gonadotropin releasing hormone antagonist (GnRHant, n = 182) subgroups, and in in vitro fertilisation (IVF) (n = 243) and intracytoplasmic sperm injection (ICSI) (n = 135) cycles, respectively. RESULTS The percentage of 3PN was significantly lower in LH activity-added group compared to rFSH-only group (3.6% vs. 5.6%, p = 0.029). Both in GnRHa and GnRHant subgroups, this incidence tended to be lower in LH-supplemented group, although these differences did not reach statistical significance. In IVF cycles, LH activity-added group showed a lower 3PN rate versus rFSH-only group (4.0% vs. 6.7%, p = 0.018). No difference of 3PN rate was found in ICSI cycles. CONCLUSIONS Supplementation of exogenous LH activity to ovarian stimulation may be associated with lower prevalence of 3PN zygotes in IVF cycles, but not in ICSI cycles.
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Affiliation(s)
- Yong Jin Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul, South Korea
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Antimüllerian hormone as a predictor of controlled ovarian hyperstimulation outcome: comparison of two commercial immunoassay kits. Fertil Steril 2011; 95:2602-4. [DOI: 10.1016/j.fertnstert.2011.01.126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 01/16/2011] [Accepted: 01/18/2011] [Indexed: 11/18/2022]
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Al-Inany HG, Youssef MA, Aboulghar M, Broekmans F, Sterrenburg M, Smit J, Abou-Setta AM. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev 2011:CD001750. [PMID: 21563131 DOI: 10.1002/14651858.cd001750.pub3] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gonadotrophin-releasing hormone (GnRH) antagonists can be used to prevent a luteinizing hormone (LH) surge during controlled ovarian hyperstimulation (COH) without the hypo-estrogenic side-effects, flare-up, or long down-regulation period associated with agonists. The antagonists directly and rapidly inhibit gonadotropin release within several hours through competitive binding to pituitary GnRH receptors. This property allows their use at any time during the follicular phase. Several different regimes have been described including multiple-dose fixed (0.25 mg daily from day six to seven of stimulation), multiple-dose flexible (0.25 mg daily when leading follicle is 14 to 15 mm), and single-dose (single administration of 3 mg on day 7 to 8 of stimulation) protocols, with or without the addition of an oral contraceptive pill. Further, women receiving antagonists have been shown to have a lower incidence of ovarian hyperstimulation syndrome (OHSS). Assuming comparable clinical outcomes for the antagonist and agonist protocols, these benefits would justify a change from the standard long agonist protocol to antagonist regimens. This is an update of a Cochrane review first published in 2001, and previously updated in 2006. OBJECTIVES To evaluate the effectiveness and safety of gonadotrophin-releasing hormone (GnRH) antagonists with the standard long protocol of GnRH agonists for controlled ovarian hyperstimulation in assisted conception cycle SEARCH STRATEGY We performed electronic searches of major databases, for example Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL, MEDLINE, EMBASE (from 1987 to April 2010); and handsearched bibliographies of relevant publications and reviews, and abstracts of major scientific meetings, for example the European Society of Human Reproduction and Embryology (ESHRE) and American Society for Reproductive Medicine (ASRM). A date limited search of Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL from April 2010 to April 2011 was run. Eighteen studies have been entered into the Classification pending references section of this update. These studies will be appraised for inclusion or exclusion in the next update of this review, due April 2012. SELECTION CRITERIA Two review authors independently screened the relevant citations for randomised controlled trials (RCTs) comparing different agonist versus antagonist protocols in women undergoing IVF or ICSI. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial risk of bias and extracted data. If relevant data were missing or unclear, the authors were contacted for clarification. MAIN RESULTS Forty-five RCTs (n = 7511) comparing the antagonist to the long agonist protocols fulfilled the inclusion criteria. There was no evidence of a statistically significant difference in rates of live-births (9 RCTs; odds ratio (OR) 0.86, 95% CI 0.69 to 1.08) or ongoing pregnancy (28 RCTs; OR 0.87, 95% CI 0.77 to 1.00). There was a statistically significant lower incidence of OHSS in the GnRH antagonist group (29 RCTs; OR 0.43, 95% CI 0.33 to 0.57). AUTHORS' CONCLUSIONS The use of antagonist compared with long GnRH agonist protocols was associated with a large reduction in OHSS and there was no evidence of a difference in live-birth rates.
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Affiliation(s)
- Hesham G Al-Inany
- Obstetrics & Gynaecology, Faculty of Medicine, Cairo University, 8 Moustapha Hassanin St, Manial, Cairo, Egypt
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Kim YJ, Ku SY, Jee BC, Suh CS, Kim SH, Choi YM, Kim JG, Moon SY. Increased responsiveness may be associated with tripronuclear embryos in both conventional in vitro fertilization and intracytoplasmic sperm injection cycles using gonadotropin-releasing hormone agonist long protocols: a self-matched observational study. J Obstet Gynaecol Res 2010; 37:37-44. [PMID: 21040208 DOI: 10.1111/j.1447-0756.2010.01313.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS In this self-matched observational study, the factors associated with the presence of tripronuclear (3PN) embryos, in conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles using gonadotropin-releasing hormone agonist long protocols, were investigated. MATERIAL & METHODS Clinical parameters were analyzed in 202 consecutive IVF-IVF or ICSI-ICSI matched cycles. The differences between the former and latter cycles were evaluated and compared according to the presence of 3PN embryos: group A [3PN (-) followed by 3PN (-)]; group B [3PN (-) followed by 3PN (+)]; group C [3PN (+) followed by 3PN (-)]; group D [3PN (+) followed by 3PN (+)]. RESULTS For the IVF-IVF cycles, the E(2) on human chorionic gonadotropin injection day and the number of retrieved oocytes were increased in the 3PN (+) cycles compared to the 3PN (-) cycles of Groups B (2165.2 ± 1423.3 pg/mL vs 1468.2 ± 796.2 pg/mL, P=0.016; 10.4 ± 9.1 vs 7.2 ± 5.7, P=0.010) and C (2382.7 ± 1214.5 pg/mL vs 1553.0 ± 1119.6 pg/mL, P = 0.004; 13.1 ± 9.1 vs 9.1 ± 7.0, P < 0.001), while these outcome variables did not differ when the former and latter cycles in Groups A and D were compared. These trends were observed in the ICSI-ICSI cycles. CONCLUSIONS An increased responsiveness, based on the higher E(2) and greater number of retrieved oocytes, may be associated with the presence of 3PN in both conventional IVF and ICSI cycles.
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Affiliation(s)
- Yong Jin Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
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Lee JR, Kim SH, Kim SM, Jee BC, Ku SY, Suh CS, Choi YM, Kim JG, Moon SY. Anti-Mullerian hormone dynamics during controlled ovarian hyperstimulation and optimal timing of measurement for outcome prediction. Hum Reprod 2010; 25:2597-604. [DOI: 10.1093/humrep/deq204] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dynamics of early estradiol production may be associated with outcomes of in vitro fertilization. Fertil Steril 2010; 94:2868-70. [PMID: 20674903 DOI: 10.1016/j.fertnstert.2010.06.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/11/2010] [Accepted: 06/18/2010] [Indexed: 11/23/2022]
Abstract
This study investigated the effects of total E(2) production during controlled ovarian stimulation (COS) calculated by "modified area under the curve for E(2) (AUC-E(2))" and of the changes in E(2) level during the initial stimulation period calculated as "slope of initial increase in E(2) (Sl-E(2))" on the outcomes of IVF cycles using GnRH antagonist protocols. The findings suggest that the rate of initial increase in E(2) rather than total E(2) production during COS might affect the competence of retrieved oocytes in GnRH antagonist cycles.
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Murai M, Takatori E, Omi H, Isurugi C, Honda T, Kumagai S, Shoji T, Oyama R, Yoshisaki A, Sugiyama T. Anti-Mϋllerian hormone and 3D-power Doppler histogram: markers of ovarian function with in vitro fertilization treatment. Reprod Med Biol 2010; 9:151-161. [PMID: 29699338 DOI: 10.1007/s12522-010-0051-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 03/14/2010] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the ability of three-dimensional (3D) ultrasonography and anti-Mϋllerian hormone (AMH) to predict successful embryo development in patients undergoing in vitro fertilization (IVF) treatment. Methods We prospectively studied 28 patients undergoing IVF treatment, using 3D ultrasound Sono automatic volume calculation (AVC) and a 3D-power Doppler volume histogram. Sono AVC was used to automatically measure the number and volume of follicles. The volume histogram was used to measure the vascularization index (VI), flow index, and vascularization flow index in the ovaries. Serum AMH (S-AMH) was determined by enzyme immunoassay (ng/ml). Results The number of embryos isolated was 3.3 ± 2.8. The S-AMH of the patients who were under 35 years of age (0.570 ± 0.216 ng/ml) was higher than that in the patients over 40 years of age (0.377 ± 0.071 ng/ml; p = 0.0003). Principal component analyses determined that the quality of the embryo depended on the patients's age, S-AMH, and VI of the ovary. The receiver operating characteristic (ROC) curve showed that the cutoff for the S-AMH was 0.2855 ng/ml, and the optimal age of the patient was 32.5 years, when implanted with an embryo on day 16. Conclusions We demonstrated that investigating the relationships between the number of the embryo and ovarian function, using a combination of AMH with a volume histogram, might be useful to predict the response to IVF treatment.
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Affiliation(s)
- Masatoshi Murai
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Eriko Takatori
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Hideo Omi
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Chizuko Isurugi
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Tatsuya Honda
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Seisuke Kumagai
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Tadahiro Shoji
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Rie Oyama
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Akira Yoshisaki
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
| | - Toru Sugiyama
- Department of Obstetrics and Gynecology Iwate Medical University 19-1 Uchimaru 020-8505 Morioka Iwate Japan
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Kim YJ, Ku SY, Jee BC, Suh CS, Kim SH, Choi YM, Kim JG, Moon SY. A comparative study on the outcomes of in vitro fertilization between women with polycystic ovary syndrome and those with sonographic polycystic ovary-only in GnRH antagonist cycles. Arch Gynecol Obstet 2010; 282:199-205. [DOI: 10.1007/s00404-010-1401-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 02/08/2010] [Indexed: 11/29/2022]
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Gonadotropin releasing hormone antagonists suppress aromatase and anti-Müllerian hormone expression in human granulosa cells. Fertil Steril 2009; 94:1832-9. [PMID: 19896656 DOI: 10.1016/j.fertnstert.2009.09.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the effects of a gonadotropin-releasing hormone antagonist (GnRH-ANT) on the expression of anti-Müllerian Hormone (AMH) and aromatase (via the exon CYP19IIa promoter), in cultured human granulosa cells (hGCs) and the human granulosa cell line (HGL5). DESIGN Primary cell cultures of hGCs and culture of HGL5 cells. SETTING Academic center. PATIENT(S) Women undergoing IVF because of male factor, tubal infertility, or donor eggs. INTERVENTION(S) hGCs and HGL5 cells were treated with a GnRH-ANT (1 nM and 1 μM) alone or in combination with cAMP (1 mM). Media was collected and stored at -80°C until assayed. MAIN OUTCOME MEASURE(S) mRNA levels of CYP19 IIa, AMH, steroidogenic factor 1 (SF-1) and liver receptor homologue-1 (LRH-1) were determined by quantitative polymerase chain reaction. ELISA was used to determined estradiol (E(2)) levels in the culture media. Pooled results from triplicate experiments were analyzed using one-way analysis of variance with Student-Newman-Keuls multiple-comparison methods. RESULT(S) The GnRH-ANT decreased the expressions of CYP19 IIa, AMH, SF-1, and LRH-1. cAMP induced aromatase and AMH expression. Cotreatment with cAMP and GnRH-ANT caused a dose-dependent suppression of AMH and CYP19 IIa mRNA. A GnRH agonist (GnRH-A) increased the mRNA expressions of CYP 19 IIa and AMH. The GnRH-ANT decreased E(2) production in cultured hGCs. CONCLUSION(S) GnRH-ANTs, in addition to their central suppressive effects on the pituitary, may have a direct effect on ovarian granulosa cells with inhibition of aromatase and AMH expression. Furthermore, the inhibitory effect could be mediated via suppression of SF-1 and LRH-1, and may play a role in estrogen-mediated ovarian folliculogenesis.
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