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Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1026448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fernández-Prada S, Martín-Cameán M, Armijo O, Diez-Sebastián J, Iniesta S, Lobo S, Silva P, Sanz C, Sánchez MJ, Hernández A. Use of steroid pre-treatments in IVF-ICSI cycles with GnRH antagonist protocol and their impact on gestational outcomes. J OBSTET GYNAECOL 2021; 42:478-484. [PMID: 34151671 DOI: 10.1080/01443615.2021.1916806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Different steroid pre-treatments have been used to schedule the start of the ovarian stimulation in IVF cycles. Currently, there is controversy about their effects on gestational outcomes. We designed a three-armed randomised controlled trial (RCT). Eighty-six normoresponder patients undergoing IVF treatment with antagonist GnRH protocol were allocated to three different groups. In the group 1, 34 patients received oral contraceptive pill (OCP) from the first day of the cycle to five days before starting ovarian stimulation, in the group 2, 25 patients received 2 mg/12 hours of oral E2 valerate from day 25 of the previous cycle until the day before starting stimulation, and finally, in the group 3, 27 patients did not receive any treatment. There are no statistically significant differences neither in clinical pregnancy rate (CPR) (40.9% OCP vs. 28.6% E2 vs. 53.3% no treatment group, p=.388) nor live birth rate (LBR) (31.8% OCP vs. 28.6% E2 vs. 46.7% no treatment group, p=.537) between groups in fresh embryo transfer. Likewise, no differences were found in the cumulative CPR, nor in cumulative LBR. However, there is a tendency to worst outcomes in the E2 group. In this E2 group, we observed better results with longer exposition, although no significant differences are reached (E2 mean days in the pregnant group 8.29 vs. 6.83 in the non-pregnant group, p=.08). Our study shows no significant differences in pregnancy rates between groups, but the E2 group is trending at worse gestational results. Trial registration number: Eudra-CT registration number is 2014-001809-40.Impact StatementWhat is already known on this subject? Nowadays, there is much controversy about how pregnancy rates could be affected by the selection of steroid pre-treatments used in order to schedule IVF cycles. However, these treatments are widely utilised in clinical practice.What the results of this study add? The results support the clinical findings of most of the studies previously published. No significant differences in gestational outcomes were found between the groups treated with steroid pre-treatments and the control group. Additionally, oestrogen pre-treatment seems to be related to better pregnancy outcomes when the exposition is longer. Thus, an earlier start of this treatment in the luteal phase could be the optimal approach.What the implications are of these findings for clinical practice and/or further research? This study pretends to provide clarity about the treatment guidelines of steroid pre-treatments to schedule the clinical work without impact on gestational outcomes.
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Affiliation(s)
- Sara Fernández-Prada
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - María Martín-Cameán
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Onica Armijo
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | | | - Silvia Iniesta
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Sonia Lobo
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Patricia Silva
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Clara Sanz
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Maria José Sánchez
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
| | - Alicia Hernández
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, La Paz University Hospital, Madrid, Spain
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Anğın AD, Gün I, Sakin Ö, Çıkman MS, Şimşek EE, Karakuş R, Başak K, Kaptanağası AO. Investigation of the preventive effects of dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) on cisplatin-induced ovarian damage in rats. Ultrastruct Pathol 2020; 44:71-80. [PMID: 31909696 DOI: 10.1080/01913123.2019.1711479] [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: 01/28/2023]
Abstract
To investigate whether Dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) had any preventive effect against the ovarian damage caused by cisplatin (CP) (cis-diamminedichloroplatinum) in rats. On the first day ovaries were removed, Anti-Müllerian hormone (AMH) was measured (Group1, n:6), in the other groups 7.5 mg/kg cisplatin was administered intraperitoneally. In Group 2 (n = 6), 0.1 ml saline, in Group 3 (n = 5), 20 umol/kg CAPE, in Group 4 (n = 7), DHEA 6 mg/kg were administered every day. On the 10th day, ovaries were removed, AMH was measured. Ovary reserve (primordial/primary/secondary/tertiary/atretic follicles, AMH), ovarian damage scores (follicular degeneration, congestion, hemorrhage, edema, inflammation) were compared. The number of tertiary follicles were statistically high in the CAPE group (p = .015), the inflammation score in the DHEA group (p = .012), AMH level (p = .009) in the control group. The lowest number of atretic follicles (AF) was in the control group, while the highest number of AF was in the DHEA group (p = .002). Significant decreases in AF were the case in the cisplatin and DHEA groups compared to the control group (p < .008). The AMH values had the highest positive correlation with the number of primordial follicles and the highest negative correlation with the number of AF. The cut off point for AMH was 1.57 ng/ml as an indicator of low ovarian reserve. Cisplatin causes total damage and increased numbers of AF on the ovary. Depending on this, AMH levels fall. These negative effects of cisplatin are not obstructed by CAPE or DHEA, and may even be increased by DHEA.
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Affiliation(s)
- Ali Doğukan Anğın
- Department of Obstetrics and Gynecology, University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Ismet Gün
- Department of Obstetrics and Gynecology, University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Önder Sakin
- Department of Obstetrics and Gynecology, University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Muzaffer Seyhan Çıkman
- Department of Obstetrics and Gynecology, University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Engin Ersin Şimşek
- Department of Family Medicine, University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Resul Karakuş
- Department of Obstetrics and Gynecology, University of Health Sciences, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, İstanbul, Turkey
| | - Kayhan Başak
- Department of Pathology, University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Asuman Orçun Kaptanağası
- Department of Biochemistry, University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
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Sefrioui O, Madkour A, Kaarouch I, Louanjli N. Luteal estradiol pretreatment of poor and normal responders during GnRH antagonist protocol. Gynecol Endocrinol 2019; 35:1067-1071. [PMID: 31142165 DOI: 10.1080/09513590.2019.1622086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Luteal estradiol pretreatment (LEP) to IVF protocols designed to improve follicle synchronization and retrieval of mature oocytes. We conducted a retrospective study including women undergoing IVF program who were given a course of 4 mg oral estradiol-17β daily from day 20 of the same cycle until day 1 of their next cycle before starting an antagonist protocol, forming LEP-group but control-group started on day 3 a stimulation without pretreatment. A total is divided into 2 groups (poor (group 1, n = 148) and normal responders (group 2, n = 244)). Our findings show for group 1 a significant decrease in cancelation rate (3% vs 14%) and a significant improvement in clinical outcomes (clinical pregnancy per transfer and live birth rate respectively: 47% and 44% vs 12% and 11%). For group 2, this pretreatment could increase significantly the maturation rate (77% vs 68%). The rate of frozen embryos was improved in both groups: (group 1: 11% vs 2% and group 2: 53% vs 41%). LEP increases the frozen embryos rate whatever the nature of the ovarian response, but especially for normal responders it coordinates follicular recruitment increasing the maturation rate. In the case of poor responders, it affects positively clinical outcomes decreasing the canceled cycles.
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Affiliation(s)
- Omar Sefrioui
- Anfa Fertility Center, Fertility clinic and cryopreservation, Casablanca, Morocco
| | - Aicha Madkour
- Biochemistry and Immunology Laboratory, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Ismail Kaarouch
- Anfa Fertility Center, Fertility clinic and cryopreservation, Casablanca, Morocco
- Biochemistry and Immunology Laboratory, Faculty of Sciences, Mohammed V University, Rabat, Morocco
- Human Reproduction Department, Labomac, Laboratory of Clinical Analysis, Casablanca, Morocco
| | - Noureddine Louanjli
- Anfa Fertility Center, Fertility clinic and cryopreservation, Casablanca, Morocco
- Human Reproduction Department, Labomac, Laboratory of Clinical Analysis, Casablanca, Morocco
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Ranjbaran A, Nejabati HR, Ghasemnejad T, Latifi Z, Hamdi K, Hajipour H, Raffel N, Bahrami-Asl Z, Hakimi P, Mihanfar A, Nouri M, Fattahi A. Follicular Fluid Levels of Adrenomedullin 2, Vascular Endothelial Growth Factor and its Soluble Receptors Are Associated with Ovarian Response During ART Cycles. Geburtshilfe Frauenheilkd 2019; 79:86-93. [PMID: 30686838 PMCID: PMC6336467 DOI: 10.1055/a-0764-4765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/08/2018] [Accepted: 10/18/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction
Adrenomedullin 2 (ADM2) and vascular endothelial growth factor (VEGF) affect ovarian function, especially angiogenesis and follicular development. The actions of VEGF can be antagonized by its soluble receptors, soluble Fms-like tyrosine kinase-1 (sFlt-1) and soluble VEGF receptor 2 (sVEGFR-2), as they decrease its free form. In the present study, we evaluated the relationship between follicular fluid (FF) levels of AMD2, VEGF and its soluble receptors, and ICSI outcomes.
Materials and Methods
ICSI cycle outcomes were evaluated and FF levels of VEGF, sFlt-1, sVEGFR-2 and ADM2 were determined using ELISA kits.
Results
FF levels of ADM2, VEGF, and sVEGFR-2 were significantly higher in non-responders compared to other ovarian response groups (p < 0.05). There were significant correlations between ADM2, VEGF and sVEGFR-2 levels as well as VEGF/sFlt-1 and VEGF/sVEGFR-2 ratios (r = 0.586, 0.482, 0.260, and − 0.366, respectively). Based on the ROC curve, the cutoff value for ADM2 as a non-responder predictor was 348.55 (pg/ml) with a sensitivity of 67.7% and a specificity of 94.6%.
Conclusions
For the first time we measured FF ADM2 levels to determine the relationship to VEGF and its soluble receptors. We suggest that ADM2 could be a potential predictive marker for non-responders. Although the exact function of ADM2 in ovarian angiogenesis is not yet understood, our study may shed light on the possible role of ADM2 in folliculogenesis and ovulation.
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Affiliation(s)
- Ali Ranjbaran
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Reza Nejabati
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Biochemistry and Clinical Laboratories, Faculty of Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tohid Ghasemnejad
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Latifi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Biochemistry and Clinical Laboratories, Faculty of Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kobra Hamdi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Hajipour
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nathalie Raffel
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Zahra Bahrami-Asl
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Hakimi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aynaz Mihanfar
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Nouri
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Lin X, Du J, Du Y, Wu R, Fang X, Liao Y, Quan S. Effects of dehydroepiandrosterone supplementation on mice with diminished ovarian reserve. Gynecol Endocrinol 2018; 34:357-359. [PMID: 29221424 DOI: 10.1080/09513590.2017.1409712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Dehydroepiandrosterone (DHEA) has been used to improve the pregnancy rate in women with diminished ovarian reserve(DOR) during in vitro fertilization. We aimed to validate the effects of DHEA and identify the possible mechanisms. We constructed a mice model with DOR and analyzed the hormone parameters and follicle counts. In vivo experiment, FSH and LH concentrations in the serum were significantly elevated in the DOR group. However, the FSH and LH concentrations were partially reversed in the DOR + DHEA group. The E2, AMH and INHB were down-regulated in the DOR group and reversed in the DOR + DHEA group. Our study supported evidences that DHEA might modulate the hormone receptors in the ovary and hormone secretions to the peripheral circulation to regulate the ovary reserve functions.
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Affiliation(s)
- Xiufeng Lin
- a Reproductive Medical Center, Department of Obstetrics and Gynecology , Nanfang Hospital, Southern Medical University , Guangzhou , China
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Jing Du
- a Reproductive Medical Center, Department of Obstetrics and Gynecology , Nanfang Hospital, Southern Medical University , Guangzhou , China
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Yan Du
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Riran Wu
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Xiaowu Fang
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Yuechan Liao
- b Reproductive Medical Center , Boai Hospital of Zhongshan , Zhongshan , Guangdong Province , China
| | - Song Quan
- a Reproductive Medical Center, Department of Obstetrics and Gynecology , Nanfang Hospital, Southern Medical University , Guangzhou , China
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Liu Y, Hu L, Fan L, Wang F. Efficacy of dehydroepiandrosterone (DHEA) supplementation for in vitro fertilization and embryo transfer cycles: a systematic review and meta-analysis. Gynecol Endocrinol 2018; 34:178-183. [PMID: 29073790 DOI: 10.1080/09513590.2017.1391202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Dehydroepiandrosterone (DHEA) supplementation might hold some promise in vitro fertilization and embryo transfer cycles. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy of DHEA in patients for in vitro fertilization. PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of DHEA versus placebo on in vitro fertilization were included. Two investigators independently searched articles, extracted data and assessed the quality of included studies. The primary outcomes were clinical pregnancy and live birth rate. Meta-analysis was performed using random-effect model. Six RCTs involving 745 patients were included in the meta-analysis. Overall, compared with placebo, DHEA supplementation was associated with the significant increase in clinical pregnancy (OR = 1.45; 95% CI = 1.04-2.03; p = .03), live birth rate (OR = 2.70; 95% CI = 1.24-5.85; p = .01) and endometrial thickness (Std. mean difference = 0.67; 95% CI = 0.02-1.32; p = .04) but showed no influence on E2 on hCG day (Std. mean difference = 0.69; 95% CI = -0.46 to 1.85; p = .24), embryos transferred (Std. mean difference = 0.42; 95% CI = -0.04 to 0.88; p = .07) and miscarriage rate (OR = 0.43; 95% CI = 0.03-6.66; p = .55). DHEA supplementation could significantly improve clinical pregnancy, live birth rate, endometrial thickness and retrieved oocytes but failed to alter E2 on hCG day, embryos transferred and miscarriage rate.
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Affiliation(s)
- Yaofang Liu
- a Department of Gynecology and Obstetrics , The Affiliated Hospital of Southwest Medical University , Luzhou , Sichuan , China
| | - Lina Hu
- b Department of Gynecology , The Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Lingye Fan
- a Department of Gynecology and Obstetrics , The Affiliated Hospital of Southwest Medical University , Luzhou , Sichuan , China
| | - Fang Wang
- a Department of Gynecology and Obstetrics , The Affiliated Hospital of Southwest Medical University , Luzhou , Sichuan , China
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Efficacy of luteal estrogen administration and an early follicular Gonadotropin-releasing hormone antagonist priming protocol in poor responders undergoing in vitro fertilization. Obstet Gynecol Sci 2018; 61:102-110. [PMID: 29372156 PMCID: PMC5780304 DOI: 10.5468/ogs.2018.61.1.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 11/08/2022] Open
Abstract
Objectives We investigated whether luteal estrogen administration and an early follicular Gonadotropin-releasing hormone antagonist (E/G-ant) priming protocol improves clinical outcomes in poor responders to controlled ovarian stimulation for in vitro fertilization (IVF)-embryo transfer, and identified underlying mechanisms. Methods This restrospective study consisted of 65 poor responders who underwent the E/G-ant priming protocol. Sixty-four other poor responders undergoing conventional protocols without pretreatment were included as the control group. Clinical outcomes were compared between 2 groups. Results The E/G-ant priming protocol group exhibited improvements over the control group in terms of the number of retrieved oocytes (3.58±2.24 vs. 1.70±1.45; P=0.000), mature oocytes (2.68±2.11 vs. 1.65±1.23; P=0.000), fertilized oocytes (2.25±1.74 vs. 1.32±1.26; P=0.001), good embryos (1.62±0.91 vs. 1.14±0.90, P=0.021). Day 3 follicle-stimulating hormone (FSH; 8.40±4.84 vs. 16.39±13.56; P=0.000) and pre-ovulation progesterone levels (0.67 vs. 1.28 ng/mL; P=0.016) were significantly higher in the control group than in the E/G-ant priming group. The overall rate of positive human chorionic gonadotropin tests was higher in the E/G-ant priming group than in the control group (32.3% vs.16.1%; P=0.039). Also, clinical pregnancy rate (26.2% vs. 12.5%; P=0.048) and the rate of live births (23.1% vs. 7.1%; P=0.023) were significantly higher in the E/G-ant priming group than in the control group. Conclusion The E/G-ant priming protocol would lead to promising results in poor responders to IVF by suppressing endogenous FSH and by preventing premature luteinization.
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Mutlu MF, Mutlu İ, Erdem M, Güler İ, Erdem A. Comparison of the standard GnRH antagonist protocol and the luteal phase estradiol/GnRH antagonist priming protocol in poor ovarian responders. Turk J Med Sci 2017; 47:470-475. [PMID: 28425233 DOI: 10.3906/sag-1602-111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/17/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of the study was to compare the luteal estradiol patch/GnRH antagonists priming protocol (LPP) with the standard GnRH antagonist protocol in poor ovarian responders (PORs) in terms of the outcomes of in vitro fertilization (IVF) treatment. MATERIALS AND METHODS IVF outcomes of 265 cycles in 265 patients (106 in the LPP group, 159 in the standard GnRH antagonist group) were evaluated retrospectively. RESULTS Mean length of stimulation (11.4 ± 2.7 vs. 10.0 ± 2.7 days; P < 0.05) and the total gonadotropin dose (3403 ± 1060 vs. 2984 ± 1112) used were significantly greater in the LPP group than in the standard GnRH antagonist protocol group. The mean number of oocytes retrieved (3.5 ± 2.6 vs. 3.7 ± 2.8), the number of mature oocytes (2.8 ± 2.2 vs. 2.6 ± 2.2), fertilization rates (65% vs. 62%), the number of embryos transferred (1.6 ± 0.6 vs. 1.7 ± 0.6), and implantation rates (16% vs. 13%) were similar. The cancellation rate did not significantly differ between the groups (9.4% vs. 13.2%). There were no significant differences in the clinical pregnancy (11.3% vs. 13.2%) or live birth rates per patient (3.8% vs. 9.4%) and clinical pregnancy (18.8% vs. 22.6%) or live birth rates per embryo transfer (6.3% vs. 12.9%) between the groups. CONCLUSION LPP does not improve IVF outcomes when compared with the standard GnRH antagonist protocol in PORs.
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Affiliation(s)
- Mehmet Fırat Mutlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yüksek İhtisas University Ankara, Turkey
| | - İlknur Mutlu
- IVF Unit, Novaart IVF and Women Health Center, Ankara, Turkey
| | - Mehmet Erdem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - İsmail Güler
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ahmet Erdem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Steroid hormone pretreatments in assisted reproductive technology. Fertil Steril 2016; 106:1608-1614. [DOI: 10.1016/j.fertnstert.2016.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 01/22/2023]
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11
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Precycle Estradiol in Synchronization and Scheduling of Antagonist Cycles. J Obstet Gynaecol India 2016; 66:295-9. [PMID: 27382226 DOI: 10.1007/s13224-016-0877-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 03/19/2016] [Indexed: 10/21/2022] Open
Abstract
Antagonist cycles have an inherent issue of lack of flexibility. As a result where batching of cycles is desired, it is not the preferred protocol in ART cycles. There is also the limitation of ovarian response in antagonist cycle due to the size heterogenesities of antral follicles at the start of stimulation. Among the different options available, use of estrogen in the luteal phase of the preceding cycle has definitely shown benefits with regard to better control of cycle as well as synchronization of follicles available for stimulation. The article gives a detailed analysis of the different options available for timing the egg collection in antagonist cycles, the advantages and drawbacks, and the method of use of estrogen. Whereas in the majority of the trials where estrogen pretreatment was used, the goal of scheduling of egg collection was definitely achieved, increased duration and dose of gonadotropin stimulation were required. There was definite advantage of higher oocyte yield in these cycles. The possibility of premature LH rise later during stimulation and subsequent poor implantation in these cycles has to be further evaluated. Nevertheless, batching of patient friendly antagonist cycles can be effectively possible by use of precycle estrogen treatment.
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Clancy KB, Baerwald AR, Pierson RA. Cycle-phase dependent associations between CRP, leptin, and reproductive hormones in an urban, Canadian sample. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 160:389-96. [DOI: 10.1002/ajpa.22976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 02/03/2016] [Accepted: 02/22/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Kathryn B.H. Clancy
- Laboratory for Evolutionary Endocrinology, Department of Anthropology; University of Illinois; Urbana IL 61801
| | - Angela R. Baerwald
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of Saskatchewan; Saskatoon SK Canada S7N0W8
| | - Roger A. Pierson
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of Saskatchewan; Saskatoon SK Canada S7N0W8
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Gunes S, Hekim GNT, Arslan MA, Asci R. Effects of aging on the male reproductive system. J Assist Reprod Genet 2016; 33:441-54. [PMID: 26867640 DOI: 10.1007/s10815-016-0663-y] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/18/2016] [Indexed: 01/01/2023] Open
Abstract
The study aims to discuss the effects of aging on the male reproductive system. A systematic review was performed using PubMed from 1980 to 2014. Aging is a natural process comprising of irreversible changes due to a myriad of endogenous and environmental factors at the level of all organs and systems. In modern life, as more couples choose to postpone having a child due to various socioeconomic reasons, research for understanding the effects of aging on the reproductive system has gained an increased importance. Paternal aging also causes genetic and epigenetic changes in spermatozoa, which impair male reproductive functions through their adverse effects on sperm quality and count as, well as, on sexual organs and the hypothalamic-pituitary-gonadal axis. Hormone production, spermatogenesis, and testes undergo changes as a man ages. These small changes lead to decrease in both the quality and quantity of spermatozoa. The offspring of older fathers show high prevalence of genetic abnormalities, childhood cancers, and several neuropsychiatric disorders. In addition, the latest advances in assisted reproductive techniques give older men a chance to have a child even with poor semen parameters. Further studies should investigate the onset of gonadal senesce and its effects on aging men.
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Affiliation(s)
- Sezgin Gunes
- Faculty of Medicine, Department of Medical Biology, Ondokuz Mayis University, 55139, Samsun, Turkey.
- Health Sciences Institute, Department of Multidisciplinary Molecular Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | | | - Mehmet Alper Arslan
- Faculty of Medicine, Department of Medical Biology, Ondokuz Mayis University, 55139, Samsun, Turkey
- Health Sciences Institute, Department of Multidisciplinary Molecular Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ramazan Asci
- Health Sciences Institute, Department of Multidisciplinary Molecular Medicine, Ondokuz Mayis University, Samsun, Turkey
- Faculty of Medicine, Department of Urology, Ondokuz Mayis University, 55139, Samsun, Turkey
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Çelik S, Turgut NE, Yağmur E, Boynukalın K, Çelik DC, Fındıklı N, Purisa S, Bahçeci M. The effects of fresh embryo transfers and elective frozen/thawed embryo transfers on pregancy outcomes in poor ovarian responders as defined by the Bologna criteria. Turk J Obstet Gynecol 2015; 12:132-138. [PMID: 28913057 PMCID: PMC5558386 DOI: 10.4274/tjod.76402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 06/30/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To compare the effects of fresh embryo transfers (ET) and elective frozen/thawed embryo transfers (eFET) on implantation, clinical pregnancy, and live birth rates in poor ovarian responders, as defined by the Bologna criteria. MATERIALS AND METHODS All electronic databases of embryo transfers between January 2011 and January 2014 were retrospectively reviewed. Two hundred fifty-nine of all the fresh ET and 96 of all eFET were included into the study. An antagonist protocol with letrozole was used for the controlled ovarian hyperstimulation (COH) in all participants. RESULTS The mean age was 36.9 years (range, 21-43 years) in the fresh ET arm and 37.2 years (range, 21-43 years) in the eFET arm (p=0.45). The clinical pregnancy rate was 35% (90/259) versus 29% (28/96); the abortion rate was 27% (20/75) versus 36% (9/25); and the live birth rate was 21% (55/259) versus 17% (16/99). There were no significant differences between groups and p values were 0.32, 0.52, and 0.42, respectively. The mean E2 level was 389 (range, 50-2055 pg/mL) in the fresh ET group (on hCG day) and 418 pg/mL (range, 121-3073 pg/mL) in the eFET group (on day 14 of cycle) (p=0.122). No differences were found between the two groups with respect to the total number of retrieved oocytes (p=0.55) and number of metaphase II (MII) oocytes (p=0.81). The number of embryo transfers was statistically different (p=0.005). The effects of age, total number of retrieved oocytes, number of MII oocytes, type of treatment, number of ET, and the day of ET and E2 level to live birth outcomes were investigated using binary logistic regresion analyses, and no stastical effect was determined by any of the parameters. P values were p=0.50, 0.66, 0.45, 0.30, 0.30, 0.08, and 0.90, respectively. CONCLUSION E2 levels tend to be lower in poor responders, thus the receptivity of the endometrium may be damaged less than normal, which may explain why pregnancy results are the same between eFET and ET groups.
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Affiliation(s)
- Serdar Çelik
- Bahçeci Fulya in Vitro Fertilization Center, İstanbul, Turkey
| | | | - Erbil Yağmur
- Bahçeci Fulya in Vitro Fertilization Center, İstanbul, Turkey
| | | | | | - Necati Fındıklı
- Bahçeci Fulya in Vitro Fertilization Center, İstanbul, Turkey
| | - Sevim Purisa
- İstanbul University Faculty of Medicine, Department of Biostatistics and Medical Informatics, İstanbul, Turkey
| | - Mustafa Bahçeci
- Bahçeci Fulya in Vitro Fertilization Center, İstanbul, Turkey
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Li J, Yuan H, Chen Y, Wu H, Wu H, Li L. A meta-analysis of dehydroepiandrosterone supplementation among women with diminished ovarian reserve undergoing in vitro fertilization or intracytoplasmic sperm injection. Int J Gynaecol Obstet 2015; 131:240-5. [PMID: 26421833 DOI: 10.1016/j.ijgo.2015.06.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 06/02/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence for the efficacy of dehydroepiandrosterone (DHEA) in improving ovarian responsiveness among poor responders, especially women with diminished ovarian reserve (DOR), remains inconsistent. OBJECTIVES To evaluate the effectiveness of DHEA in women with DOR undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). SEARCH STRATEGY PubMed and Embase were searched for reports published in any language before October 31, 2014, using keywords such as "DHEA," "poor ovarian response," "diminished ovarian reserve," and "premature ovarian aging." SELECTION CRITERIA Studies that explored the effects of DHEA in women with DOR undergoing IVF/ICSI were included if they evaluated the number of oocytes retrieved and/or the rates of clinical pregnancy, implantation, and spontaneous abortion. DATA COLLECTION AND ANALYSIS Risk ratios (RRs) and standardized mean differences with 95% confidence intervals (CIs) were calculated, combined with subgroup and sensitivity analyses. MAIN RESULTS Eight studies were included. The use of DHEA increased the clinical pregnancy rate (RR 2.13; 95% CI 1.12-4.08). Similar results were obtained in subgroup analyses including randomized controlled trials and case-control studies (RR 2.57; 95% CI 1.43-4.63) and self-controlled studies (RR 3.95; 95% CI 1.28-12.19). However, the effects of DHEA on oocyte retrieval, implantation, and abortion were not significant. CONCLUSIONS Supplementation with DHEA has a positive effect in women undergoing IVF/ICSI treatment for DOR.
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Affiliation(s)
- Jie Li
- Research Center for Guangxi Reproductive Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hua Yuan
- Research Center for Guangxi Reproductive Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yang Chen
- Department of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hongbo Wu
- Research Center for Guangxi Reproductive Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huimei Wu
- Research Center for Guangxi Reproductive Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liuming Li
- Research Center for Guangxi Reproductive Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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Abstract
The current study aims to compare cycle outcomes of two ovarian stimulation protocols in poor responders according to the Bologna criteria; luteal estrogen priming (LE) or letrozole (LZ) co-treatment in antagonist protocol. Following retrospective chart review of a single center, 162 cycles were found eligible for the comparison of two ovarian stimulation protocols. After interpreting data, significantly higher serum estradiol levels, longer duration of cycle, higher number of fertilized oocytes and good quality embryos were detected in patients who received LE. Despite any statistical significance, higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) per embryo transfer (ET) were detected with LE protocol compared with LZ (12.3% versus 18.2% and 9.6% versus 12.7%, respectively). Younger patients (<40 years) revealed higher CPR and OPR per started cycle compared with older patients (≥40 years) where only OPR was statistically significant. Multivariable analysis demonstrated that basal antral follicle count, peak serum estradiol levels and number of fertilized oocytes were independent variables significantly associated with clinical pregnancies (p < 0.05). In the current analysis, LE or LZ protocols revealed comparable but quite low pregnancy rates in poor responders according to the Bologna criteria. Younger patients were more likely to achieve pregnancy compared to older patients with both protocols.
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Affiliation(s)
- Emre Göksan Pabuccu
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ufuk University , Ankara , Turkey and
| | - Gamze Sinem Caglar
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ufuk University , Ankara , Turkey and
| | - Recai Pabuccu
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ufuk University , Ankara , Turkey and
- b Centrum Clinic Assisted Reproductive Technology Unit , Ankara , Turkey
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Zhang HH, Xu PY, Wu J, Zou WW, Xu XM, Cao XY, Wei LZ. Dehydroepiandrosterone improves follicular fluid bone morphogenetic protein-15 and accumulated embryo score of infertility patients with diminished ovarian reserve undergoing in vitro fertilization: a randomized controlled trial. J Ovarian Res 2014; 7:93. [PMID: 25330837 PMCID: PMC4210503 DOI: 10.1186/s13048-014-0093-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 09/30/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the effect of dehydroepiandrosterone (DHEA) on infertility patients with diminished ovarian reserve undergoing in vitro fertilization. Methods This is a prospective study. Ninety-five patients with diminished ovarian reserve were included in this study. Of them, 42 patients were randomly allocated to the DHEA group, who received DHEA 75 mg daily for three consecutive menstrual cycles prior to IVF cycles, and 53 patients were allocated to the control group, who entered IVF cycles directly. All patients were treated with the same ovarian stimulation protocol. Follicular fluid samples from both groups were collected for bone morphogenetic protein-15 (BMP-15) and growth differentiation factor-9 (GDF-9). Fluid from the first aspirated follicle without any visible blood contamination was carefully collected. In addition, day 3 Blood samples were collected pre- and post-treatment of DHEA for serum anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH) and estradiol (E2) in the DHEA group. Results The level of BMP-15 in follicular fluid samples from the DHEA group was significantly higher than that of the control samples (P=.000). Patients after DHEA treatment demonstrated a significantly higher level of AMH and a significantly lower level of FSH, E2 compared to themselves prior to DHEA therapy (P=.015; P=.036; P=.002; respectively). Moreover, the accumulated score of embryos was significantly higher in the DHEA group (P=.033). Conclusions These observations confirm the beneficial effect of DHEA for infertility patients with diminished ovarian reserve. Trial registration ChiCTR-TRC-14005002
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Affiliation(s)
| | | | | | | | | | | | - Lian Z Wei
- Department of Reproductive Endocrinology, the Reproductive Medicine Center, The Affiliated Hospital of Anhui Medical University, Anhui, People's Republic of China.
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Almog B, Eldar I, Barkan G, Amit A, Wagman I, Levin I. Embryo quality in controlled ovarian stimulation for in vitro fertilization in young poor responders. Gynecol Endocrinol 2014; 30:657-9. [PMID: 24845413 DOI: 10.3109/09513590.2014.920003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This retrospective matched case control study was conducted to evaluate the effects of poor ovarian response in a group of young women (20-30 years) on embryos quality in controlled ovarian hyperstimulation (COH) for in vitro fertilization. Thirty-nine young patients with poor ovarian response (≤5 oocytes on retrieval) were enrolled and compared to age- and date-matched controls. Maximal Estradiol levels, number of oocytes aspirated, number of M2 oocytes and number of fertilized oocytes were significantly lower in the study group compared to controls. Implantation rate and rate of good quality embryos transferred of the study group and control were comparable (15.3 versus 16.3% and 62 versus 67.2%, respectively). Additionally, clinical pregnancy rate per transfer and delivery rate per transfer were also comparable (26.6 versus 35.8% and 23.3 versus 30.7%, respectively). The rate of cycles with no transfer, however, was 23.07% in the study group compared to zero cycles with no transfer in the control group. We conclude that young poor responders may still have reasonable proportion of good quality embryos when compared to controls. This results in comparable implantation rate and clinical pregnancy rate. Cycle transfer cancelation, however, represents a true barrier for achieving pregnancy.
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Affiliation(s)
- Benny Almog
- Sarah Racine IVF Unit , Tel Aviv , Israel and
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Abstract
One of the most vexing challenges in the practice of reproductive medicine is the management of the "poor responder," specifically the patient manifesting an inadequate follicular response to ovarian stimulation. Poor response predicts a reduction in the number of mature oocytes retrieved, with the consequences of fewer embryos available for selection and transfer, reduced pregnancy rates, and a markedly decreased likelihood of residual embryos for cryopreservation. This chapter reviews the definition and prediction of poor response and discusses strategies that have been developed and incorporated into the reproductive endocrinologist's clinical armamentarium in an effort to optimize outcomes for these women. It should be stated at the outset that no single approach is successful for all patients, and that there is currently no firm clinical consensus regarding the relative efficacy of the different stimulation protocols. This arises in part due to inconsistency regarding the definition of what constitutes a poor response and a paucity of well-designed, randomized controlled trials.
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Affiliation(s)
- Owen K Davis
- Weill Medical College of Cornell University, Center of Reproductive Medicine and Infertility, 1305 York Avenue, New York, NY, 10021, USA,
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Singh N, Zangmo R, Kumar S, Roy KK, Sharma JB, Malhotra N, Vanamail P. A prospective study on role of dehydroepiandrosterone (DHEA) on improving the ovarian reserve markers in infertile patients with poor ovarian reserve. Gynecol Endocrinol 2013; 29:989-92. [PMID: 24004296 DOI: 10.3109/09513590.2013.824957] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The aim of this study was to evaluate the role of dehydroepiandrosterone (DHEA) supplementation on the ovarian reserve markers in infertile patients who were poor responders in previous in vitro fertilization (IVF) cycles. STUDY DESIGN A prospective clinical trial was conducted on 30 patients with history of poor response in previous IVF cycles. These patients were treated with DHEA, (Tab Eema-D, Corona Remedies Pvt Ltd., Ahmedabad, Gujurat, India) 25 mg thrice a day for four months. Ovarian stimulation was done using the previous protocol. Clinical parameters were measured before and treatment with DHEA. Results were analysed using Student's "t" paired test. RESULTS DHEA resulted in a significant increase (p < 0.05) in the serum Antimullerian hormone in all age groups (35, 36-38 and >38 years). Peak estradiol level on the day of human chorionic gonadotrophin administration also increased significantly (p < 0.05). A significant decrease (p < 0.05) was noted in Day 2 follicle-stimulating hormone (FSH) in all age groups. There was no statistically significant difference in the antral follicle count (AFC). Pregnancy rate was 16.7% after treatment. Thus, DHEA has a significant effect in improving the ovarian reserve in poor responders with previously failed IVF cycles. It can help in enhancing clinical pregnancy rate in these patients.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
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Are urinary bisphenol A levels in men related to semen quality and embryo development after medically assisted reproduction? Fertil Steril 2013; 101:215-221.e5. [PMID: 24182411 DOI: 10.1016/j.fertnstert.2013.09.030] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/15/2013] [Accepted: 09/20/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate whether urinary bisphenol A (BPA) levels in men adversely influence semen quality and embryo development after medically assisted reproduction. DESIGN Prospective, cohort study. SETTING University-based tertiary care center. PATIENT(S) A total of 149 couples undergoing their first or second IVF or intracytoplasmic sperm injection (ICSI) procedure. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Semen quality and embryo development parameters until the blastocyst stage after the IVF or ICSI procedure. RESULT(S) Bisphenol A was detected in 98% (n = 146) of the samples with 0.1 ng/mL limit of detection. The geometric mean BPA concentration was 1.55 ng/mL. After the adjustment for potential confounders using linear regression models, an increase of natural logarithm transformed urinary BPA concentration was associated with lower natural logarithm transformed sperm count (β = -0.241, 95% confidence interval [CI] -0.470 to -0.012), natural logarithm transformed sperm concentration (β = -0.219, 95% CI -0.436 to -0.003), and sperm vitality (β = -2.660, 95% CI -4.991 to -0.329). The embryo development parameters from oocyte fertilization to the blastocyst formation stage were not affected by BPA exposure. CONCLUSION(S) Urinary BPA concentrations in male partners of subfertile couples may influence semen quality parameters, but do not affect embryo development up to the blastocyst stage after medically assisted reproduction.
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Fusi FM, Ferrario M, Bosisio C, Arnoldi M, Zanga L. DHEA supplementation positively affects spontaneous pregnancies in women with diminished ovarian function. Gynecol Endocrinol 2013; 29:940-3. [PMID: 23889217 DOI: 10.3109/09513590.2013.819087] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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 article is to describe unexpected spontaneous pregnancies in poor responder patients with long-term infertility, when treated with dehydroepiandrosterone (DHEA) supplementation prior to in vitro fertilization (IVF). Our evaluation was carried out in two groups of women. The first group included 39 young women with <40 years, all treated with DHEA because of a previous poor response. The second group included 38 women over 40 years who received DHEA supplementation. Controls for latter group were 24 comparable women who had not been treated with DHEA before the first IVF cycle to evaluate the spontaneous pregnancy rate during preparation to IVF. Three tablets daily of 25 mg micronized DHEA were administered for at least 12 weeks before starting a long stimulation protocol for IVF. Surprisingly, spontaneous pregnancy rate significantly increased after DHEA treatment, allowing to achieve 10 spontaneous pregnancies and 9 spontaneous ongoing pregnancies among young poor responders. Pregnancy rate and ongoing pregnancy rate obtained before starting the IVF cycle were also significantly higher in older women treated with DHEA than in the control group: 21.05% and 13.15% and 4.1% and 0, respectively. Our results show that DHEA supplementation improves the ovarian function in poor responders and in women over 40 years, suggesting that this molecule alone can raise fecundity and fertility treatment success in women with poor prognosis for pregnancy.
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Affiliation(s)
- Francesco M Fusi
- Reproductive Medicine Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
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Progress in understanding human ovarian folliculogenesis and its implications in assisted reproduction. J Assist Reprod Genet 2013; 30:213-9. [PMID: 23388838 DOI: 10.1007/s10815-013-9944-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To highlight recent progress in understanding the pattern of follicular wave emergence of human menstrual cycle, providing a brief overview of the new options for human ovarian stimulation and oocyte retrieval by making full use of follicular physiological waves of the patients either with normal or abnormal ovarian reserve. METHODS Literature review and editorial commentary. RESULTS There has been increasing evidence to suggest that multiple (two or three) antral follicular waves are recruited during human menstrual cycle. The treatment regimens designed based on the theory of follicular waves, to promote increased success with assisted reproduction technology (ART) and fertility preservation have been reported. These new options for human ovarian stimulation and oocyte retrieval by making full use of follicular waves of the patients either with normal or abnormal ovarian reserve lead to new thinking about the standard protocols in ART and challenge the traditional theory that a single wave of antral follicles grows only during the follicular phase of the menstrual cycle. CONCLUSIONS The understanding of human ovarian folliculogenesis may have profound implications in ART and fertility preservation. Further studies are needed to evaluate the optimal regimens in ART based on the theory of follicular waves and to identify non-invasive markers for predicting the outcome and the potential utilities of follicles obtained from anovulatory follicular waves in ART.
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Weissman A, Ravhon A, Steinfeld Z, Nahum H, Golan A, Levran D. Controlled ovarian stimulation using a long gonadotropin-releasing hormone antagonist protocol: a proof of concept and feasibility study. Gynecol Obstet Invest 2013; 76:113-8. [PMID: 23920048 DOI: 10.1159/000351570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To evaluate the feasibility of a long protocol of controlled ovarian stimulation prior to in vitro fertilization (IVF) and embryo transfer with a gonadotropin-releasing hormone (GnRH) antagonist used for pituitary and ovarian suppression. METHODS Thirty patients undergoing IVF/intracytoplasmic sperm injection were randomized into two groups. The control group (n = 16) received a standard flexible GnRH antagonist protocol. Ovarian stimulation consisted of 225 IU/day of recombinant follicle-stimulating hormone for 5 days, followed by 225 IU/day of human menopausal gonadotropin until human chorionic gonadotropin (hCG) administration. The study group (n = 14) received 0.25 mg of GnRH antagonist daily for 7 days, thereafter, upon confirmation of pituitary and ovarian suppression, ovarian stimulation was commenced with the same protocol as used in the control group. Hormone and follicle dynamics, as well as laboratory characteristics and cycle outcome, were compared for both groups. RESULTS Both groups were comparable in baseline characteristics. Pituitary and ovarian suppression were effectively achieved in 12/14 patients in the study group. The duration of ovarian stimulation and gonadotropin consumption were similar in both groups, as was also the number and size of follicles on hCG day. CONCLUSION The results of our study confirm the feasibility of a long GnRH antagonist protocol. This regimen could become another option to optimize GnRH antagonist protocols, and should thus be further explored.
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Affiliation(s)
- Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Reynolds KA, Omurtag KR, Jimenez PT, Rhee JS, Tuuli MG, Jungheim ES. Cycle cancellation and pregnancy after luteal estradiol priming in women defined as poor responders: a systematic review and meta-analysis. Hum Reprod 2013; 28:2981-9. [PMID: 23887073 DOI: 10.1093/humrep/det306] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does a luteal estradiol (LE) stimulation protocol improve outcomes in poor responders to IVF? SUMMARY ANSWER LE priming is associated with decreased cycle cancellation and increased chance of clinical pregnancy in poor responders WHAT IS KNOWN ALREADY Poor responders to IVF are one of the most challenging patient populations to treat. Many standard protocols currently exist for stimulating these patients but all have failed to improve outcomes. STUDY DESIGN, SIZE, DURATION Systematic review and meta-analysis including eight published studies comparing assisted reproduction technology (ART) outcomes in poor responders exposed to controlled ovarian hyperstimulation with and without LE priming. A search of the databases MEDLINE, EMBASE and PUBMED was carried out for studies in the English language published up to January 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Studies evaluating women defined as poor responders to ART were evaluated. These studies were identified following a systematic review of the literature and data were analyzed using the DerSimonian-Laird random effects model. The main outcomes of interest were cycle cancellation rate and clinical pregnancy. Although the definition of clinical pregnancy varied between studies, the principal definition included fetal cardiac activity as assessed by transvaginal ultrasonography after 5 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE A total of 2249 publications were identified from the initial search, and the bibliographies, abstracts and other sources yielded 11 more. After excluding duplications, 1227 studies remained and 8 ultimately met the inclusion criteria. Compared with women undergoing non-LE primed protocols (n = 621), women exposed to LE priming (n = 468) had a lower risk of cycle cancellation [relative risk (RR): 0.60, 95% confidence interval (CI): 0.45-0.78] and an improved chance of clinical pregnancy (RR: 1.33, 95% CI: 1.02-1.72). There was no significant improvement in the number of mature oocytes obtained or number of zygotes obtained per cycle. LIMITATIONS, REASONS FOR CAUTION These findings are limited by the body of literature currently available. As the poor responder lacks a concrete definition, there is some heterogeneity to these results, which merits caution when applying our findings to individual patients. Furthermore, the increased clinical pregnancy rate demonstrated when using the LE protocol may be principally related to the decreased cycle cancellation rate. WIDER IMPLICATIONS OF THE FINDINGS The LE protocol may be of some utility in the poor responder to IVF and may increase clinical pregnancy rates in this population by improving stimulation and thereby decreasing cycle cancellation. STUDY FUNDING/COMPETING INTERESTS NIH K12 HD063086 (ESJ, MGT), NIH T32 HD0040135-11 (KAR), F32 HD040135-10 NIH (KRO), 5K12HD000849-25 (PTJ). No competing interests.
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Affiliation(s)
- Kasey A Reynolds
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Ave., Ste. 3100, St Louis, MO 63108, USA
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Hur YS, Park JH, Ryu EK, Park SJ, Lee JH, Lee SH, Yoon J, Yoon SH, Hur CY, Lee WD, Lim JH. Effect of micro-vibration culture system on embryo development. J Assist Reprod Genet 2013; 30:835-41. [PMID: 23657828 DOI: 10.1007/s10815-013-0007-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/26/2013] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Micro-vibration culture system was examined to determine the effects on mouse and human embryo development and possible improvement of clinical outcomes in poor responders. MATERIALS AND METHODS The embryonic development rates and cell numbers of blastocysts were compared between a static culture group (n = 178) and a micro-vibration culture group (n = 181) in mice. The embryonic development rates and clinical results were compared between a static culture group (n = 159 cycles) and a micro-vibration culture group (n = 166 cycles) in poor responders. A micro-vibrator was set at a frequency of 42 Hz, 5 s/60 min duration for mouse and human embryo development. RESULTS The embryonic development rate was significantly improved in the micro-vibration culture group in mice (p < 0.05). The cell numbers of mouse blastocysts were significantly higher in the micro-vibration group than in the static culture group (p < 0.05). In the poor responders, the rate of high grade embryos was not significantly improved in the micro-vibration culture group on day 3. However, the optimal embryonic development rate on day 5 was improved in the micro-vibration group, and the total pregnancy rate and implantation rate were significantly higher in the micro-vibration group than in the static culture group (p < 0.05). CONCLUSIONS Micro-vibration culture methods have a beneficial effect on embryonic development in mouse embryos. In poor responders, the embryo development rate was improved to a limited extent under the micro-vibration culture conditions, but the clinical results were significantly improved.
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Affiliation(s)
- Yong Soo Hur
- Department of Anatomy, School of Medicine, Kangwon National University, Chuncheon, 200-701, Korea.
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Yilmaz N, Uygur D, Inal H, Gorkem U, Cicek N, Mollamahmutoglu L. Dehydroepiandrosterone supplementation improves predictive markers for diminished ovarian reserve: serum AMH, inhibin B and antral follicle count. Eur J Obstet Gynecol Reprod Biol 2013; 169:257-60. [PMID: 23664458 DOI: 10.1016/j.ejogrb.2013.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/15/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the effect of dehydroepiandrosterone (DHEA) supplementation on ovarian reserve by measuring markers such as antral follicle count, serum anti-Müllerian hormone (AMH) and inhibin B in patients with diminished ovarian reserve. STUDY DESIGN This prospective study was undertaken at Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey. Forty-one patients with diminished ovarian reserve were included in the study and received supplementation with DHEA 25mg, t.i.d., for at least 6 weeks. Serum AMH, inhibin B, follicle-stimulating hormone (FSH) and oestradiol, and antral follicle count were determined before and after DHEA supplementation. Baseline ovarian reserve parameters such as antral follicle count, FSH, oestradiol, AMH, inhibin B, clinical and laboratory IVF outcomes, and pregnancy rates were studied. RESULTS There were significant differences in day 3 FSH, oestradiol, antral follicle count, AMH and inhibin B levels before and after DHEA supplementation in all patients (p=0.001, 0.001, 0.002, 0.001 and 0.001, respectively). The study population was divided into two age groups (<35 and ≥35 years) to determine whether there was a difference in the effect of DHEA supplementation between younger and older patients with diminished ovarian reserve. Significant differences were found in all of the parameters in both study groups (p<0.05). CONCLUSIONS DHEA supplementation is an effective option for patients with diminished ovarian reserve. Prior to assisted reproductive technology, patients with diminished ovarian reserve should be offered DHEA supplementation as an alternative to oocyte donation.
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Affiliation(s)
- N Yilmaz
- IVF Department, Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey.
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Abstract
BACKGROUND In view of the discrepancies about the luteal estradiol treatment before stimulation protocols having some potential advantages compared with the standard protocols in poor ovarian responders undergoing IVF, a meta-analysis of the published data was performed to compare the efficacy of the luteal estradiol pre-treatment protocols in IVF poor response patients. METHODS We searched for all published articles. The searches yielded 32 articles, from which seven studies met the inclusion criteria. We performed this meta-analysis involving 450 IVF patients in luteal estradiol pre-treatment protocol group and 606 patients in standard protocol group. RESULTS The luteal estradiol protocol resulted in a significantly higher duration of stimulation compared with the standard protocol. In addition, the number of oocytes retrieved and mature oocytes retrieved were significantly higher in the luteal estradiol protocols than those in the standard protocols. The cycle cancellation rate (CCR) in the luteal estradiol protocols was lower than the standard protocols. Moreover, no significant difference was found in the clinical pregnancy rate (CPR). CONCLUSIONS The addition of the estradiol in the luteal phase preceding IVF in poor responders improved IVF cycle outcomes, including increasing the number of oocytes retrieved and mature oocytes retrieved and decreasing the CCR.
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Affiliation(s)
- Xiaoxia Chang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Mohsen IA, El Din RE. Minimal stimulation protocol using letrozole versus microdose flare up GnRH agonist protocol in women with poor ovarian response undergoing ICSI. Gynecol Endocrinol 2013; 29:105-8. [PMID: 23134528 DOI: 10.3109/09513590.2012.730569] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To compare the IVF outcomes of letrozole/antagonist and microdose GnRH agonist flare up protocols in poor ovarian responders undergoing intracytoplasmic sperm injection. MATERIALS AND METHODS A randomized controlled trial was performed in patients with one or more previous failed IVF cycles in which four or less oocytes were retrieved when the gonadotrophin starting dose was at least 300 IU/day. Sixty patients were randomized by computer-generated list to receive either letrozole/antagonist (mild stimulation) n = 30 or GnRH-a protocol (microdose flare) n = 30. RESULTS Both groups were similar with respect to background and hormonal characteristics (age, duration of infertility, BMI, FSH, LH and E2). The clinical pregnancy rate per cycle was similar in both groups (13.3 vs. 16.6%; OR = 0.769; 95% CI = 0.185, 3.198). The doses of used gonadotropins and the number of stimulation days were significantly lower in the letrozole/antagonist protocol. The peak E2 level on the day of hCG, the endometrial thickness, the retrieved oocytes, the number of fertilized oocytes, the number of transferred embryos and the cancellation rate were statistically similar in both groups. CONCLUSIONS The letrozole/antagonist protocol is a cost-effective and patient-friendly protocol that may be used in poor ovarian responders for IVF/ICSI.
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Affiliation(s)
- Iman Abdel Mohsen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Davar R, Rahsepar M, Rahmani E. A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients. Arch Gynecol Obstet 2013; 287:149-53. [PMID: 22923150 DOI: 10.1007/s00404-012-2522-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/09/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study aims to verify if luteal estradiol pre-treatment improves IVF/ICSI outcomes in a GnRH antagonist protocol as compared with a micro dose GnRH agonist protocol in poor-responding patients. METHODS A total of 116 IVF/ICSI cycles were included in this prospective randomized single blind clinical trial. The selected women were randomly assigned to receive an estradiol pre-treatment in a GnRH antagonist protocol (daily oral Estradiol Valerate 4 mg preceding the IVF cycle from the 21st day until the first day of the next cycle) or in oral contraceptive pill micro dose GnRH agonist protocol. RESULTS The patients in the luteal estradiol protocol required more days of stimulation (10.9 ± 1.6 vs. 10.2 ± 1.8) and a greater gonadotropin requirement (3,247.8 ± 634.6 vs. 2,994.8 ± 611 IU), yet similar numbers of oocytes were retrieved and fertilized. There was no significant difference between the two groups in terms of the implantation rates (9.8 vs. 7.9 %) and the clinical pregnancy rates per transfer (16.3 vs. 15.6 %). CONCLUSION This study demonstrates that the use of estradiol during a preceding luteal phase in a GnRH antagonist protocol can provide similar IVF outcomes when compared to a micro dose GnRH agonist protocol.
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Affiliation(s)
- Robab Davar
- Yazd Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Bouali Street, Safaieh, 8916877391 Yazd, Iran
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Moawad A, Shaeer M. Long-term androgen priming by use of dehydroepiandrosterone (DHEA) improves IVF outcome in poor-responder patients. A randomized controlled study. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2012. [DOI: 10.1016/j.mefs.2012.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chang EM, Han JE, Won HJ, Kim YS, Yoon TK, Lee WS. Effect of estrogen priming through luteal phase and stimulation phase in poor responders in in-vitro fertilization. J Assist Reprod Genet 2011; 29:225-30. [PMID: 22160464 DOI: 10.1007/s10815-011-9685-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/20/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To verify whether a novel protocol administering E(2) during the luteal phase of the preceding cycle and during ovarian stimulation in GnRH antagonist cycle could enhance follicular response and hence improve outcomes in poor responders. METHODS In this retrospective analysis, a total of 155 poor responder patients subjected to IVF/ICSI were analyzed. All the patients had history of more than one prior IVF cycle failure with poor response (less than 5 oocytes retrieved and/or maximal E₂ level less than 500 pg/mL) by using conventional long agonist or antagonist protocol. In luteal E2 treatment protocol (n = 86), oral estradiol valerate 4 mg/day was initiated on luteal day 21 and either stopped at menstrual cycle day 3 (Protocol A, n = 28) or continued during the period of ovarian stimulation until the day of hCG injection (Protocol B, n = 58). IVF parameters and pregnancy outcome of luteal E2 treatments group were compared with a standard GnRH antagonist protocol (n = 69) which the patients received no hormonal pretreatment. RESULTS Compared to standard GnRH antagonist protocol, cancellation rate was lower with luteal E2 group (15.1% vs 37.7%, p < 0.01). Moreover, patients treated with luteal estrogen resulted in an increased number of oocytes retrieved (4.5 ± 2.9 vs 3.2 ± 1.9; p < 0.01). A trend toward increase in number of normally fertilized embryos (2.9 ± 2.1vs 2.3 ± 1.9; p = 0.043), and increased prevalence of good quality embryos (51.2% vs 25%; p = 0.047) were noted. Comparing protocol A and B, there were no significant difference between embryologic data, however there were slight increase in ongoing pregnancy rate in protocol B compared to A (27.1% vs 20%, p = 0.357), although statistical significance was not achieved. CONCLUSION Estrogen priming through luteal phase and stimulation phase improved ovarian responsiveness and this may lead to an increase in pregnancy rate in poor responders with failed cycle.
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Affiliation(s)
- Eun Mi Chang
- Fertility Center of CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, College of Medicine, CHA University, 650-9 Yeoksam, Kangnamgu, Seoul 135-081, Korea
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Aghahosseini M, Aleyassin A, Khodaverdi S, Esfahani F, Mohammadbeigi R, Movahedi S, Kord Valeshabad A, Mahdavi A, Fallahi P, Shabani P, Rezaeeian Z, Khodaverdi M. Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial. J Assist Reprod Genet 2011; 28:785-90. [PMID: 21720788 DOI: 10.1007/s10815-011-9595-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 05/31/2011] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was designed to evaluate the effects of adding Estradiol (E2) supplementation to progesterone (P) on improvement of pregnancy outcomes in poor responder patients who underwent in vitro fertilization (IVF). METHODS In a prospective randomized clinical trial, 118 poor responder patients, older than 38 years without contraindications of estradiol consumption from Infertility clinic of a university hospital were randomly divided (by computerized software) into two groups. Control group (59 patients) received only P and intervention group (59 patients) received P and E2 (4 mg/d). Supplementation was done with 4 mg E2 in the luteal phase. Fertilization rate, implantation rate, biochemical and clinical pregnancy rates, abortion rate, ongoing pregnancy, multiple pregnancy and ectopic pregnancy rates were documented for those who completed the study protocol in each group (per protocol analysis) and compared between groups. RESULT Fifty five patients in control group and 53 patients in intervention group successfully completed the study protocol. Treatment outcomes were not significantly different between two groups. CONCLUSION For poor responder women who underwent IVF, addition of E2 to P supplementation could not significantly improve pregnancy outcomes.
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Affiliation(s)
- Marzieh Aghahosseini
- Department of Infertility, Zanjan University of Medical Sciences, North Karegar Street, Zanjan, Iran
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Ferraretti AP, La Marca A, Fauser BCJM, Tarlatzis B, Nargund G, Gianaroli L. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26:1616-24. [PMID: 21505041 DOI: 10.1093/humrep/der092] [Citation(s) in RCA: 1127] [Impact Index Per Article: 86.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The definition presented here represents the first realistic attempt by the scientific community to standardize the definition of poor ovarian response (POR) in a simple and reproducible manner. POR to ovarian stimulation usually indicates a reduction in follicular response, resulting in a reduced number of retrieved oocytes. It has been recognized that, in order to define the poor response in IVF, at least two of the following three features must be present: (i) advanced maternal age or any other risk factor for POR; (ii) a previous POR; and (iii) an abnormal ovarian reserve test (ORT). Two episodes of POR after maximal stimulation are sufficient to define a patient as poor responder in the absence of advanced maternal age or abnormal ORT. By definition, the term POR refers to the ovarian response, and therefore, one stimulated cycle is considered essential for the diagnosis of POR. However, patients of advanced age with an abnormal ORT may be classified as poor responders since both advanced age and an abnormal ORT may indicate reduced ovarian reserve and act as a surrogate of ovarian stimulation cycle outcome. In this case, the patients should be more properly defined as 'expected poor responder'. If this definition of POR is uniformly adapted as the 'minimal' criteria needed to select patients for future clinical trials, more homogeneous populations will be tested for any new protocols. Finally, by reducing bias caused by spurious POR definitions, it will be possible to compare results and to draw reliable conclusions.
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Affiliation(s)
- A P Ferraretti
- S.I.S.Me.R Reproductive Medicine Unit, Via Mazzini 12, 40138 Bologna, Italy.
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Shastri SM, Barbieri E, Kligman I, Schoyer KD, Davis OK, Rosenwaks Z. Stimulation of the young poor responder: comparison of the luteal estradiol/gonadotropin-releasing hormone antagonist priming protocol versus oral contraceptive microdose leuprolide. Fertil Steril 2011; 95:592-5. [DOI: 10.1016/j.fertnstert.2010.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/11/2010] [Accepted: 10/04/2010] [Indexed: 11/24/2022]
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Luteal phase estradiol versus luteal phase estradiol and antagonist protocol for controlled ovarian stimulation before in vitro fertilization in poor responders. Fertil Steril 2011; 95:324-6. [DOI: 10.1016/j.fertnstert.2010.07.1058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/10/2010] [Accepted: 07/13/2010] [Indexed: 11/21/2022]
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Wiser A, Gonen O, Ghetler Y, Shavit T, Berkovitz A, Shulman A. Addition of dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod 2010; 25:2496-500. [PMID: 20729538 DOI: 10.1093/humrep/deq220] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effect of dehydroepiandrosterone (DHEA) supplementation on in vitro fertilization (IVF) data and outcomes among poor-responder patients. METHODS A randomized, prospective, controlled study was conducted. All patients received the long-protocol IVF. Those in the study group received 75 mg of DHEA once a day before starting the next IVF cycle and during treatment. RESULTS Thirty-three women with significantly diminished ovarian reserves were enrolled, 17 in the DHEA group and 16 in the control group. The 33 patients underwent 51 IVF cycles. The DHEA group demonstrated a non-significant improvement in estradiol levels on day of hCG (P = 0.09) and improved embryo quality during treatment (P = 0.04) between first and second cycles. Patients in the DHEA group also had a significantly higher live birth rate compared with controls (23.1% versus 4.0%; P = 0.05), respectively. Six of seven deliveries were among patients with secondary infertility (P = 0.006). CONCLUSION Dehydroepiandrosterone supplementation can have a beneficial effect on ovarian reserves for poor-responder patients on IVF treatment. Clinicaltrials.gov: NCT01145144.
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Affiliation(s)
- A Wiser
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.
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Wei Z, Cheng X, Li H, Cao Y, Cong L, Zhou P, Li J. Effects of prolonging administration gonadotropin on unexpectedly poor ovarian responders undergoing in vitro fertilization. Reprod Biol Endocrinol 2010; 8:26. [PMID: 20236519 PMCID: PMC2845138 DOI: 10.1186/1477-7827-8-26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 03/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are still some patients who show poor response to ovarian stimulation prior to evidence of normal ovarian reserve in vitro fertilization. However, there are few studies about how to treat the unexpectedly ovarian poor responder in vitro fertilization. The main aim of this study evaluate the effect of prolonging administration follicle-stimulating hormone in woman with the unexpectedly ovarian poor responder in vitro fertilization on implantation rate, clinical pregnancy rate and live birth rate. METHODS 922 patients subjected to IVF were divided into two groups according to the predicted criterion of ovarian poor response. 116 patients predicted poor response received the short protocol (group C). The others received the long protocol, among the latter, there were 149 patients undergoing unexpectedly ovarian poor response (group B) and 657 patients exhibited normal ovarian response (group A). The doses of gonadotropin, duration of administration, implantation rate, clinical pregnancy rate and live birth rate were recorded among three groups. RESULTS The implantation rate of embryo, clinic pregnancy rate and delivery rate are similar between the group A and group B, while there are significant differences between the doses of gonadotropins (35.1 +/- 8.9 ampules vs.53.0 +/- 15.9 ampules) and the duration of administration (15.3 +/- 3.6D vs. 9.8 +/- 2.6D) of these two groups. There are no significant differences about clinical pregnancy rate and live birth rate between group B and group C. CONCLUSION Prolonging administration gonadotropin on the unexpectedly poor ovarian responders does not lower live birth rate in vitro fertilization.
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Affiliation(s)
- Zhaolian Wei
- Reproductive Medicine Center, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, PR China
| | - Xianxia Cheng
- Reproductive Medicine Center, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, PR China
| | - Huirong Li
- Reproductive Medicine Center, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, PR China
| | - Yunxia Cao
- Reproductive Medicine Center, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, PR China
| | - Lin Cong
- Reproductive Medicine Center, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, PR China
| | - Ping Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, PR China
| | - Jun Li
- Pharmacological college, Anhui Medical University, Hefei, 230022, PR China
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Adjuncts for ovarian stimulation: when do we adopt "orphan indications" for approved drugs? Fertil Steril 2009; 92:13-8. [PMID: 19423104 DOI: 10.1016/j.fertnstert.2009.03.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 03/12/2009] [Accepted: 03/20/2009] [Indexed: 11/23/2022]
Abstract
Several drugs, shown to be safe for other uses, have proven to be highly effective adjuncts for ovarian stimulation. The authors evaluate these "orphan" indications and make recommendations so that more patients will benefit from their use.
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A luteal estradiol protocol for anticipated poor-responder patients may improve delivery rates. Fertil Steril 2009; 91:739-43. [DOI: 10.1016/j.fertnstert.2007.12.073] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 12/24/2007] [Accepted: 12/24/2007] [Indexed: 11/18/2022]
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Successful pregnancy following novel IVF protocol and transmyometrial embryo transfer after radical vaginal trachelectomy. Reprod Biomed Online 2009; 18:700-3. [DOI: 10.1016/s1472-6483(10)60017-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Loutradis D, Beretsos P, Arabatzi E, Anagnostou E, Drakakis P. The role of steroid hormones in ART. J Steroid Biochem Mol Biol 2008; 112:1-4. [PMID: 18848889 DOI: 10.1016/j.jsbmb.2008.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
Abstract
Steroid hormones hold a major role in female fertility and their proper utilisation and monitoring in modern assisted reproduction protocols is important. Oocyte maturation and endometrial receptivity are the two major factors that appear to be related to a successful outcome in Assisted Reproductive Technology (ART). Many reports suggest that oocyte immaturity accounts for a considerable loss of efficiency in ART, mainly due to the poor quality of the obtained embryos and their inability to develop normally. Oestrogen appears to exert its effects on the cytoplasmic maturation of the oocyte, while progesterone has been shown to accelerate meiotic resumption. Moreover, ovarian stimulation appears to affect the normal luteal function and shifts in the window of implantation as a response to hormonal supplementation have also been observed. The ethical limitations in conducting in vivo studies of human implantation, have led to an indirect hormonal- and morphologic-oriented assessment of endometrial receptivity. The two main protocols of luteal support involve either progesterone supplementation or hCG administration, whereas the combined supplementation with oestradiol remains controversial. This brief review aims to summarize the current knowledge on steroidal actions during the above processes and to address their potential use in the improvement of current ART protocols.
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Affiliation(s)
- Dimitris Loutradis
- First Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Athens University Medical School, Athens, Greece.
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