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Pirtea P, de Ziegler D, Poulain M, Ayoubi JM. New Twists in Ovarian Stimulation and Their Practical Implications. Front Med (Lausanne) 2019; 6:197. [PMID: 31555650 PMCID: PMC6737035 DOI: 10.3389/fmed.2019.00197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/21/2019] [Indexed: 01/07/2023] Open
Abstract
Ovarian stimulation (OS) has for objective to induce multiple ovulation in order to yield a multiple oocyte harvest and offer multiple embryos available for transfer thereby increasing the efficacy of ART. Originally, the primary risk associated with OS was the occurrence of frank ovarian hyperstimulation syndrome (OHSS), a possibly dreadful—sometime fatal—complication of ART. These fears limited the number of oocytes aimed for during OS in order to curb the risk of OHSS. On the contrary, the meager implantation rates of the early days of ART led to easily transfer multiple embryos in order to achieve acceptable pregnancy rates. Today the perspectives have changed. The advent of antagonist-based OS protocol and the possibility to trigger the ultimate phase of oocyte maturation with GnRH-a has allowed to reduce the risk of OHHS. Conversely, the markedly increased implantation rates of today's ART makes multiple pregnancy a worry that has come in the limelight worldwide, pushing the practice of single embryo transfer (SET).
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Affiliation(s)
- Paul Pirtea
- Department of Ob Gyn and Reproductive Medicine, Hopital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| | - Dominique de Ziegler
- Department of Ob Gyn and Reproductive Medicine, Hopital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| | - Marine Poulain
- Department of Ob Gyn and Reproductive Medicine, Hopital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| | - Jean Marc Ayoubi
- Department of Ob Gyn and Reproductive Medicine, Hopital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
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Benchabane M, Santulli P, Maignien C, Bourdon M, De Ziegler D, Chapron C, Gayet V. [Corifollitropin alfa compared to daily FSH in controlled ovarian stimulation for oocyte donors]. ACTA ACUST UNITED AC 2017; 45:83-88. [PMID: 28368800 DOI: 10.1016/j.gofs.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/29/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To demonstrate that corifollitropin alfa is as effective as daily FSH in controlled ovarian stimulation of oocyte donors. METHODS From January 2013 to October 2015, 77 cycles controlled ovarian stimulation, derived from a continuous cohort of 77 oocyte donors, were analyzed. After synchronization by oestroprogestatif or estrogens, ovarian stimulation was started by corifollitropin alfa (Group corifollitropin alfa) or by daily FSH (Group daily FSH). In both groups, a GnRH antagonist was used for the prevention of premature surge of luteinizing hormone (LH). The induction of ovulation was induced by a GnRH agonist. The duration of treatment, estradiol rate, numbers of mature oocytes, fertilization rate, clinical and ongoing pregnancies rates were evaluated in the two groups. RESULTS There is no difference for the age, the markers of ovarian reserve and the duration of treatment. The average rate of estradiol on the eighth day of the stimulation is lower for the corifollitropin alfa (845±694.5 vs 1742±1177.3, P<0.001), there is no difference in the number of mature oocytes retrieved (14.4 vs 13.4, P=0.979), with a fertilization rate significantly higher in the corifollitropin alfa group (59.8% vs 49.3%, P<0.001). The rate of ongoing pregnancies is higher but without reaching significant difference in this same group (36.6% vs 26%, P=0.277). CONCLUSION As compared to daily FSH, corifollitropin alfa, in oocyte donors offers, advantages in terms of ease of use with identical efficiency.
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Affiliation(s)
- M Benchabane
- Department of gynaecology obstetrics II and reproductive medicine Paris, faculté de médecine, hôpital universitaire Paris centre, université Paris Descartes, Sorbonne Paris Cité, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - P Santulli
- Department of gynaecology obstetrics II and reproductive medicine Paris, faculté de médecine, hôpital universitaire Paris centre, université Paris Descartes, Sorbonne Paris Cité, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; Institut Cochin, Inserm U1016, laboratoire d'immunologie, université Paris Descartes, Sorbonne Paris Cité, Paris, France; Institut Cochin, Inserm U1016, département de « génetique, développement et cancer », université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - C Maignien
- Department of gynaecology obstetrics II and reproductive medicine Paris, faculté de médecine, hôpital universitaire Paris centre, université Paris Descartes, Sorbonne Paris Cité, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - M Bourdon
- Department of gynaecology obstetrics II and reproductive medicine Paris, faculté de médecine, hôpital universitaire Paris centre, université Paris Descartes, Sorbonne Paris Cité, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - D De Ziegler
- Department of gynaecology obstetrics II and reproductive medicine Paris, faculté de médecine, hôpital universitaire Paris centre, université Paris Descartes, Sorbonne Paris Cité, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - C Chapron
- Department of gynaecology obstetrics II and reproductive medicine Paris, faculté de médecine, hôpital universitaire Paris centre, université Paris Descartes, Sorbonne Paris Cité, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; Institut Cochin, Inserm U1016, laboratoire d'immunologie, université Paris Descartes, Sorbonne Paris Cité, Paris, France; Institut Cochin, Inserm U1016, département de « génetique, développement et cancer », université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - V Gayet
- Department of gynaecology obstetrics II and reproductive medicine Paris, faculté de médecine, hôpital universitaire Paris centre, université Paris Descartes, Sorbonne Paris Cité, centre hospitalier universitaire (CHU) Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
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Vincent-Rohfritsch A, Marszalek A, Santulli P, Gayet V, Chapron C, Goffinet F, Le Ray C. [Risk of perinatal complication and egg donation: Role of resorting to cross-border care?]. ACTA ACUST UNITED AC 2016; 45:866-875. [PMID: 27083429 DOI: 10.1016/j.jgyn.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 03/03/2016] [Accepted: 03/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In France, egg donation is covered by Social insurance among women<43 years old. Because of shortage of egg donor, women aged 43 years or more cannot resort to egg donation in French infertility centers, leading them to turn to the foreign centers having practices different and less regulated than in France. We are thus brought to take care of the pregnancy and of the delivery of these women. Our objective was to estimate if the perinatal risks are more important after egg donation abroad than in case of egg donation in a French center. MATERIAL AND METHODS Retrospective study between January, 2010 and April, 2013, comparing women having had an egg donation to Cochin then having delivered in the maternity hospital of their choice (n=88) and the women having had an egg donation abroad then having delivered in the Port-Royal maternity (n=121). First, the modalities of egg donation were compared between the Cochin hospital and the foreign centers. Second, the obstetric and perinatal outcomes were compared between both groups, then by stratifying according to the type of pregnancy (singleton or multiple). RESULTS Among women having had an egg donation abroad, the age of the donor was lower (25.7 vs. 31.7, P=0.001), the average number of embryos transferred higher (2.1±0.6 vs. 1.7±0.5, P=0.001) and the rate of multiple pregnancies higher (47.9% vs. 9.1%, P=0.001) than among women having had an egg donation at Cochin. We observed after egg donation abroad compared to egg donation at Cochin, a birth weight significantly lower (2678±745g vs. 3045±682g, P=0.001) and a prevalence of intrauterine growth retardation higher (11.1% vs. 4.2%, P=0.04). Among singletons, abnormal placentation was more frequent in case of egg donation abroad (17.5% vs. 5.1%, P=0.02). In case of twin pregnancy, we highlighted very high rates of complications, without significant difference according to the place where egg donation was practiced. CONCLUSION We observed an increased risk of intrauterine growth retardation after egg donation abroad, which could essentially be explained by the association between advanced maternal age and multiple gestation. For other obstetric and perinatal complications, the differences between both groups were less important than expected, but very high in both groups, whether the egg donation was realized in France or abroad. The complications seem mainly due to the multiple gestations, justifying the transfer of a single embryo whenever possible.
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Affiliation(s)
- A Vincent-Rohfritsch
- Maternité Port-Royal, hôpital Hôtel-Dieu, groupe hospitalier Cochin, Broca, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris Cité, 123, boulevard de Port-Royal, 75014 Paris, France.
| | - A Marszalek
- Service de gynécologie-obstétrique 2 et médecine de la reproduction, hôpital Hôtel-Dieu, groupe hospitalier Cochin, Broca, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris Cité, 123, boulevard de Port-Royal, 75014 Paris, France
| | - P Santulli
- Service de gynécologie-obstétrique 2 et médecine de la reproduction, hôpital Hôtel-Dieu, groupe hospitalier Cochin, Broca, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris Cité, 123, boulevard de Port-Royal, 75014 Paris, France
| | - V Gayet
- Service de gynécologie-obstétrique 2 et médecine de la reproduction, hôpital Hôtel-Dieu, groupe hospitalier Cochin, Broca, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris Cité, 123, boulevard de Port-Royal, 75014 Paris, France
| | - C Chapron
- Service de gynécologie-obstétrique 2 et médecine de la reproduction, hôpital Hôtel-Dieu, groupe hospitalier Cochin, Broca, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris Cité, 123, boulevard de Port-Royal, 75014 Paris, France
| | - F Goffinet
- Maternité Port-Royal, hôpital Hôtel-Dieu, groupe hospitalier Cochin, Broca, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris Cité, 123, boulevard de Port-Royal, 75014 Paris, France
| | - C Le Ray
- Maternité Port-Royal, hôpital Hôtel-Dieu, groupe hospitalier Cochin, Broca, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris Cité, 123, boulevard de Port-Royal, 75014 Paris, France
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de Ziegler D, Sator M, Binelli D, Leuratti C, Cometti B, Bourgain C, Fu YSX, Garhöfer G. A randomized trial comparing the endometrial effects of daily subcutaneous administration of 25 mg and 50 mg progesterone in aqueous preparation. Fertil Steril 2013; 100:860-6. [PMID: 23806850 DOI: 10.1016/j.fertnstert.2013.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study the efficacy of a new P preparation in aqueous solution for subcutaneous injection for inducing the predecidual transformation of the endometrium. DESIGN Prospective, single-blinded, randomized, parallel pilot trial. SETTING University-affiliated clinical research center. PATIENT(S) Twenty-five regularly cycling female volunteers. INTERVENTION(S) Volunteers, aged 18-45 years, body mass index 19-25 kg/m(2), whose ovaries were suppressed with a GnRH agonist were estrogenized for 14 or 21 days with the use of transdermal systems delivering 0.1 mg/d E₂. After confirming that the endometrial thickness was >7 mm, the women were randomized to 25 mg or 50 mg of subcutaneous P injections daily for 11 days, after which the endometrium was sampled with the use of a Pipelle device. The endometrial biopsies were evaluated by two independent pathologists. Adverse events and subjective tolerance were checked every day by the study investigator. MAIN OUTCOME MEASURE(S) Predecidual changes in endometrial biopsies obtained after 11 days of subcutaneous administration of P. RESULT(S) Of 24 biopsies performed (one dropout), 22 provided tissue for histologic analysis. Evidence of predecidual changes in the endometrial stroma was found in 100% of the cases, with no differences between the two studied doses. CONCLUSION(S) Both doses of the new aqueous P preparation available for subcutaneous administration demonstrated predecidual changes in 100% of the interpretable endometrial biopsies in total absence of endogenous P. This offers good prospect of efficacy in luteal phase support for the lowest dose tested, 25 mg/d, the physiologic amount produced daily by the ovary during the midluteal phase. CLINICAL TRIAL REGISTRATION NUMBER NCT00377923.
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Affiliation(s)
- Dominique de Ziegler
- Department of Obstetrics and Gynecology II, Université Paris Descartes-Hôpital Cochin, Reproductive Endocrinology and Infertility, Paris, France.
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Cai LB, Qian XQ, Wang W, Mao YD, Yan ZJ, Liu CZ, Ding W, Huang J, Chai DC, Chian RC, Liu JY. Oocyte vitrification technology has made egg-sharing donation easier in China. Reprod Biomed Online 2012; 24:186-90. [DOI: 10.1016/j.rbmo.2011.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 10/14/2011] [Accepted: 11/01/2011] [Indexed: 10/15/2022]
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de Ziegler D, Streuli I, Meldrum DR, Chapron C. The value of growth hormone supplements in ART for poor ovarian responders. Fertil Steril 2011; 96:1069-76. [PMID: 22036051 DOI: 10.1016/j.fertnstert.2011.09.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 09/28/2011] [Accepted: 09/28/2011] [Indexed: 01/27/2023]
Abstract
Recently, three meta-analyses have concluded that cotreatment with GH improves assisted reproduction outcome in poor controlled ovarian stimulation responders. Although generally GH supplements did not increase controlled ovarian stimulation response or number of oocytes, the supplements improved pregnancy and live-birth rates-thus speaking for an effect on oocyte quality.
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Affiliation(s)
- Dominique de Ziegler
- Université Paris Descartes-Assistance Publique Hôpitaux de Paris, CHU Cochin, Department of Obstetrics, Gynecology, and Reproductive Medicine, Paris, France.
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Chalas Boissonnas C, Davy C, Marszalek A, Duranteau L, de Ziegler D, Wolf JP, Cabanes L, Jouannet P. Cardiovascular findings in women suffering from Turner syndrome requesting oocyte donation. Hum Reprod 2011; 26:2754-62. [DOI: 10.1093/humrep/der262] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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