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Yahyaei A, Vesali S, Ghaffari F. Introduce an optimal method of ovarian stimulation in the polycystic ovarian syndrome affected: a randomized controlled trial. BMC Womens Health 2023; 23:323. [PMID: 37340371 DOI: 10.1186/s12905-023-02473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/10/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Currently, optimal method of ovarian stimulation (OS) to in-vitro fertilization (IVF) in the patients with polycystic ovarian syndrome (PCOS) is unknown. The present research aims to study the efficiency of minimal-OS method in treatment of infertile patients with PCOS and also the effect of gonadotropin type (recombinant FSH (r-FSH) vs. urinary Human menopausal gonadotropin (u-HMG)) on treatment cycles with GnRH-antagonist. METHODS In this randomized controlled trial, a total of 120 eligible patients were randomly allocated into four groups of OS to IVF: minimal-OS with r-FSH, minimal-OS with u-HMG, mild-OS with r-FSH and mild-OS with u-HMG. IVF outcomes of groups were analyzed statically. RESULTS The statistical analysis showed that there were significant differences among groups regarding stimulation duration (p < 0.0001), number of retrieved oocytes (p < 0.0001), number of obtained embryos (p < 0.0001). There were no statistically significant differences in fertilization rate (p = 0.289) and implantation rate (p = 0.757) among our participants. There were also significant differences among these four groups in terms of clinical pregnancy rate (/ET and /cycles) (p < 0.0001, p = 0.021, respectively) and live birth rate/cycles (p < 0.0001). Also cases of freeze all embryos due to prevention of ovarian hyper stimulation syndrome (OHSS) (p = 0.004). CONCLUSIONS On the basis of present results the minimal-OS with u-HMG may be one of optimal methods of control OS in the patients with PCOS in respect to serum levels of estradiol on the day of triggering final oocyte maturation, total dose of prescribed gonadotropin, the optimal number of oocytes and embryos obtained, rate of clinical pregnancy and the incidence of OHSS risk. TRIAL REGISTRATION NCT, NCT03876145. Registered 15/03/2019. Retrospectively registered, http://www. CLINICALTRIAL gov/ NCT03876145.
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Affiliation(s)
- Azar Yahyaei
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Samira Vesali
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Firouzeh Ghaffari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
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Ochin H, Ma X, Wang L, Li X, Song J, Meng Y, Shen J, Cui YG, Liu J. Low dose clomiphene citrate as a mild stimulation protocol in women with unsuspected poor in vitro fertilization result can generate more oocytes with optimal cumulative pregnancy rate. J Ovarian Res 2018; 11:37. [PMID: 29728130 PMCID: PMC5934891 DOI: 10.1186/s13048-018-0408-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of long protocol during controlled ovarian stimulation for assisted reproduction attracts high dosage of gonadotropins. High dose of gonadotropins can be detrimental to oocyte development, which affects its quality and compromises the treatment outcome. Mild stimulation protocols that attract low dose gonadotropins could be useful alternative regimen to address such problems. This study evaluated the efficacy of low dose clomiphene citrate based protocol plus low dose gonadotropins on predicted normal responder patients who had unsuspected poor in vitro fertilization (IVF) result, following an initial stimulation with long gonadotropin-releasing hormone (GnRH) agonist protocol. METHODS This a retrospective study of 65 infertile women who underwent 130 cycles in our center from January 2011 to December 2014. The initial IVF cycle (Group 1) was treated with long GnRH-a protocol plus a high dose of gonadotropins (≥150 IU/d), while second IVF cycle (Group 2) had low dose clomiphene citrate based protocol plus low dose gonadotropins (75-112.5 IU/d). RESULTS The rate of cumulative pregnancy/started cycle (9.2% [6/65] vs. 51% [33/65]; P < 0001) was significantly better in CC protocol than the long GnRH agonist protocol. The number of oocytes retrieved was also higher in CC protocol compared to the long protocol (7.26 ± 1.95 vs. 5.98 ± 1.31; P = 0.03). There was a lower number of patients without embryos (12.31% vs. 33.85%; p < 0.0001) in CC protocol than long protocol. CONCLUSIONS This study showed a better cumulative pregnancy rate in the low dose CC based protocol. There was a higher number of oocytes retrieved after using a lower total dose of recombinant FSH in CC protocol. Thus, clomiphene treatment plus low dose rFSH can be an alternative option for such patients in second cycle stimulation instead of repeating long protocol regimen. Randomized controlled studies with larger number of patients will be needed for more accurate evidence.
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Affiliation(s)
- Humphrey Ochin
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China
| | - Xiang Ma
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China
| | - Lin Wang
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China
| | - Xuan Li
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China
| | - Jie Song
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China
| | - Yan Meng
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China
| | - Jiandong Shen
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China
| | - Yu-Gui Cui
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China
| | - Jiayin Liu
- Clinical Center for Reproductive Medicine, 300 Guangzhou Road. First Affiliated Hospital of Nanjing Medical University, 210029, The State Key Laboratory of Reproductive Medicine., Nanjing, People's Republic of China.
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Gonda KJ, Domar AD, Gleicher N, Marrs RP. Insights from clinical experience in treating IVF poor responders. Reprod Biomed Online 2017; 36:12-19. [PMID: 29223475 DOI: 10.1016/j.rbmo.2017.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/27/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022]
Abstract
'Poor responders' is a term used to describe a subpopulation of IVF patients who do not respond well to ovarian stimulation with gonadotrophins. While there is no standard definition of a poor responder, these patients tend to be of advanced maternal age (≥40 years), have a history of poor ovarian response with conventional stimulation protocols, and/or have low ovarian reserve. Despite the heterogeneity of this patient group, there are characteristics and needs common to many poor responders that can be addressed through a holistic approach. Stimulation during the earlier stages of follicle maturation may help synchronize follicle development for improved response to later gonadotrophin stimulation, and supplementation with dehydroepiandrosterone or human growth hormone may promote early follicle development in poor responders. IVF protocols should be specifically tailored to poor responders to complement the patient's natural cycle. Because poor responders tend to have high levels of stress and anxiety, patients should receive psychological counselling and support, both prior to and during IVF cycles, to ensure optimal outcomes and improve patients' experience. It is important to set realistic expectations with poor responders and their partners to help patients make informed decisions and better manage their distress and anxiety.
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Affiliation(s)
| | - Alice D Domar
- Domar Center for Mind/Body Health, Waltham, MA, USA; Boston IVF, Waltham, MA, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Norbert Gleicher
- Center for Human Reproduction, New York, NY, USA; Foundation for Reproductive Medicine, New York, NY, USA; Rockefeller University, New York, NY, USA; Medical University of Vienna, Vienna, Austria
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Fan Y, Zhang X, Hao Z, Ding H, Chen Q, Tian L. Effectiveness of mild ovarian stimulation versus GnRH agonist protocol in women undergoing assisted reproductive technology: a meta-analysis. Gynecol Endocrinol 2017; 33:746-756. [PMID: 28508683 DOI: 10.1080/09513590.2017.1320385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE our meta-analysis was conducted to evaluate the effectiveness of the mild ovulation induction protocol using CC/gonadotropin/GnRH antagonist compared to the conventional GnRH agonist protocol in women undergoing ART. METHOD Six electronic databases were searched from their date of establishment until August 2016. Outcomes in our analysis were calculated in terms of relative risk (RR) and weighted mean differences (WMD) and standard mean differences (SMD) with 95% confidence intervals (CI) using random effect models or fixed effect models. RESULTS Six prospective controlled clinical trials with 1543 women comparing the clinical impacts of the two protocols were included. The synthesized results suggested a significant reduction in the quantity of gonadotropins (SMD: -1.96, 95% CI: -2.28 to 1.64, I2 = 78.5%), the incidence of OHSS (RR: 0.16, 95% CI 0.03-0.86, I2 = 0%) and an increase in the cycle cancelation rate (RR: 1.46, 95% CI 1.05-2.03, I2 = 89.4%). While no evidence of statistically significant differences between the groups existed in the other clinical outcomes. CONCLUSION This study suggested that the probable benefits of the mild protocol, including its less costs and safer process without reducing the overall IVF treatment success rates, seemed to make it a better treatment option. Larger sample prospective trials evaluating live birth, clinical pregnancy, OHSS, multiple pregnancy incidence and so on were desired to establish.
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Affiliation(s)
- Yuan Fan
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Xiaowei Zhang
- b Department of Urology , Peking University People's Hospital , Beijing , China , and
| | - Zhidong Hao
- c Department of Obstetrics and Gynecology , Haidian Maternal & Child Health Hospital , Beijing , China
| | - Huanfei Ding
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Quanyu Chen
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
| | - Li Tian
- a Reproductive Medical Centre, Peking University People's Hospital , Beijing , China
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Zhang JJ, Yang M, Merhi Z. Efficiency of metaphase II oocytes following minimal/mild ovarian stimulation in vitro fertilization. FERTILITY RESEARCH AND PRACTICE 2017; 2:2. [PMID: 28620528 PMCID: PMC5424370 DOI: 10.1186/s40738-016-0025-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/22/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND An inverse relationship between oocyte efficiency and ovarian response was reported in conventional IVF. The purpose of this study was to report metaphase II (MII) oocyte efficiency according to oocyte yield in minimal/mild stimulation IVF (mIVF) and to assess whether oocyte yield affects live birth rate (LBR). METHODS Infertile women (n = 264) aged < 39 years old with normal ovarian reserve who had mIVF were recruited. All participants received the same protocol for ovarian stimulation. All the embryos were cultured to the blastocyst stage and vitrified using a freeze-all approach. This was followed by a single blastocyst transferred to each participant in subsequent cycles over a 6-month period. Ovarian response was categorized according to the number of MII oocyte yield (low: 1-2, intermediate: 3-6 and high ≥ 7 MII oocytes). MII oocyte utilization rate was calculated as the number of live births divided by the number of MII oocytes produced after only one oocyte retrieval and subsequent transfers of vitrified/warmed blastocysts. The main outcome measure was cumulative LBR over a 6-month period. RESULTS Among all the participants, 1173 total retrieved oocytes (4.4 ± 0.2 per patient) resulted in 1019 (3.9 ± 0.2 per patient) total MII oocytes, a clinical pregnancy rate of 48.1 % and a LBR of 41.2 %. Oocyte utilization rate was inversely related to ovarian response where it was 30.3 % in the "low" vs. 9.3 % in the "intermediate" vs. 4.3 % in the "high" oocyte yield groups (p < 0.05). Implantation rate significantly dropped as the number of MII oocytes increased and was highest in the "low" oocyte yield group (p < 0.0001). Cumulative LBR was similar in "low," "intermediate," and "high" oocyte yield groups (p > 0.05). The number of MII oocytes had poor sensitivity and specificity for predicting a live birth. CONCLUSION These data extend the hypothesis of oocyte efficiency reported in conventional IVF protocols to mIVF protocols. TRIAL REGISTRATION Registration clinicaltrials.gov: NCT00799929.
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Affiliation(s)
- John J Zhang
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, New York, NY USA
| | - Mingxue Yang
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, New York, NY USA
| | - Zaher Merhi
- Division of Reproductive Biology, Department of Obstetrics and Gynecology, New York University School of Medicine, 180 Varick Street, sixth floor, New York, NY 10014 USA
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Chen YH, Wang Q, Zhang YN, Han X, Li DH, Zhang CL. Cumulative live birth and surplus embryo incidence after frozen-thaw cycles in PCOS: how many oocytes do we need? J Assist Reprod Genet 2017; 34:1153-1159. [PMID: 28580513 DOI: 10.1007/s10815-017-0959-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/17/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study aimed to evaluate the cumulative live birth rate (CLBR) and surplus embryo rate of polycystic ovarian syndrome (PCOS) patients during in vitro fertilization and embryo transfer (IVF-ET) treatment. METHODS In this retrospective cohort study, we analyzed 1142 PCOS patients who underwent first IVF in our institution between January 2011 and December 2014. All patients were categorized into five groups according to the number of oocytes retrieved. Main outcomes include CLBR and surplus embryo rate. RESULTS A strong correlation was observed between number of oocytes retrieved and CLBR as well as surplus embryo rate in PCOS patients. CLBR was elevated with the increasing number of oocytes and plateaued when oocyte number was up to ten, whereas the surplus embryo rate steadily increased in line with the increase of oocyte number. Patients transferred with frozen embryos showed higher CLBR and LBR during first ET than patients transferred with fresh embryos. CONCLUSIONS For PCOS patients, retrieving more than ten oocytes leads to no significant benefit to CLBR but generates surplus embryos. Thus, moderate ovarian stimulation should be reconsidered during IVF treatment.
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Affiliation(s)
- Yuan-Hui Chen
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Qian Wang
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Ya-Nan Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Xiao Han
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Dong-Han Li
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Cui-Lian Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China. .,Reproductive Medical Center, People's Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.
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Ebrahimi M, Akbari-Asbagh F, Ghalandar-Attar M. Letrozole+ GnRH antagonist stimulation protocol in poor ovarian responders undergoing intracytoplasmic sperm injection cycles: An RCT. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.2.101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Zhang J. Resurgence of Minimal Stimulation In Vitro Fertilization with A Protocol Consisting of Gonadotropin Releasing Hormone-Agonist Trigger and Vitrified-Thawed Embryo Transfer. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:148-53. [PMID: 27441046 PMCID: PMC4948065 DOI: 10.22074/ijfs.2016.4903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 10/10/2015] [Indexed: 11/30/2022]
Abstract
Minimal stimulation in vitro fertilization (mini-IVF) consists of a gentle controlled
ovarian stimulation that aims to produce a maximum of five to six oocytes. There is
a misbelief that mini-IVF severely compromises pregnancy and live birth rates. An
appraisal of the literature pertaining to studies on mini-IVF protocols was performed.
The advantages of minimal stimulation protocols are reported here with a focus on
the use of clomiphene citrate (CC), gonadotropin releasing hormone (GnRH) ago-
nist trigger for oocyte maturation, and freeze-all embryo strategy. Literature review
and the author’s own center data suggest that minimal ovarian stimulation protocols
with GnRH agonist trigger and freeze-all embryo strategy along with single embryo
transfer produce a reasonable clinical pregnancy and live birth rates in both good
and poor responders. Additionally, mini-IVF offers numerous advantages such as: i.
Reduction in cost and stress with fewer office visits, needle sticks, and ultrasounds,
and ii. Reduction in the incidence of ovarian hyperstimulation syndrome (OHSS).
Mini-IVF is re-emerging as a solution for some of the problems associated with
conventional IVF, such as OHSS, cost, and patient discomfort.
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Affiliation(s)
- John Zhang
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, New York, United States
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Minimal stimulation IVF vs conventional IVF: a randomized controlled trial. Am J Obstet Gynecol 2016; 214:96.e1-8. [PMID: 26259908 DOI: 10.1016/j.ajog.2015.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/21/2015] [Accepted: 08/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Minimal stimulation in vitro fertilization (mini-in vitro fertilization) is an alternative in vitro fertilization treatment protocol that may reduce ovarian hyperstimulation syndrome, multiple pregnancy rates, and cost while retaining high live birth rates. OBJECTIVE We performed a randomized noninferiority controlled trial with a prespecified border of 10% that compared 1 cycle of mini-in vitro fertilization with single embryo transfer with 1 cycle of conventional in vitro fertilization with double embryo transfer. STUDY DESIGN Five hundred sixty-four infertile women (<39 years old) who were undergoing their first in vitro fertilization cycle were allocated randomly to either mini-in vitro fertilization or conventional in vitro fertilization. The primary outcome was cumulative live birth rate per woman over a 6-month period. Secondary outcomes included ovarian hyperstimulation syndrome, multiple pregnancy rates, and gonadotropin use. The primary outcome was cumulative live birth per randomized woman within a time horizon of 6 months. RESULTS Five hundred sixty-four couples were assigned randomly between February 2009 and August 2013 with 285 couples allocated to mini-in vitro fertilization and 279 couples allocated to conventional in vitro fertilization. The cumulative live birth rate was 49% (140/285) for mini-in vitro fertilization and 63% (176/279) for conventional in vitro fertilization (relative risk, 0.76; 95% confidence interval, 0.64-0.89). There were no cases of ovarian hyperstimulation syndrome after mini-in vitro fertilization compared with 16 moderate/severe ovarian hyperstimulation syndrome cases (5.7%) after conventional in vitro fertilization. The multiple pregnancy rates were 6.4% in mini-in vitro fertilization compared with 32% in conventional in vitro fertilization (relative risk, 0.25; 95% confidence interval, 0.14-0.46). Gonadotropin consumption was significantly lower with mini-in vitro fertilization compared with conventional in vitro fertilization (459 ± 131 vs 2079 ± 389 IU; P < .0001). CONCLUSION Compared with conventional in vitro fertilization with double embryo transfer, mini-in vitro fertilization with single embryo transfer lowers live birth rates, completely eliminates ovarian hyperstimulation syndrome, reduces multiple pregnancy rates, and reduces gonadotropin consumption.
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Zhang JJ, Choo S, Yang M. Autologous oocyte cryopreservation in women aged 40 and older using minimal stimulation IVF. Reprod Biol Endocrinol 2015; 13:112. [PMID: 26444973 PMCID: PMC4596373 DOI: 10.1186/s12958-015-0110-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The value of oocyte cryopreservation in older women remains controversial. The aim of this study was to report the oocyte freezing experience in women aged 40 and older at a single fertility center. FINDINGS One hundred fifty eight women (mean age 43.9 ± 0.2) who underwent minimal ovarian stimulation IVF were enrolled. IVF protocol included the use of clomiphene citrate (50 mg/day) or letrozole (2.5 mg/day) with or without low dose gonadotropins (started at 75 IU/day and increased as needed to 150 IU/day). 584 retrieved oocytes (2.1 ± 0.15 per patient) yielded 532 mature MII oocytes that were frozen. After thawing and fertilization by ICSI, a total of 344 embryos (1.9 ± 0.1 per patient) were formed. A total of 57 relatively good embryos were transferred and yielded three live births (5.3 % per embryo transfer), three spontaneous abortions, and one chemical pregnancy. CONCLUSIONS These data are important in counseling older women who desire autologous oocyte freezing.
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Affiliation(s)
- John J Zhang
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, 4 Columbus Avenue, New York, NY, USA.
| | - Simon Choo
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, 4 Columbus Avenue, New York, NY, USA.
| | - Mingxue Yang
- Reproductive Endocrinology and Infertility, New Hope Fertility Center, 4 Columbus Avenue, New York, NY, USA.
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Zhang JJ, Feret M, Chang L, Yang M, Merhi Z. Obesity adversely impacts the number and maturity of oocytes in conventional IVF not in minimal stimulation IVF. Gynecol Endocrinol 2015; 31:409-13. [PMID: 25856299 DOI: 10.3109/09513590.2015.1014785] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the relationship between BMI and oocyte number and maturity in participants who underwent minimal stimulation (mini-) or conventional IVF. METHODS Participants who underwent their first autologous cycle of either conventional (n = 219) or mini-IVF (n = 220) were divided according to their BMI to analyze IVF outcome parameters. The main outcome measure was the number of oocytes in metaphase II (MII). Secondary outcomes included the number of total oocytes retrieved, fertilized (2PN) oocytes, cleavage and blastocyst stage embryos, clinical pregnancy (CP), and live birth (LB) rates. RESULTS In conventional IVF, but not in mini-IVF, the number of total oocytes retrieved (14.5 ± 0.8 versus 8.8 ± 1.3) and MII oocytes (11.2 ± 0.7 versus 7.1 ± 1.1) were significantly lower in obese compared with normal BMI women. Multivariable linear regression adjusting for age, day 3 FSH, days of stimulation, and total gonadotropin dose demonstrated that BMI was an independent predictor of the number of MII oocytes in conventional IVF (p = 0.0004). Additionally, only in conventional IVF, BMI was negatively correlated with the total number of 2PN oocytes, as well as the number of cleavage stage embryos. CONCLUSIONS Female adiposity might impair oocyte number and maturity in conventional IVF but not in mini-IVF. These data suggest that mild ovarian stimulation might yield healthier oocytes in obese women.
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Affiliation(s)
- John J Zhang
- Department of Reproductive Endocrinology and Infertility, New Hope Fertility Center , New York, NY , USA and
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Williams RS, Doody KJ, Schattman GL, Adashi EY. Public reporting of assisted reproductive technology outcomes: past, present, and future. Am J Obstet Gynecol 2015; 212:157-62. [PMID: 24813599 DOI: 10.1016/j.ajog.2014.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
The clinic-specific public reporting of assisted reproductive technology (ART) outcomes has been mandated by Federal law since 1992. As of late, a series of scientific and medical advances have all but deconstructed ART practice patterns thereby demanding that current reporting platforms be reevaluated for their continued ability to afford the public with credible and understandable estimates of conception per initiated cycle. In this Clinical Opinion, we trace the history of the public reporting of ART, describe the recently modified (present day) reporting platform, and explore potential future improvements thereof.
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Clinical use of fertility agents and risk of breast cancer: a recent update for an old problem. Curr Opin Obstet Gynecol 2015; 26:130-7. [PMID: 24751999 DOI: 10.1097/gco.0000000000000067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Female infertility is today a very common, expanding problem and therefore restoring fertility strategies are increasing in the last few years. An association between ovarian stimulation and breast cancer risk has been hypothesized, but the question has not yet been clarified. RECENT FINDINGS In the last 2 years, many important studies have been published on this topic. A lot of new combinations of drugs are in experimentation and other recent drugs are already in current use, such as aromatase inhibitors. Furthermore, the data from older studies were investigated by two recent meta-analyses. SUMMARY Infertility affects many couples in western countries and the use of fertility stimulation techniques is widespread in the last few years, determining personal anxiety, social costs, and organizing difficulties. It is well known that one of the most important causative agents for the development of breast cancer is the proliferative activity of endogenous and exogenous female hormones. Therefore, it seems appropriate to investigate the risk of breast cancer derived from the use of hormonal therapies in infertile women. The final clarification of this question is very important so that all women can realize their dream of having children, with the certainty of not being exposed to an increased risk of breast cancer.
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Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve. Int J Reprod Med 2014; 2014:581451. [PMID: 25763403 PMCID: PMC4334044 DOI: 10.1155/2014/581451] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/17/2022] Open
Abstract
We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR). Inclusion criteria included patients with an anti-Müllerian hormone (AMH) ≤8 pmol/L and/or antral follicle count (AFC) ≤5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5 mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14 mm or larger. The HS group received gonadotropins (≥300 IU/day) throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (P = 0.007). Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (P = 0.034). In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage) and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders.
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Barbosa MAP, Teixeira DM, Navarro PAAS, Ferriani RA, Nastri CO, Martins WP. Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:261-278. [PMID: 24639087 DOI: 10.1002/uog.13366] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate whether the presence or severity of endometriosis affects the outcome of assisted reproductive techniques (ART). METHODS In this systematic review, all studies comparing the outcome of ART in women with and those without endometriosis, or at different stages of the disease, were considered eligible. We used either risk ratio (RR) or mean difference (MD) and their 95%CIs for comparisons. The primary outcome was live birth; the secondary outcome was clinical pregnancy. Miscarriage and the number of oocytes retrieved were examined as additional outcomes. RESULTS We included 92 studies in the review and 78 in the meta-analysis: 20,167 women with endometriosis were compared with 121,931 women without endometriosis, and 1703 women with Stage-III/IV endometriosis were compared with 2227 women with Stage-I/II endometriosis. The following results were observed for the comparison of women with endometriosis vs women without endometriosis: live birth, RR = 0.99 (95%CI, 0.92-1.06); clinical pregnancy, RR = 0.95 (95%CI, 0.89-1.02); miscarriage, RR = 1.31 (95%CI, 1.07-1.59); number of oocytes retrieved, MD = -1.56 (95%CI, -2.05 to -1.08). The following results were observed for the comparison of women with Stage-III/IV vs Stage-I/II endometriosis: live birth, RR = 0.94 (95%CI, 0.80-1.11); clinical pregnancy, RR = 0.90 (95%CI, 0.82-1.00); miscarriage, RR = 0.99 (95%CI, 0.73-1.36); number of oocytes retrieved, MD = -1.03 (95%CI, -1.67 to -0.39). CONCLUSIONS Women with endometriosis undergoing ART have practically the same chance of achieving clinical pregnancy and live birth as do women with other causes of infertility. No relevant difference was observed in the chance of achieving clinical pregnancy and live birth following ART when comparing Stage-III/IV with Stage-I/II endometriosis. The quality of the evidence for the additional examined outcomes was very low, not allowing meaningful conclusions to be drawn.
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Affiliation(s)
- M A P Barbosa
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo (FMRP-USP), Ribeirao Preto, Brazil
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Gleicher N, Kushnir VA, Weghofer A, Barad DH. The "graying" of infertility services: an impending revolution nobody is ready for. Reprod Biol Endocrinol 2014; 12:63. [PMID: 25012752 PMCID: PMC4105876 DOI: 10.1186/1477-7827-12-63] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 07/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As demand for infertility services by older women continues to grow, because achievable in vitro fertilization (IVF) outcomes are widely underestimated, most fertility centers do not offer maximal treatment options with use of autologous oocytes. Limited data suggest that clinical IVF outcomes in excess of what the American Society for Reproductive Medicine (ASRM) considers "futile" can, likely, be achieved up to at least age 45 years. METHODS In an attempt to point out an evolving demographic trend in IVF, we here report our center's IVF data for 2010-2012 and national U.S. data for 1997-2010. Though our center's data are representative of only one IVF center's patients, they, likely, are unique since they probably represent the most adversely selected IVF patient population ever reported and, thus, are predictive of future demographic trends. In addition we performed a systematic review of the literature on the subject based on PubMed, Medline and Google Scholar searches till year-end 2013. The literature search was performed using key words and phrases relevant to fertility treatments in older women. RESULTS As demonstrated by our center's patient demographics and national U.S. data, IVF centers are destined to treat increasingly adversely selected patients. Despite our center's already extremely adversely selected patient population, age-specific IVF cycle outcomes in women above age 40 years, nevertheless, exceeded criteria for "futility" by the ASRM and widely quoted outcome expectations in the literature for patient ages. Age 43 discriminates between better and poorer clinical pregnancy and live birth rates. CONCLUSIONS "Graying" of the infertility populations in the developed world, a problem with potentially far-reaching medical and societal consequences, has so far been only insufficiently addressed in the literature. As women's postmenopausal life spans already exceed postmenarcheal life spans at the start of the 20th century, the "graying" of infertility services can be expected to further accelerate, no longer as in recent decades bringing only women in their 40s into maternity wards but also women in their 50s and 60s. Medicine and society better get ready for this revolution.
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Affiliation(s)
- Norbert Gleicher
- Center for Human Reproduction, New York, NY 10021, USA
- Foundation for Reproductive Medicine, New York, NY 10021, USA
| | | | - Andrea Weghofer
- Center for Human Reproduction, New York, NY 10021, USA
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University Vienna, Vienna 1090, Austria
| | - David H Barad
- Center for Human Reproduction, New York, NY 10021, USA
- Foundation for Reproductive Medicine, New York, NY 10021, USA
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Tomao F, Lo Russo G, Spinelli GP, Stati V, Prete AA, Prinzi N, Sinjari M, Vici P, Papa A, Chiotti MS, Benedetti Panici P, Tomao S. Fertility drugs, reproductive strategies and ovarian cancer risk. J Ovarian Res 2014; 7:51. [PMID: 24829615 PMCID: PMC4020377 DOI: 10.1186/1757-2215-7-51] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/24/2014] [Indexed: 11/12/2022] Open
Abstract
Several adverse effects have been related to infertility treatments, such as cancer development. In particular, the relationship between infertility, reproductive strategies, and risk of gynecological cancers has aroused much interest in recent years. The evaluation of cancer risk among women treated for infertility is very complex, mainly because of many factors that can contribute to occurrence of cancer in these patients (including parity status). This article addresses the possible association between the use of fertility treatments and the risk of ovarian cancer, through a scrupulous search of the literature published thus far in this field. Our principal objective was to give more conclusive answers on the question whether the use of fertility drug significantly increases ovarian cancer risk. Our analysis focused on the different types of drugs and different treatment schedules used. This study provides additional insights regarding the long-term relationships between fertility drugs and risk of ovarian cancer.
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Affiliation(s)
- Federica Tomao
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, University of Rome “Sapienza” Viale Regina Elena 324, 00161 Rome, Italy
| | - Giuseppe Lo Russo
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza,” Corso della Repubblica, 04100 Latina, Italy
| | - Gian Paolo Spinelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza,” Corso della Repubblica, 04100 Latina, Italy
| | - Valeria Stati
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza,” Corso della Repubblica, 04100 Latina, Italy
| | - Alessandra Anna Prete
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza,” Corso della Repubblica, 04100 Latina, Italy
| | - Natalie Prinzi
- Department of Experimental Medicine, University of Rome “Sapienza”, Viale Regina Elena 324, 00161 Rome, Italy
| | - Marsela Sinjari
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza,” Corso della Repubblica, 04100 Latina, Italy
| | - Patrizia Vici
- Department of Medical Oncology, National Cancer Institute of Rome, Italy, Rome
| | - Anselmo Papa
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza,” Corso della Repubblica, 04100 Latina, Italy
| | - Maria Stefania Chiotti
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza,” Corso della Repubblica, 04100 Latina, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, University of Rome “Sapienza” Viale Regina Elena 324, 00161 Rome, Italy
| | - Silverio Tomao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza,” Corso della Repubblica, 04100 Latina, Italy
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Cabry R, Merviel P, Hazout A, Belloc S, Dalleac A, Copin H, Benkhalifa M. Management of infertility in women over 40. Maturitas 2014; 78:17-21. [PMID: 24679892 DOI: 10.1016/j.maturitas.2014.02.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 11/16/2022]
Abstract
Women's fertility potential is declining with age because of multiples intrinsic and extrinsic factors such as life style, oxidative stress and/or endocrine disruptors and is affecting the ability of these women to conceive naturally. This declining fertility potential and the late age of motherhood is increasing significantly the number of patients consulting infertility specialists. Different strategies of investigation and management are proposed to patients over 40 in order to overcome their infertility and improve the live birth rate in these patients. Intra Uterine Insemination (IUI) in women over 40 is associated with a low rate of ongoing pregnancy and IUI should not therefore be offered always as the first line of treatment. When the predictive factors are positive IVF/ICSI seem to be good alternatives until 43 years of age. Customized ovarian stimulation and flexible laboratory methods such as in vitro maturation (IVM), preimplantation genetic diagnosis (PGD), embryo vitrification and transfer after thawing in subsequent natural or artificial cycles can improve the success rate of ART in patients over 40. Meanwhile, oocyte and embryos donation remain good options for patient over 40 with a bad prognosis and can lead to successful ongoing pregnancies until 45 years of age. Ovarian tissue cryopreservation, oocyte vitrification at the germinal vesicle (GV) stage or metaphase II stage present a breakthrough for fertility preservation but the ideal age for starting fertility preservation is still debated as well as the minimum number of oocytes to be vitrified in order to optimize the chances of pregnancy when needed at an older age. This manuscript reports the results of our own experience from patients older than 40 in the light of the published data and discusses the different therapeutic alternatives which can be proposed to patients over 40 consulting ART centres.
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Affiliation(s)
- Rosalie Cabry
- Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France.
| | - Philippe Merviel
- Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France.
| | - Andre Hazout
- Eylau/Unilabs Laboratory, Reproductive Biology Unit, 55 Rue Saint Didier, 75016 Paris, France.
| | - Stephanie Belloc
- Eylau/Unilabs Laboratory, Reproductive Biology Unit, 55 Rue Saint Didier, 75016 Paris, France.
| | - Alain Dalleac
- Eylau/Unilabs Laboratory, Reproductive Biology Unit, 55 Rue Saint Didier, 75016 Paris, France.
| | - Henri Copin
- Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France.
| | - Moncef Benkhalifa
- Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France.
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20
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Magri F, Capelli V, Gaiti M, Brambilla E, Montesion L, Rotondi M, Spinillo A, Nappi RE, Chiovato L. Impaired outcome of controlled ovarian hyperstimulation in women with thyroid autoimmune disease. Thyroid 2013; 23:1312-8. [PMID: 23556516 DOI: 10.1089/thy.2013.0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Controlled ovarian hyperstimulation (COH) is a crucial step of assisted reproductive technology (ART). Thyroid dysfunction and autoimmune thyroid disease (ATD) may negatively affect the outcome of ART, but the underlying mechanisms are still poorly understood. Our aim was to evaluate the respective role of ATD and thyroid function, as assessed by serum thyrotropin (TSH), on the early outcome of COH. METHODS In total, 262 (202 ATD-negative and 60 ATD-positive) euthyroid subfertile women underwent ART. Before COH, serum follicle-stimulating hormone (FSH), luteinizing hormone, and estradiol (E2) were measured at cycle day 3, and progesterone at cycle day 21. At oocyte pickup and at embryo transfer, we evaluated the performance of recombinant FSH (r-FSH), as assessed by serum E2 concentration/total administered r-FSH units (E2/r-FSH) ratio and by oocyte quality. RESULTS At both oocyte pickup and embryo transfer, the performance of r-FSH was significantly poorer in ATD-positive than in ATD-negative women. In the ATD-positive group, women with a TSH <2.5 mIU/L displayed a higher serum E2 concentration at oocyte pickup, a higher E2/r-FSH ratio, and a greater number of mature metaphase II oocytes than women with a TSH >2.5 mIU/L. When ATD-positive women were divided into quartiles according to their serum TSH level, both the ovarian response to r-FSH and the number of mature metaphase II oocytes significantly increased from the lowest to the highest quartiles of serum TSH concentration. CONCLUSIONS ATD has a negative effect on the early outcome of COH, but this negative influence may be avoided with adequate levothyroxine therapy aimed at keeping TSH <2.5 mU/L. Thyroid antibodies and serum TSH should be checked in any woman undergoing ART.
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MESH Headings
- Adult
- Cohort Studies
- Ectogenesis/drug effects
- Embryo Transfer
- Female
- Fertility Agents, Female/pharmacology
- Fertility Agents, Female/therapeutic use
- Follicle Stimulating Hormone, Human/pharmacology
- Follicle Stimulating Hormone, Human/therapeutic use
- Hormone Replacement Therapy
- Humans
- Infertility, Female/complications
- Infertility, Female/therapy
- Italy/epidemiology
- Ovarian Hyperstimulation Syndrome/blood
- Ovarian Hyperstimulation Syndrome/complications
- Ovarian Hyperstimulation Syndrome/immunology
- Ovarian Hyperstimulation Syndrome/prevention & control
- Ovary/drug effects
- Ovary/immunology
- Ovulation/drug effects
- Ovulation Induction/adverse effects
- Pregnancy
- Pregnancy Rate
- Recombinant Proteins/pharmacology
- Recombinant Proteins/therapeutic use
- Retrospective Studies
- Sperm Injections, Intracytoplasmic
- Thyroid Gland/drug effects
- Thyroid Gland/immunology
- Thyroid Gland/physiopathology
- Thyroiditis, Autoimmune/complications
- Thyroiditis, Autoimmune/drug therapy
- Thyroiditis, Autoimmune/immunology
- Thyroiditis, Autoimmune/physiopathology
- Thyrotropin/blood
- Thyroxine/therapeutic use
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Affiliation(s)
- Flavia Magri
- 1 Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia , Pavia, Italy
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Lo Russo G, Spinelli GP, Tomao S, Rossi B, Frati L, Panici PB, Vici P, Codacci Pisanelli G, Tomao F. Breast cancer risk after exposure to fertility drugs. Expert Rev Anticancer Ther 2013; 13:149-57. [PMID: 23406556 DOI: 10.1586/era.12.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years, there has been an increase in the diagnosis of infertility. In industrialized countries, approximately 15% of couples experience this problem today, with a negative impact on quality of life. For this reason, assisted reproductive technologies and other treatments, finalized to overcome infertility, have become very common in clinical practice. For a long time, different ovulation-inducing drugs have been used for ovarian follicle stimulation, either as independent therapies or treatments used during in vitro fertilization cycles. Despite this long-term use, the medical care for infertility gave rise to a lively debate about the potential risk of developing breast cancer that has never been settled. Many studies have been conducted to address this question; but their results have been, and still are, contradictory. The aim of this review is to determine the potential link between the use of fertility drugs and the risk of developing breast cancer in women treated for infertility.
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Affiliation(s)
- Giuseppe Lo Russo
- Department of Medical-Surgical Sciences and Biotechnologies, University of Rome Sapienza Corso della Repubblica, 04100, Latina, Italy
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22
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Baker VL. Mild ovarian stimulation for in vitro fertilization: one perspective from the USA. J Assist Reprod Genet 2013; 30:197-202. [PMID: 23381553 DOI: 10.1007/s10815-013-9946-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To provide a perspective regarding mild ovarian stimulation, taking into account particular issues relevant in the United States METHODS Literature review and editorial commentary RESULTS Mild ovarian stimulation for IVF has some proven and some theoretical advantages over conventional stimulation, such as lower risk of ovarian hyperstimulation syndrome and lower cost per fresh IVF cycle. However, cumulative live birth rate, including transfers from fresh and frozen embryos, is likely to be lower with mild stimulation. The cost-effectiveness of mild stimulation IVF in the United States has not been established. CONCLUSIONS Mild ovarian stimulation is an appropriate option to consider for certain patient groups or based on patient preference. However, significant potential disadvantages limit its widespread acceptability for patients in the United States at this time.
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Affiliation(s)
- Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 900 Welch Road, Palo Alto, CA 94304, USA.
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Sugiyama R, Nakagawa K, Nishi Y, Ojiro Y, Juen H, Sugiyama R, Kuribayashi Y. Using a mild stimulation protocol combined with clomiphene citrate and recombinant follicle-stimulating hormone to determine the optimal number of oocytes needed to achieve pregnancy and reduce the concerns of patients. Reprod Med Biol 2013; 12:105-110. [PMID: 29699137 PMCID: PMC5907126 DOI: 10.1007/s12522-013-0148-y] [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: 01/08/2013] [Accepted: 04/01/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate how many oocytes are needed to achieve an adequate pregnancy rate per 1 oocyte retrieval cycle in mild ovarian stimulation. METHODS This protocol consisted of clomiphene citrate and recombinant-follicle-stimulating hormone injection without a gonadotropin-releasing hormone-antagonist. From January 2009 through December 2010, there were 1,227 women who underwent assisted reproductive technologies treatment with mild stimulation at the Sugiyama Clinic. The overall pregnancy rate per single oocyte retrieval cycle was evaluated using both fresh and cryopreserved-and-thawed embryos according to the retrieved oocyte number. RESULTS According to the retrieved oocyte number, a total of 1,227 cycles were divided into 4 groups: group A (the oocyte number <4; 433 cycles), group B (the oocyte number = 4, 5; 317 cycles), group C (the oocyte number = 6, 7; 206 cycles), and group D (the oocyte number ≥8; 271 cycles). The overall pregnancy rates for groups A, B, C, and D were 22.2, 42.9, 52.4, and 56.0 %, respectively, the rates for groups C and D were significantly higher than that for group A (p < 0.01). CONCLUSIONS The optimal number of retrieved oocytes proved to be between 6 and 7 for the patients who received our milder stimulation protocol and experienced no reduction in their overall pregnancy rate.
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Affiliation(s)
- Rikikazu Sugiyama
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1 Ohara, Setagaya‐ku156‐0041TokyoJapan
| | - Koji Nakagawa
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1 Ohara, Setagaya‐ku156‐0041TokyoJapan
| | - Yayoi Nishi
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1 Ohara, Setagaya‐ku156‐0041TokyoJapan
| | - Yuko Ojiro
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1 Ohara, Setagaya‐ku156‐0041TokyoJapan
| | - Hiroyasu Juen
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1 Ohara, Setagaya‐ku156‐0041TokyoJapan
| | - Rie Sugiyama
- Center for Reproductive Medicine and EndoscopySugiyama Clinic Marunouchi1‐6‐2 Marunouchi, Chiyoda‐ku100‐0005TokyoJapan
| | - Yasushi Kuribayashi
- Center for Reproductive Medicine and EndoscopySugiyama Clinic Marunouchi1‐6‐2 Marunouchi, Chiyoda‐ku100‐0005TokyoJapan
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Donoso P, Devroey P. Low tolerance for complications. Fertil Steril 2013; 100:299-301. [PMID: 23806852 DOI: 10.1016/j.fertnstert.2013.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/29/2013] [Accepted: 06/07/2013] [Indexed: 11/27/2022]
Abstract
Assisted reproductive techniques can lead to medical complications such as multiple pregnancy and ovarian hyperstimulation syndrome. A critical appraisal and strategies to reduce the occurrence of these complications are discussed in this manuscript.
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Affiliation(s)
- Patricio Donoso
- Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
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25
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Clomiphene combined with gonadotropins and GnRH antagonist versus conventional controlled ovarian hyperstimulation without clomiphene in women undergoing assisted reproductive techniques: systematic review and meta-analysis. Arch Gynecol Obstet 2012; 287:779-90. [PMID: 23250342 DOI: 10.1007/s00404-012-2672-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the effectiveness and safety of controlled ovarian hyperstimulation (COH) using clomiphene citrate associated with gonadotropin and GnRH antagonist (CC + Ant) versus conventional COH without clomiphene citrate (Non-CC) for women undergoing assisted reproductive techniques (ART). METHODS Systematic review and meta-analysis of randomized controlled-trials comparing CC + Ant versus non-CC. The last search was performed in Apr 13 2012. The following outcomes were retrieved from included trials and compared between CC + Ant versus non-CC: live birth, clinical pregnancy, ovarian hyperstimulation syndrome (OHSS), miscarriage, multiple pregnancy, endometrial thickness, total oocytes retrieved, MII oocytes retrieved, total gonadotropin used, and duration of COH. RESULTS Seven trials (702 participants) were included. There was no significant difference in live birth (55/182 = 30.2 % vs. 47/181 = 26.0 %, p = 0.26, CC + Ant vs. non-CC, respectively), clinical pregnancy (98/346 = 28.3 % vs. 84/356 = 23.6 %, p = 0.12), miscarriage (6/35 = 17.1 % vs. 7/32 = 21.9 %, p = 0.42), endometrial thickness, and on the number of oocytes retrieved. There was a significant reduction in OHSS (1/216 = 0.5 % vs. 9/217 = 4.1 %, p = 0.01), consumption of gonadotropins, and duration of COH. CONCLUSIONS Compared to non-CC, CC + Ant is likely to reduce the risk of OHSS, medication costs, and the duration of COH without evidence of effect on live birth and clinical pregnancy. More trials are still needed to improve the quality of the evidence. Future studies should evaluate women with PCOS or at increased risk of OHSS, quality of life, satisfaction with the treatment, total cost per live birth, and frequency of congenital anomalies.
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Brezina PR, Ning N, Mitchell E, Zacur HA, Baramki TA, Zhao Y. Recent Advances in Assisted Reproductive Technology. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2012. [DOI: 10.1007/s13669-012-0019-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gleicher N, Weghofer A, Barad DH. A case–control pilot study of low-intensity IVF in good-prognosis patients. Reprod Biomed Online 2012; 24:396-402. [DOI: 10.1016/j.rbmo.2011.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 12/16/2011] [Accepted: 12/22/2011] [Indexed: 11/27/2022]
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