1
|
Kol S, Castillo Farfan JC, Trolice MP, Quaas AM. Monitoring of controlled ovarian stimulation in IVF. J Assist Reprod Genet 2024:10.1007/s10815-024-03182-x. [PMID: 38963604 DOI: 10.1007/s10815-024-03182-x] [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: 05/15/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024] Open
Abstract
Since the inception of in vitro fertilization (IVF), monitoring of controlled ovarian stimulation (COS) has traditionally involved numerous appointments for ultrasound and laboratory testing to guide medication use and dosing, determine trigger timing, and allow for measures to reduce the risk of ovarian hyperstimulation syndrome (OHSS). Recent advances in the field of assisted reproductive technology (ART) have called into question the timing and frequency of COS monitoring appointments, as discussed in this commentary.
Collapse
Affiliation(s)
- Shahar Kol
- IVF Unit, Elisha Hospital, Haifa, Israel
| | | | - Mark P Trolice
- Fertility Care, The IVF Center Orlando, Orlando, FL, USA
| | - Alexander M Quaas
- Shady Grove Fertility, 462 Stevens Ave., Ste. 206, Solana Beach, San Diego, CA, 92075, USA.
| |
Collapse
|
2
|
Yerushalmi GM, Avraham S, Kedem A, Youngster M, Barkat J, Baruchin O, Gat I, Yaakov O, Gidoni Y, Hourvitz A. GnRH agonist early follicular challenge test as a predictor of ovarian response in antagonist cycles for fertility preservation. Sci Rep 2024; 14:14308. [PMID: 38906914 PMCID: PMC11192755 DOI: 10.1038/s41598-024-65059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024] Open
Abstract
The aim of our study was to evaluate if the response to follicular GnRH agonist (GnRHa) trigger be used to predict intracycle ovarian response in GnRH antagonist cycles among women undergoing fertility preservation IVF. We conducted a prospective study of 146 GnRH antagonist oocyte pickup (OPU) cycles to evaluate GnRHa stimulation test (GAST). On day 2 of the cycle, basal E2 were measured, followed by injection of 0.2 mg GnRHa as part of the initial ovarian stimulation. 12 h later blood sampling was repeated (GAST E3). E2 response was used as test parameter. The major outcome was the number of mature cryopreserved oocytes. We found a linear correlation between both GAST E3 level and GAST E3/E2 ratio and number of M2 oocytes. ROC curve analysis of GAST E3, GAST E3/E2 ratio, AFC and day 3 FSH for > 15 M2 and < 5 M2 oocytes was calculated. For GAST E3 levels obtaining < 5 M2 oocytes, an AUC value of 0.79 was found. For GAST E3 levels obtaining > 15 M2 oocytes, AUC value of 0.8. Patients with GAST E3 ≤ 384 pmol/l has 58.6% risk to obtain < 5 oocytes. Patients younger than 35 with GAST E3 > 708 pmol/l have 66% chance for freezing > 15 oocytes. The response to single GnRHa administration during GnRH antagonist cycle can be used as biomarker of ovarian reserve. This simple, widely available marker, which reflect the estradiol response of small follicles, might predict the response of the specific cycle, and can potentially be used to adjust the treatment dose.Trial registration number: 0304-20-ASF.
Collapse
Affiliation(s)
- Gil M Yerushalmi
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel.
| | - Sarit Avraham
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Alon Kedem
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Michal Youngster
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Barkat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Baruchin
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Odelia Yaakov
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Gidoni
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
- Alan and Ada Selwyn Chair for Clinical Infertility Research and Molecular Medicine, Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Del Gallego R, Lawrenz B, Ata B, Kalafat E, Melado L, Elkhatib I, Fatemi H. Association of 'normal' early follicular FSH concentrations with unexpected poor or suboptimal response when ovarian reserve markers are reassuring: a retrospective cohort study. Reprod Biomed Online 2024; 48:103701. [PMID: 38309124 DOI: 10.1016/j.rbmo.2023.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/06/2023] [Accepted: 11/06/2023] [Indexed: 02/05/2024]
Abstract
RESEARCH QUESTION Are basal FSH measurements, when elevated within its normal range, useful for assessing overall ovarian response and predicting unexpected poor or suboptimal ovarian response? DESIGN Retrospective cohort study of ovarian stimulation cycles. RESULTS A total of 1058 ovarian stimulation cycles (891 first, 167 repeated) were included. Anti-Müllerian hormone (AMH) values were categorized into four (0 to ≤0.6, >0.6 to ≤1.2, >1.2 to ≤3.0, >3.0 to ≤6.25 ng/ml) and basal FSH levels into four groups (<25th percentile: >3.5 to 6.1 IU/ml; 25-75th percentile: >6.1 to ≤8.5 IU/ml; >75-90th percentile: >8.5 to ≤9.9 IU/ml; >90th percentile: >9.9 to ≤12.5 IU/ml). Including only first cycles, a significant independent effect of basal FSH on retrieved cumulus-oocyte complex (COC) count was seen for all basal FSH categories (>90th, >75 to ≤90th, >25 to ≤75th compared with ≤25th percentile, P < 0.001, P = 0.001 and P = 0.007, respectively), when adjusted for age, body mass index (BMI), AMH, antral follicle count (AFC), starting dose and gonadotrophin type. Including only first cycles, patients aged 35 years or older with AFC of 5 or above and AMH 1.2 ng/ml or above, showed significantly higher odds of unexpected poor or suboptimal response if they had higher basal FSH values. Most prominently in the above 90th percentile group (OR 8.64, 95% CI 2.84 to 28.47 compared with <25th percentile) but lower categories (>25th to ≤75th percentile: OR 3.04, 95% CI 1.42 t 6.99; >75th to ≤90th percentile: OR 3.47, 95% CI 1.28 to 9.83 compared with ≤25th percentile) also showed a significant association after adjusting for age, AMH, BMI, AFC, dose, and gonadotrophin type. In patients with a second cycle, an increase in FSH levels in the second round compared with the first was associated with fewer retrieved COCs (estimate: -0.44, 95% CI -0.44 to -0.05, P = 0.027). This effect was adjusted for changes in age, FSH, AFC, starting dose, stimulation duration and change in medication type. CONCLUSIONS Basal FSH is independently associated with overall ovarian response. Moreover, it is associated with unexpected poor or suboptimal response in patients, who would fulfill POSEIDON group 2 criteria after oocyte retrieval.
Collapse
Affiliation(s)
| | - Barbara Lawrenz
- ART Fertility Clinic, Royal Marina Village, B22-23, Abu Dhabi, UAE; Department of Reproductive Medicine UZ Ghent, Belgium.
| | - Baris Ata
- ART Fertility Clinic, Jumeirah St - Umm Suqeim - Umm Suqeim 3 - Dubai, UAE; Faculty of Medicine, Department of Obstetrics & Gynecology, Koc University, Istanbul, Turkey
| | - Erkan Kalafat
- ART Fertility Clinic, Jumeirah St - Umm Suqeim - Umm Suqeim 3 - Dubai, UAE; Faculty of Medicine, Department of Obstetrics & Gynecology, Koc University, Istanbul, Turkey
| | - Laura Melado
- ART Fertility Clinic, Royal Marina Village, B22-23, Abu Dhabi, UAE
| | - Ibrahim Elkhatib
- ART Fertility Clinic, Royal Marina Village, B22-23, Abu Dhabi, UAE; School of Biosciences, University of Kent, Canterbury, UK
| | - Human Fatemi
- ART Fertility Clinic, Royal Marina Village, B22-23, Abu Dhabi, UAE; ART Fertility Clinic, Jumeirah St - Umm Suqeim - Umm Suqeim 3 - Dubai, UAE
| |
Collapse
|
4
|
Reitz L, Balaya V, Pache B, Feki A, Le Conte G, Benammar A, Ayoubi JM. Ovarian Follicular Response Is Altered by Salpingectomy in Assisted Reproductive Technology: A Pre- and Postoperative Case-Control Study. J Clin Med 2023; 12:4942. [PMID: 37568343 PMCID: PMC10419397 DOI: 10.3390/jcm12154942] [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: 05/22/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Objectives: The goal of this study was to assess the effect of unilateral salpingectomy on the number of mature follicles in the ipsilateral ovary during an assisted reproductive technology (ART) stimulation cycle, as compared to the contralateral ovary. Methods: This was a retrospective, single-center, case-control cohort study conducted from 2017 to 2022. Patients from 18 to 43 years old who underwent at least one ART cycle before and after a unilateral salpingectomy were included. The number of recruited follicles, including mature (≥16 mm) and intermediate follicles (13-15.5 mm), on the salpingectomy side (case) were compared to those present on the contralateral ovary (control) during an ART attempt. To take into account the inter-ovarian variability, the comparison was performed on two ART cycles, performed before then after the salpingectomy. Results: Overall, 24 patients were included in our study. While the number of mature follicles was similar in both ovaries before surgery, the mean number of mature follicles was significantly reduced after salpingectomy in the operated side, as compared to the control side, being, respectively 3.00 vs. 5.08 (p = 0.048). There was no significant difference between the intermediate and total recruited follicles. Conclusions: Our study suggests that salpingectomy may impact the follicle recruitment on the ipsilateral side by altering the vascularization during mesosalpinx coagulation. Gynecologists should be mindful of this concept and accurately set surgical indications. Beyond the indication, this emphasizes the critical role of having infertility surgeons sensitive to fertility preservation for optimal management of ART patients. Further studies with larger patient populations are required to confirm these results.
Collapse
Affiliation(s)
- Laurianne Reitz
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
- Gynecology and Obstetrics Unit, University Hospital of Reunion Island, BP 350, 97448 Saint Pierre Cedex, France
- Department of Obstetrics and Gynecology, Félix Guyon Hospital, CHU Nord of La Réunion, 97400 Saint-Denis, France;
| | - Vincent Balaya
- Department of Obstetrics and Gynecology, Félix Guyon Hospital, CHU Nord of La Réunion, 97400 Saint-Denis, France;
| | - Basile Pache
- Obstetrics and Gynecology Department, Fribourg Cantonal Hospital, 1708 Fribourg, Switzerland; (B.P.); (A.F.)
- Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Anis Feki
- Obstetrics and Gynecology Department, Fribourg Cantonal Hospital, 1708 Fribourg, Switzerland; (B.P.); (A.F.)
- Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Grégoire Le Conte
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
| | - Achraf Benammar
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
| | - Jean-Marc Ayoubi
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
- Medical School, University of Versailles Saint-Quentin, 78000 Versailles, France
| |
Collapse
|
5
|
Bosch A, Albero S, Castillo JC, Ten J, Guerrero J, Ortiz JA, Bernabeu A, Bernabeu R. Does mRNA COVID-19 vaccination in oocyte donors impact ovarian stimulation parameters or IVF outcomes for recipients? Reprod Biomed Online 2023; 46:697-704. [PMID: 36803967 PMCID: PMC9831660 DOI: 10.1016/j.rbmo.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023]
Abstract
RESEARCH QUESTION What is the effect of mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in young oocyte donors in terms of ovarian response to stimulation, fertilization rate, embryo development and clinical outcomes in recipients? DESIGN This retrospective, multicentre cohort study evaluated 115 oocyte donors who had undergone at least two ovarian stimulation protocols (before and after complete SARS-CoV-2 vaccination) between November 2021 and February 2022. Comparisons were made of the primary outcomes of days of stimulation, total dose of gonadotrophins and laboratory performance in ovarian stimulation in oocyte donors before and after vaccination. A total of 136 cycles in matched recipients were analysed as secondary outcomes and, from those, 110 women received a fresh single-embryo transfer, with analysis of biochemical β-human chorionic gonadotrophin concentrations and rates of clinical pregnancy with heartbeat. RESULTS Longer stimulation was required in the post-vaccination than pre-vaccination group (10.31 ± 1.5 versus 9.51 ± 1.5 days; P < 0.001) along with higher gonadotrophin consumption (2453.5 ± 740 versus 2235.5 ± 615 IU; P < 0.001) with a similar starting dose of gonadotrophins in both groups. More oocytes were retrieved in the post-vaccination group (16.62 ± 7.1 versus 15.38 ± 7.0; P = 0.02). However, the number of metaphase II (MII) oocytes was similar between groups (pre-vaccination 12.61 ± 5.9 versus post-vaccination 13.01 ± 6.6; P = 0.39) and the ratio of MII/retrieved oocytes favoured the pre-vaccination group (0.83 ± 0.1 versus 0.77 ± 0.2 post-vaccination; P = 0.019). In recipients with a similar number of provided oocytes, the fertilization rate, total number of obtained blastocysts, number of top-quality blastocysts, and rates of biochemical pregnancy and clinical pregnancy with heartbeat were not significantly different between groups. CONCLUSIONS This study shows no adverse influence of mRNA SARS-CoV-2 vaccination on ovarian response in a young population.
Collapse
Affiliation(s)
- Aránzazu Bosch
- Department of Reproductive Medicine, Instituto Bernabeu, Cartagena, Spain.
| | - Sonia Albero
- Department of Reproductive Medicine, Accuna, Alicante, Spain
| | | | - Jorge Ten
- Department of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
| | - Jaime Guerrero
- Department of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
| | | | - Andrea Bernabeu
- Department of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
| | - Rafael Bernabeu
- Department of Reproductive Medicine, Instituto Bernabeu, Alicante, Spain
| |
Collapse
|
6
|
Martinez F, Clua E, Roca M, Garcia S, Polyzos NP. Comparison of blastocyst euploidy rates following luteal versus follicular phase stimulation in a GnRH antagonist protocol: a prospective study with repeated ovarian stimulation cycles. Hum Reprod 2022; 37:2777-2786. [PMID: 36269092 DOI: 10.1093/humrep/deac222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Is there any difference in the mean number of euploid embryos following luteal phase start (LS) and follicular phase start (FS) of ovarian stimulation? SUMMARY ANSWER The mean number of euploid blastocysts is equivalent independent of whether the inseminated oocytes are derived from FS or LS. WHAT IS KNOWN ALREADY Starting ovarian stimulation at any time of the cycle ('random-start') is commonly used for emergency fertility preservation in cancer patients. A few retrospective studies have been published evaluating LS in women undergoing ovarian stimulation in the context of IVF, but there is a lack of robust data on the comparative efficacy of LS versus FS.Although 'random start' is commonly used in cancer survivors, few retrospective and uncontrolled studies have been published evaluating luteal phase stimulation in women undergoing ovarian stimulation in the context of IVF. Owing to this evident lack of robust data on the efficacy of LS, guidelines typically recommend the LS approach only for medical reasons and not in the context of IVF. STUDY DESIGN, SIZE, DURATION This is a prospective, equivalence study, with repeated stimulation cycles, conducted between May 2018 and December 2021. Overall, 44 oocyte donors underwent two identical consecutive ovarian stimulation cycles, one initiated in the FS and the other in the LS. The primary outcome of the study was to evaluate whether FS and LS in the same patient would result in equivalent numbers of euploid embryos following fertilization of oocytes with the same sperm sample. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall, 44 oocyte donors underwent two consecutive ovarian stimulation protocols with 150 μg corifollitropin alpha followed by 200 IU recombinant FSH (rFSH) in a fixed GnRH antagonist protocol. The only difference between the two cycles was the day of initiation of ovarian stimulation, which was in the early follicular phase (FS) in one cycle, and in the luteal phase (LS) in the other. Forty-four oocyte recipients participated in the study receiving a mean of six metaphase II (MII) oocytes from each stimulation cycle (FS and LS). All MIIs were inseminated with the corresponding recipient's partner sperm (which had been previously frozen) or donor sperm, in order to safeguard the use of the same sample for either the FS or LS. Following fertilization and blastocyst culture, all generated embryos underwent genetic analysis for aneuploidy screening (preimplantation genetic testing for aneuploidy). MAIN RESULTS AND THE ROLE OF CHANCE FS resulted in a significantly shorter duration of ovarian stimulation (difference between means (DBM) -1.05 (95% CI -1.89; -0.20)) and a lower total additional dose of daily rFSH was needed (DBM -196.02 (95% CI -319.92; -72.12)) compared with LS. The donors' hormonal profile on the day of trigger was comparable between the two stimulation cycles, as well as the mean number of oocytes (23.70 ± 10.79 versus 23.70 ± 8.81) (DBM 0.00 (95% CI -3.03; 3.03)) and MII oocytes (20.27 ± 9.60 versus 20.73 ± 8.65) (DBM -0.45 (95% CI -2.82; 1.91)) between FS and LS cycles, respectively. Following fertilization, the overall blastocyst formation rate was 60.70% with a euploid rate of 57.1%. Comparisons between the two stimulation cycles did not reveal any significance differences in terms of fertilization rates (71.9% versus 71.4%), blastocyst formation rates (59.4% versus 62%) and embryo euploidy rates (56.9 versus 57.3%) for the comparison of FS versus LS, respectively. The mean number of euploid blastocysts was equivalent between the FS (1.59 ± 1.30) and the LS (1.61 ± 1.17), (DBM -0.02 (90%CI -0.48; 0.44)). LIMITATIONS, REASONS FOR CAUTION The study was performed in young, potentially fertile oocyte donors who are patients with high blastocyst euploidy rates. Although results may be extrapolated to young infertile women with good ovarian reserve, caution is needed prior to generalizing the results to infertile women of older age. WIDER IMPLICATIONS OF THE FINDINGS The current study provides evidence that initiation of ovarian stimulation in the luteal phase in young potentially fertile women may result in a comparable number of oocytes and comparable blastocyst euploidy rates compared with follicular phase stimulation. This may imply that in case of a freeze-all protocol in young patients with good ovarian reserve, clinicians may safely consider initiation of ovarian stimulation during the luteal phase. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by an unrestricted grant from MSD/Organon. N.P.P. has received Research grants and honoraria for lectures from: Merck Serono, MSD/Organon, Ferring Pharmaceuticals, Besins Intenational, Roche Diagnostics, IBSA, Theramex, Gedeon Richter. F.M., E.C., M.R. and S.G. declared no conflict of interests. TRIAL REGISTRATION NUMBER The study was registered at Clinical Trials Gov (NCT03555942).
Collapse
Affiliation(s)
- Francisca Martinez
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Elisabet Clua
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Marta Roca
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Sandra Garcia
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | - Nikolaos P Polyzos
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| |
Collapse
|
7
|
Polyzos NP, Ayoubi JM, Pirtea P. General infertility workup in times of high assisted reproductive technology efficacy. Fertil Steril 2022; 118:8-18. [PMID: 35725122 DOI: 10.1016/j.fertnstert.2022.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/04/2022]
Abstract
The assessments of oocyte quality and quantity and endocrine profile have traditionally been the cornerstone of the general workup of couples with infertility. Over the years, several clinical, hormonal, and functional biomarkers have been adopted to assess ovarian function and identify endocrine disorders before assisted reproductive technology. Furthermore, the genetic workup of patients has drastically changed, introducing novel markers. This not only allowed the prediction of response to ovarian stimulation but also contributed toward the development of a safer and more efficient management of women undergoing assisted reproductive technology. The scope of this review is to provide an overview of the current and novel strategies adopted for the assessment of ovarian function and ovulatory and endocrine disorders in women planning to conceive. Furthermore, it aims to provide an insight in the role of novel genetic biomarkers and use of expanded carrier screening as part of preliminary workup of women with infertility.
Collapse
Affiliation(s)
- Nikolaos P Polyzos
- Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain; Faculty of Medicine and Health Sciences, Ghent University (UZ Gent), Gent, Belgium.
| | - Jean Marc Ayoubi
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| | - Paul Pirtea
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch-Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| |
Collapse
|
8
|
Reliability of AMH and AFC measurements and their correlation: a large multicenter study. J Assist Reprod Genet 2022; 39:1045-1053. [PMID: 35243569 PMCID: PMC9107554 DOI: 10.1007/s10815-022-02449-5] [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: 07/30/2021] [Accepted: 02/28/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Anti-Müllerian hormone (AMH) and antral follicle count (AFC) are correlated with the ovarian response, but their reliability and reproducibility are questionable. This large multicenter study describes their distribution, inter-cycle and inter-center variability, and their correlation. METHODS A total of 25,854 IVF cycles among 15,219 patients were selected in 12 ART centers. Statistical distribution of AMH and AFC was studied by using the Kolmogorov-Smirnov test and Shapiro goodness of fit test. The reproducibility of AFC and AMH was measured using a mixed model regressing the logarithmic transformation of AFC with age. RESULTS The distribution of AMH and AFC was characterized by a wide dispersion of values, twice more important for AFC, and a logarithmic distribution. The faster decline in AMH than in AFC with age suggests that their correlation changes with age. AMH and AFC showed a very low proportion of concordance in the range of expected poor responders according to Bologna cutoffs. The heterogeneity for AMH and AFC across centers was small, but much larger across patients within each center. Concerning the patients with several successive cycles, the reproducibility for AMH seemed much better than for AFC. Comparing respective performances of AMH and AFC for the prediction of ovarian response depended on the local conditions for measuring these indicators and on the reproducibility of results improved over time. CONCLUSION Distribution of AMH and AFC was characterized by the wide dispersion of values, and a logarithmic distribution. Establishing cutoffs or a direct relationship AMH/AFC without considering age seems hazardous. Correlation between AMH and AFC was very poor in the range of poor responders.
Collapse
|
9
|
El-Attar EA, Hosny TA, Ichihara K, Bedair RN, Tork ASED. Nomogram of age-specific anti-Müllerian hormone levels in healthy Egyptian females. PLoS One 2021; 16:e0254858. [PMID: 34310641 PMCID: PMC8312962 DOI: 10.1371/journal.pone.0254858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Anti-Müllerian hormone (AMH) is an important determinant of ovarian reserve in fertility workups in many clinical settings. Thus, we investigated the age dependent decline in AMH specific to the Egyptian population and sought to establish an age dependent reference interval parametrically. METHODS Serum samples were collected from 841 apparently healthy women. AMH was measured using an electro-chemiluminescent technique. Box-Cox power transformation was used to make the AMH distribution Gaussian for parametric derivation of reference intervals. RESULTS Power of 0.4 was found optimal for Gaussian transformation of AMH reference values. We demonstrate the strong negative relation between circulating AMH and female age with Spearman's correlation coefficient of rS = -0.528. Age-specific reference interval was determined for every 5 years of age from 16 to 49, and nomogram was constructed by smoothing the lines connecting adjacent lower and upper reference limits. CONCLUSION The age-specific reference intervals and the age-AMH nomogram could be valuable in the clinical practice of in reproductive medicine. To our knowledge, this is the first study to confirm AMH levels in Egyptian females. We were able to explore age-related AMH levels specific to Egyptian females in the fertile age group and to treat skewed AMH data in a multi-step scheme using power transformation. Thus, a more accurate nomogram was constructed accommodating a profile delineated for a wide age range and a rescaled AMH axis improving its usability.
Collapse
Affiliation(s)
- Eman Ahmed El-Attar
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Tamer A. Hosny
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Rania N. Bedair
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ahmed Salah El-Din Tork
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| |
Collapse
|
10
|
Kasapoglu I, Orhan A, Aslan K, Sen E, Kaya A, Avcı B, Uncu G. Are all antral follicles the same? Size of antral follicles as a key predictor for response to controlled ovarian stimulation. J OBSTET GYNAECOL 2021; 42:461-466. [PMID: 34155958 DOI: 10.1080/01443615.2021.1910640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to evaluate whether antral follicle size has any value with respect to antral follicle count (AFC) in predicting ovarian response to controlled ovarian stimulation. Patients who were considered to be normal responders based on their ovarian reserve markers were consecutively recruited. Total AFC was the number of 2-10 mm follicles in both ovaries. Antral follicles were separated into two subgroups according to the size: 2-5 mm and 6-10 mm follicles. Patients were divided into two main groups according to ovarian response to COS. Group 1 (suboptimal response, 4-9 oocytes retrieved, n = 61) and Group 2 (normal responders, ≥10 oocytes retrieved, n = 65). Demographic parameters were comparable between the groups. The number of 2-5 mm follicles was significantly lower in the suboptimal response group (5 [4:7] and 8 [6:10], respectively, p < .001). The ratio of 2-5 mm follicles to total antral follicles was also significantly lower in Group 1 (44.4% and 75%, respectively, p < .001). The ratio of small antral follicles was positively correlated with ovarian response (r = 0.587, p < .001). In conclusion, the ratio of small (2-5 mm) antral follicles could be a more specific predictive marker than AFC for ovarian response.IMPACT STATEMENTWhat is already known on this subject? Prediction of the ovarian response during ovarian stimulation is commonly based on antral follicle count and anti-mullerian hormone. The ovarian response may be inadequate even in patients with normal antral follicle count and anti-mullerian hormone.What do the results of this study add? A high ratio of small-size (2-5 mm) basal antral follicles is a predictive factor for higher ovarian response to ovarian hyperstimulation.What are the implications of these findings for clinical practice and/or further research? To obtain optimal ovarian response, the antral follicles should be evaluated initially in a more detailed and systematic way by taking their sizes into consideration in addition to their counts. Small antral follicle count rather than whole antral follicle count may be beneficial for optimising the ovarian response. Future studies may determine the cut off values of small antral follicle count for high/poor ovarian response.
Collapse
Affiliation(s)
- Isil Kasapoglu
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Adnan Orhan
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Kiper Aslan
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Esra Sen
- Department of Histology and Embryology, Istanbul Aydin University, Istanbul, Turkey
| | - Aysenur Kaya
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Berrin Avcı
- Department of Histology and Embryology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Gurkan Uncu
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| |
Collapse
|
11
|
Camargo-Mattos D, García U, Camargo-Diaz F, Ortiz G, Madrazo I, Lopez-Bayghen E. Initial ovarian sensitivity index predicts embryo quality and pregnancy potential in the first days of controlled ovarian stimulation. J Ovarian Res 2020; 13:94. [PMID: 32807228 PMCID: PMC7433193 DOI: 10.1186/s13048-020-00688-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To determine if a modified ovarian sensitivity index (MOSI), based on initial follicular measurements and the initial follicle-stimulating hormone (FSH) dose, can predict the production of high-quality embryos for successful implantation during in vitro fertilization (IVF). METHODS This study consisted of two phases: 1) a retrospective study and 2) a prospective observational study. For the first phase, 363 patients charts were reviewed, of which 283 had embryos transferred. All women underwent a standardized antagonist-based IVF protocol. At the first follow-up (Day 3/4), the number and size of the follicles were determined. MOSI was calculated as ln (number follicles (≥6 mm) × 1000 / FSH initial dose). Afterward, the number and quality of the ova, embryo development, and the number and quality of the blastocysts were determined. Embryo implantation was confirmed by β-hCG. For the second phase, 337 IVF cycles were followed to determine MOSI's accuracy. RESULTS MOSI could predict the production of ≥4 high-quality embryos by Day 2 (AUC = 0.69, 95%CI:0.63-0.75), ≥2 blastocysts (AUC = 0.74, 95%CI:0.68-0.79), and ≥ 35% rate of blastocyst formation (AUC = 0.65, 95%CI:0.58-0.72). Using linear regression, MOSI was highly associated with the number of ova captured (β = 5.15), MII oocytes (β = 4.31), embryos produced (β = 2.90), high-quality embryos (β = 0.98), and the blastocyst formation rate (β = 0.06, p < 0.01). Using logistic regression, MOSI was highly associated with achieving ≥4 high-quality embryos (odds ratio = 2.80, 95%CI:1.90-4.13), ≥2 blastocysts (odds ratio = 3.40, 95%CI:2.33-4.95), and ≥ 35% blastocysts formation rate (odds ratio = 1.96, 95%CI:1.31-2.92). This effect was independent of age, BMI, and antral follicle count. For implantation, MOSI was significantly associated with successful implantation (odds ratio = 1.79, 95%CI:1.25-2.57). For the prospective study, MOSI was highly accurate at predicting ≥6 high-quality embryos on Day 2 (accuracy = 68.5%), ≥6 blastocysts (accuracy = 68.0%), and a blastocyst formation rate of ≥35% (accuracy = 61.4%). CONCLUSION MOSI was highly correlated with key IVF parameters that are associated with achieved pregnancy. Using this index with antagonist cycles, clinicians may opt to stop an IVF cycle, under the assumption that the cycle will fail to produce good blastocysts, preventing wasting the patient's resources and time.
Collapse
Affiliation(s)
- David Camargo-Mattos
- Clinical Research, Instituto de Infertilidad y Genética México SC, Ingenes, México City, Mexico
| | - Uziel García
- Clinical Research, Instituto de Infertilidad y Genética México SC, Ingenes, México City, Mexico
| | - Felipe Camargo-Diaz
- Clinical Research, Instituto de Infertilidad y Genética México SC, Ingenes, México City, Mexico
| | - Ginna Ortiz
- Clinical Research, Instituto de Infertilidad y Genética México SC, Ingenes, México City, Mexico
| | - Ivan Madrazo
- Clinical Research, Instituto de Infertilidad y Genética México SC, Ingenes, México City, Mexico
| | - Esther Lopez-Bayghen
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Avenida Instituto Politécnico Nacional 2508, San Pedro Zacatenco, 07360, México City, Mexico.
| |
Collapse
|
12
|
Xie S, Zhang Q, Zhao J, Hao J, Fu J, Li Y. MiR-423-5p may regulate ovarian response to ovulation induction via CSF1. Reprod Biol Endocrinol 2020; 18:26. [PMID: 32264887 PMCID: PMC7137414 DOI: 10.1186/s12958-020-00585-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We have previously shown that hsa-miR-423-5p expression in ovarian granulosa cells is decreased in high ovarian response populations. The objective of the present study was to find the target gene and mechanism for miR-423-5p involved in ovarian response regulation. METHODS (a) TargetScan was used to predict the target gene of hsa-miR-423-5p. (b) A model for hsa-miR-423-5p overexpression or inhibition was constructed by transfecting KGN cells with lentivirus. CSF1 mRNA and protein expression and luciferase activity were measured. (c) The cell cycles of control and lentivirus treated KGN cells were analyzed. Western blot was used to measure the expression of CDKN1A in KGN cells. (d) The concentration of E2 in KGN cell culture medium were measured. RESULTS (a) TargetScan revealed that the 3' un-translated region of CSF1 matched 11 bases at the 5' end of miR-423-5p, making it a likely target gene. (b) Overexpression or inhibition of miR-423-5p were associated with respective decreases or increases in CSF1 expression (both mRNA and protein) (p < 0.05) and luciferase activity (p < 0.05). (c) When miR-423-5p expression increased, the number of G0/G1 phase cells and the expression of CDKN1A protein increased while estradiol concentrations in the cell culture solution decreased (p < 0.05). However, when miR-423-5p expression decreased, the number of S phase cells increased and E2 concentrations increased while the expression of CDKN1A protein decreased (p < 0.05). CONCLUSIONS Colony stimulating factor 1 is a target gene of miR-423-5p and that it may regulate ovarian response to ovulation induction by affecting granulosa cells proliferation and estrogen secretion.
Collapse
Affiliation(s)
- Shi Xie
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Human Province, Changsha, Hunan, China
| | - Qiong Zhang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Human Province, Changsha, Hunan, China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Human Province, Changsha, Hunan, China
| | - Jie Hao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Human Province, Changsha, Hunan, China
| | - Jing Fu
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
- Clinical Research Center For Women's Reproductive Health In Human Province, Changsha, Hunan, China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China.
- Clinical Research Center For Women's Reproductive Health In Human Province, Changsha, Hunan, China.
| |
Collapse
|
13
|
von Wolff M, Roumet M, Stute P, Liebenthron J. Serum anti-Mullerian hormone (AMH) concentration has limited prognostic value for density of primordial and primary follicles, questioning it as an accurate parameter for the ovarian reserve. Maturitas 2020; 134:34-40. [PMID: 32143774 DOI: 10.1016/j.maturitas.2020.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/21/2019] [Accepted: 02/03/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To evaluate the prognostic value of anti-Mullerian hormone (AMH) levels in estimating the ovarian density of primordial and primary follicles, which can be assumed to reflect the real ovarian reserve. STUDY DESIGN A total of 537 women, average age 30.4 years (range 8.0-43.7 years), underwent ovarian tissue cryopreservation prior to gonadotoxic therapies due to malignant diseases which do not affect ovarian reserve parameters. Standardized ovarian biopsies were obtained, and follicular density was analysed. The prognostic accuracy of serum AMH in estimating ovarian follicle density was evaluated. MAIN OUTCOME MEASURES Histologically determined follicle density, AMH serum concentration and their correlation. RESULTS In children, follicle density was high but AMH concentration was low. AMH concentration was predicted to be maximum at the age of 15.5 years. In women aged over 15.5 years, the relationship between AMH concentration and follicle density was evaluated. Crude analysis revealed that serum AMH levels and follicular density were moderately correlated (r = 0.34, p < 0.001). From the adjusted regression model the predicted value of follicle density of women aged 20, 30 and 40 years as well as the associated 50 % and 95 % prediction intervals (50 % PI and 95 % PI, respectively) were calculated. For example, for women aged 40 years with a serum AMH level of 1 ng/ml, a follicle density of 2.3/mm3 (50 %PI: [1.1, 4.6]; 95 %PI: [0.3, 18]) was predicted. These large prediction intervals demonstrate the low predictive value of serum AMH for the ovarian follicle density. CONCLUSIONS Serum AMH levels have limited prognostic value for the follicle density and therefore for the real ovarian reserve.
Collapse
Affiliation(s)
- Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Inselspital, University of Berne, Berne, Switzerland.
| | - Marie Roumet
- CTU Berne, Institute of Social and Preventive Medicine (ISPM), University of Berne, Berne, Switzerland
| | - Petra Stute
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Inselspital, University of Berne, Berne, Switzerland
| | - Jana Liebenthron
- UniCareD, University Cryobank for Assisted Reproductive Medicine and Fertility Protection at UniKiD Düsseldorf, University Hospital Düsseldorf, Germany
| |
Collapse
|
14
|
Shen X, Gao H, Chen Q, Cai R, Lyu Q, Wang Y, Wang L, Kuang Y. Effect of Switching from a Progestin-Primed Ovarian Stimulation Protocol to a Modified Ultra-Long Protocol Among Women Who Had 1 Progestin-Primed Ovarian Stimulation (PPOS) Failure Verses Those Who Had 2 PPOS Failures. Med Sci Monit 2020; 26:e918705. [PMID: 31953378 PMCID: PMC6986211 DOI: 10.12659/msm.918705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is little research on whether normoresponsive patients who produced poor-quality embryos once verses those who produced poor-quality embryos twice when using a single COH protocol should change to a different controlled ovarian hyperstimulation (COH) protocol. MATERIAL AND METHODS In this retrospective study, we enrolled 108 patients with 1 PPOS failure who chose to continue receiving the progestin-primed ovarian stimulation (PPOS) protocol (n=61) versus those who decided to switch to the modified ultra-long protocol (n=47). We also enrolled 131 normoresponsive patients with 2 PPOS failures who chose to continue receiving the PPOS protocol (n=60) versus those who decided to switch to the modified ultra-long protocol (n=71) in the third cycle. RESULTS We found no significant difference in clinical outcomes of patients with 1 PPOS failure who continued using the PPOS protocol verses those who switched to the modified ultra-long protocol in the second cycle, expect for a lower cancelation rate (4.3% vs. 16.4%). However, the patients with 2 PPOS failures had significantly more good-quality embryos (0.9 vs. 0.4), more viable embryos (1.8 vs. 0.9), lower cancelation rates (18.3% vs. 53.3%), and higher pregnancy rates per aspirated cycle (26.8% vs. 10.0%) when switching to the modified ultra-long protocol compared to those who decided to continue receiving the PPOS protocol (P<0.05). Furthermore, the odds of clinical pregnancy (odds ratio [OR] 5.997, 95% confidence interval [CI] 1.476-24.361, P=0.01) were positively associated with switching to the COH protocol in the third cycle. CONCLUSIONS For normoresponsive patients with poor-quality embryos when using the PPOS protocol, switching to the modified ultra-long protocol after having 2 PPOS failures was associated with better ART outcomes.
Collapse
Affiliation(s)
- Xi Shen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Hongyuan Gao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Qiuju Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Renfei Cai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Qifeng Lyu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Li Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| |
Collapse
|
15
|
Tan EC, Chincholkar P, Yu SL, Lim SL, Renuka R, Yong TT, Yeo CP, Rajesh H. Comparison of Automated Anti-Müllerian Hormone Assays and Antral Follicle Count in Predicting Ovarian Response During Ovarian Stimulation. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219500099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: Various parameters had been used to predict ovarian response. Among them, Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) demonstrate the most favourable analytical and performance characteristics. In this pilot study, we aim to determine the cut-off levels of AMH using automated AMH assays and AFC in the prediction of poor and high responders. Study Design: Prospective study of 43 women between 21 to 45 years old scheduled for assisted reproduction. AMH levels on day 3 of menstruation were analysed using two immunoassay kits, namely the Beckman Coulter Access AMH and the Roche Elecsys AMH on the two automated analysers Beckman Coulter DxI 800 and Roche Cobas e602 respectively. AFC was also assessed on day 3 of menstruation prior to in vitro fertilization (IVF). These were compared with the number of oocytes retrieved after controlled ovarian stimulation. Results: AMH (Beckman Coulter Access AMH and Roche Elecsys AMH) highly correlated with AFC and the number of oocytes retrieved after ovarian stimulation. Beckman Coulter Access AMH was the better predictor for poor ovarian response with ROC [Formula: see text] of 0.83. For the prediction of a high response, AFC had a higher ROC [Formula: see text] of 0.95. Through ROC, the AMH cut-off level for poor ovarian response was 2.23 ng/ml with Beckman Coulter Access AMH and 2.02 ng/ml with Roche Elecsys AMH, while the AMH cut-off for a high ovarian response was 5.19 ng/ml with Beckman Coulter Access AMH and 4.60 ng/ml with Roche Elecsys AMH. For AFC, the cut-off for poor ovarian response was 18 and for high response was 34. Conclusion: AMH and AFC are reliable predictors of ovarian response. Establishment of specific levels may improve individualised controlled ovarian stimulation and optimise the oocyte yield. Larger studies are required to establish these findings.
Collapse
Affiliation(s)
- Eek Chaw Tan
- Department of Obstetrics & Gynaecology, Centre for Assisted Reproduction, Singapore General Hospital, Singapore
| | - Pallavi Chincholkar
- Department of Clinical Pathology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore
| | - Su Ling Yu
- Department of Obstetrics & Gynaecology, Centre for Assisted Reproduction, Singapore General Hospital, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- Yong Loo Lin School of Medicine, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Serene Liqing Lim
- Department of Obstetrics & Gynaecology, Centre for Assisted Reproduction, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Rajkumaralal Renuka
- Department of Obstetrics & Gynaecology, Centre for Assisted Reproduction, Singapore General Hospital, Singapore
| | - Tze Tein Yong
- Department of Obstetrics & Gynaecology, Centre for Assisted Reproduction, Singapore General Hospital, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- Yong Loo Lin School of Medicine, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Chin Pin Yeo
- Department of Clinical Pathology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore
| | - Hemashree Rajesh
- Department of Obstetrics & Gynaecology, Centre for Assisted Reproduction, Singapore General Hospital, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- Yong Loo Lin School of Medicine, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore
| |
Collapse
|
16
|
Nelson SM, Larsson P, Mannaerts BMJL, Nyboe Andersen A, Fauser BCJM. Anti-Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta. Clin Endocrinol (Oxf) 2019; 90:719-726. [PMID: 30801744 DOI: 10.1111/cen.13956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The stability of anti-Müllerian hormone (AMH) across and between menstrual cycles has been the subject of debate. The objective of this analysis was to study the inter- and intracycle variability in repeated measurements and assess the impact on an individualized gonadotropin dosing algorithm and predicted oocyte yield. DESIGN Retrospective analysis of repeat AMH measures from a randomized controlled trial. PATIENTS A total of 1326 women aged 18-40 years. MEASUREMENTS Serum AMH levels at screening and at cycle day 2-3 in up to three ovarian stimulation cycles. AMH variability and its impact on gonadotropin dose and the predicted number of oocytes. RESULTS Repeat serum AMH measurements were strongly correlated within individual women (correlation coefficient 0.92). AMH exhibited limited within-subject variation (coefficient of variation 23%), a small time-related decline (mean 6% decrease/y), but no systematic variation across the menstrual cycle. Irrespective of whether the AMH screening value or the AMH at the initiation of ovarian stimulation was used, for women with an AMH level <15 pmol/L, 93% would receive the same gonadotropin dose and attain an identical number of oocytes in 97% of cases. For women with an AMH level ≥15 pmol/L, 80% would receive an individualized dose within ±1.5 μg and 90% would attain ±1 oocyte. CONCLUSION AMH variability had limited impact on individualized gonadotropin dosing, with 95% of women predicted to obtain an oocyte yield that does not vary beyond 1 oocyte count, irrespective of whether a random or early follicular AMH measurement was used to determine the individualized gonadotropin dose.
Collapse
Affiliation(s)
| | - Per Larsson
- Biometrics - Global Clinical R&D, Ferring Pharmaceuticals, Copenhagen, Denmark
| | | | - Anders Nyboe Andersen
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | |
Collapse
|
17
|
Norman RJ, Alvino H, Hull LM, Mol BW, Hart RJ, Kelly TL, Rombauts L. Human growth hormone for poor responders: a randomized placebo-controlled trial provides no evidence for improved live birth rate. Reprod Biomed Online 2019; 38:908-915. [PMID: 30954433 DOI: 10.1016/j.rbmo.2019.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/18/2019] [Accepted: 02/05/2019] [Indexed: 01/19/2023]
Abstract
RESEARCH QUESTION Does the addition of human growth hormone (HGH) to an IVF cycle improve the live birth rate in previously documented poor responders to FSH? DESIGN Double-blind, placebo-controlled, randomized clinical trial comparing HGH to placebo in maximal stimulation in an IVF cycle. The study was stopped after 4 years. Women receiving ovarian stimulation in one IVF cycle, having failed to produce more than 5 eggs in a previous cycle with more than 250 IU/day of FSH were included. Basal FSH was ≤15 IU/l, body mass index <33 kg/m2, age <41 years. HGH or placebo were added from the start of the cycle in a double-blinded manner. The primary outcome was live birth rate. MAIN RESULTS The live birth rates following an IVF cycle were 9/62 (14.5%) for growth hormone and 7/51 (13.7%) for the placebo group (risk difference 0.8%, 95% confidence interval [CI] -12.1 to 13.7%; odds ratio [OR] 1.07, 95% CI 0.37-3.10). There was a greater odds of oocyte retrieval with growth hormone (OR 5.67, 95% CI 1.54-20.80) but no better chance of embryo transfer (OR 1.42, 95% CI 0.50-4.00). Birth weights were comparable. CONCLUSIONS Planned participant numbers were not reached. It was not possible to demonstrate an increase in live birth rate from the addition of growth hormone in women with a previous poor ovarian response to IVF.
Collapse
Affiliation(s)
- Robert J Norman
- University of Adelaide, Robinson Research Institute, North Adelaide, SA 5006, Australia; , Fertility SA, 431 King William Road, Adelaide, SA 5000, Australia.
| | - Helen Alvino
- University of Adelaide, Robinson Research Institute, North Adelaide, SA 5006, Australia
| | - Louise M Hull
- University of Adelaide, Robinson Research Institute, North Adelaide, SA 5006, Australia
| | - Ben W Mol
- University of Adelaide, Robinson Research Institute, North Adelaide, SA 5006, Australia; South Australian Health and Medical Research Institute, Robinson Research Institute, North Adelaide, SA 5006; Monash University, Clayton, VIC 3800, Australia
| | - Roger J Hart
- Fertility Specialists of Western Australia, Claremont, WA 6010; The University of Western Australia, Crawley, WA 6009, Australia
| | - Thu-Lan Kelly
- Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Adelaide, SA 5006; Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, SA 5001, Australia
| | - Luk Rombauts
- Monash IVF, Monash Surgical Private Hospital, Clayton, VIC 3168, Australia
| | | |
Collapse
|
18
|
Individualization of the starting dose of follitropin delta reduces the overall OHSS risk and/or the need for additional preventive interventions: cumulative data over three stimulation cycles. Reprod Biomed Online 2018; 38:528-537. [PMID: 30713022 DOI: 10.1016/j.rbmo.2018.12.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/24/2018] [Accepted: 12/10/2018] [Indexed: 11/21/2022]
Abstract
RESEARCH QUESTION Is individualization of dosing with follitropin delta in sequential ovarian stimulation cycles an effective preventive strategy for ovarian hyperstimulation syndrome risk? If so, for which patients does an individualized strategy provide the greatest OHSS risk reduction and/or the need for additional preventive interventions? DESIGN A secondary analysis of three ovarian stimulation cycles in IVF/intracytoplasmic sperm injection patients included in one randomized, assessor-blinded trial comparing two recombinant FSH preparations (ESTHER-1, NCT01956110), and a second trial in women undergoing up to two additional cycles (ESTHER-2, NCT01956123). Of 1326 women (aged 18-40 years) randomized and treated with follitropin delta or alfa in cycle 1, 513 continued to cycle 2 and 188 to cycle 3. Follitropin delta and alfa doses were maintained/adjusted according to ovarian response in the previous cycle. RESULTS Individualized dosing with follitropin delta significantly reduced moderate/severe OHSS and/or preventive interventions (P=0.018) versus conventional dosing with follitropin alfa in patients undergoing up to three ovarian stimulation cycles. The greatest benefit was observed in patients in the highest anti-Müllerian hormone (AMH) quartile (P=0.012). On evaluating separately, individualized dosing with follitropin delta significantly lowered the incidences of moderate/severe OHSS (P=0.036) and preventive interventions (P=0.044) versus follitropin alfa. CONCLUSION An individualized follitropin delta dosing regimen decreased the risk of moderate/severe OHSS as well as the incidence of preventive interventions versus a conventional follitropin alfa regimen. An analysis per AMH quartile indicated that these statistically significant differences are driven mainly by patients with the highest pretreatment AMH levels.
Collapse
|
19
|
Tšuiko O, Catteeuw M, Zamani Esteki M, Destouni A, Bogado Pascottini O, Besenfelder U, Havlicek V, Smits K, Kurg A, Salumets A, D'Hooghe T, Voet T, Van Soom A, Robert Vermeesch J. Genome stability of bovine in vivo-conceived cleavage-stage embryos is higher compared to in vitro-produced embryos. Hum Reprod 2018; 32:2348-2357. [PMID: 29040498 DOI: 10.1093/humrep/dex286] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION Is the rate and nature of chromosome instability (CIN) similar between bovine in vivo-derived and in vitro-cultured cleavage-stage embryos? SUMMARY ANSWER There is a major difference regarding chromosome stability of in vivo-derived and in vitro-cultured embryos, as CIN is significantly lower in in vivo-derived cleavage-stage embryos compared to in vitro-cultured embryos. WHAT IS KNOWN ALREADY CIN is common during in vitro embryogenesis and is associated with early embryonic loss in humans, but the stability of in vivo-conceived cleavage-stage embryos remains largely unknown. STUDY DESIGN, SIZE, DURATION Because human in vivo preimplantation embryos are not accessible, bovine (Bos taurus) embryos were used to study CIN in vivo. Five young, healthy, cycling Holstein Friesian heifers were used to analyze single blastomeres of in vivo embryos, in vitro embryos produced by ovum pick up with ovarian stimulation (OPU-IVF), and in vitro embryos produced from in vitro matured oocytes retrieved without ovarian stimulation (IVM-IVF). PARTICIPANTS/MATERIALS, SETTING, METHODS Single blastomeres were isolated from embryos, whole-genome amplified and hybridized on Illumina BovineHD BeadChip arrays together with the bulk DNA from the donor cows (mothers) and the bull (father). DNA was also obtained from the parents of the bull and from the parents of the cows (paternal and maternal grandparents, respectively). Subsequently, genome-wide haplotyping and copy-number profiling was applied to investigate the genomic architecture of 171 single bovine blastomeres of 16 in vivo, 13 OPU-IVF and 13 IVM-IVF embryos. MAIN RESULTS AND THE ROLE OF CHANCE The genomic stability of single blastomeres in both of the in vitro-cultured embryo cohorts was severely compromised (P < 0.0001), and the frequency of whole chromosome or segmental aberrations was higher in embryos produced in vitro than in embryos derived in vivo. Only 18.8% of in vivo-derived embryos contained at least one blastomere with chromosomal anomalies, compared to 69.2% of OPU-IVF embryos (P < 0.01) and 84.6% of IVM-IVF embryos (P < 0.001). LARGE SCALE DATA Genotyping data obtained in this study has been submitted to NCBI Gene Expression Omnibus (GEO; accession number GSE95358). LIMITATIONS REASONS FOR CAUTION There were two main limitations of the study. First, animal models may not always reflect the nature of human embryogenesis, although the use of an animal model to investigate CIN was unavoidable in our study. Second, a limited number of embryos were obtained, therefore more studies are warranted to corroborate the findings. WIDER IMPLICATIONS OF THE FINDINGS Although CIN is also present in in vivo-developed embryos, in vitro procedures exacerbate chromosomal abnormalities during early embryo development. Hence, the present study highlights that IVF treatment compromises embryo viability and should be applied with care. Additionally, our results encourage to refine and improve in vitro culture conditions and assisted reproduction technologies. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Agency for Innovation by Science and Technology (IWT) (TBM-090878 to J.R.V. and T.V.), the Research Foundation Flanders (FWO; G.A093.11 N to T.V. and J.R.V. and G.0392.14 N to A.V.S. and J.R.V.), the European Union's FP7 Marie Curie Industry-Academia Partnerships and Pathways (IAPP, SARM, EU324509 to J.R.V., T.V., O.T, A.D., A.S. and A.K.) and Horizon 2020 innovation programme (WIDENLIFE, 692065 to J.R.V., O.T., T.V., A.K. and A.S.). M.Z.E., J.R.V. and T.V. are co-inventors on a patent application ZL913096-PCT/EP2014/068315-WO/2015/028576 ('Haplotyping and copy-number typing using polymorphic variant allelic frequencies'), licensed to Cartagenia (Agilent Technologies).
Collapse
Affiliation(s)
- Olga Tšuiko
- Laboratory of Cytogenetics and Genome Research, Center of Human Genetics, KU Leuven, Leuven 3000, Belgium.,Institute of Bio- and Translational Medicine, University of Tartu, Tartu 50411, Estonia.,Competence Centre on Health Technologies, Tartu 50410, Estonia.,Department of Biotechnology, Institute of Molecular and Cell Biology, University of Tartu, Tartu 51010, Estonia
| | - Maaike Catteeuw
- Department of Obstetrics, Reproduction and Herd Health, Ghent University, Merelbeke 9820, Belgium
| | - Masoud Zamani Esteki
- Laboratory of Reproductive Genomics, Center of Human Genetics, KU Leuven, Leuven 3000, Belgium
| | - Aspasia Destouni
- Laboratory of Cytogenetics and Genome Research, Center of Human Genetics, KU Leuven, Leuven 3000, Belgium
| | | | - Urban Besenfelder
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Vitezslav Havlicek
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Katrien Smits
- Department of Obstetrics, Reproduction and Herd Health, Ghent University, Merelbeke 9820, Belgium
| | - Ants Kurg
- Department of Biotechnology, Institute of Molecular and Cell Biology, University of Tartu, Tartu 51010, Estonia
| | - Andres Salumets
- Institute of Bio- and Translational Medicine, University of Tartu, Tartu 50411, Estonia.,Competence Centre on Health Technologies, Tartu 50410, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu 51014, Estonia.,Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Thomas D'Hooghe
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven 3000, Belgium
| | - Thierry Voet
- Laboratory of Reproductive Genomics, Center of Human Genetics, KU Leuven, Leuven 3000, Belgium.,Sanger-EBI Single Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - Ann Van Soom
- Department of Obstetrics, Reproduction and Herd Health, Ghent University, Merelbeke 9820, Belgium
| | - Joris Robert Vermeesch
- Laboratory of Cytogenetics and Genome Research, Center of Human Genetics, KU Leuven, Leuven 3000, Belgium
| |
Collapse
|
20
|
Geng Y, Lai Q, Xun Y, Jin L. The effect of premature luteinizing hormone increases among high ovarian responders undergoing a gonadotropin-releasing hormone antagonist ovarian stimulation protocol. Int J Gynaecol Obstet 2018. [PMID: 29542120 DOI: 10.1002/ijgo.12485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore factors causing a premature rise in luteinizing hormone among high ovarian responders undergoing the gonadotropin-releasing hormone (GnRH) antagonist ovarian stimulation protocol. METHODS The present retrospective study included healthy women undergoing fresh cycles using a fixed GnRH antagonist protocol with a predicted high response and antral follicle count (AFC) of at least 15 at the Reproductive Medicine Center of Tongji Hospital, China, between January 1 and December 31, 2016. Treatment-related characteristics, hormone changes, and pregnancy outcomes were compared between patients who did or did not experience a premature luteinizing hormone rise. RESULTS There were 314 patients included; 49 experienced premature luteinizing hormone increases. Among patients who experienced a premature rise in luteinizing hormone, a lower two pronuclear embryo rate (P=0.038); fewer high-quality embryos (P=0.020); higher serum luteinizing hormone (P=0.006), progesterone (P=0.013), and estradiol (E2) levels (P=0.003) on the day of human chorionic gonadotropin administration; a lower clinical pregnancy rate (P=0.031); and a higher cancellation rate (P=0.006) were observed. AFC of at least 22 (P=0.001) and E2 of 669 pg/mL or higher at the start of GnRH antagonist administration were predictive of early (P=0.036) and late (P=0.033) premature luteinizing hormone increases. CONCLUSION Earlier administration of GnRH antagonist could avoid premature luteinizing hormone increases among high ovarian responders, especially those with a starting AFC of 22 or more.
Collapse
Affiliation(s)
- Yudi Geng
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaohong Lai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Xun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
21
|
Drakopoulos P, Santos-Ribeiro S, Bosch E, Garcia-Velasco J, Blockeel C, Romito A, Tournaye H, Polyzos NP. The Effect of Dose Adjustments in a Subsequent Cycle of Women With Suboptimal Response Following Conventional Ovarian Stimulation. Front Endocrinol (Lausanne) 2018; 9:361. [PMID: 30083131 PMCID: PMC6064928 DOI: 10.3389/fendo.2018.00361] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Several infertile patients, who may even represent around 40% of the infertile cohort, may respond "suboptimally" (4-9 oocytes retrieved) following IVF, despite being predicted as normal responders. The aim of our longitudinal study was to evaluate the ovarian response of suboptimal responders in terms of the number of oocytes retrieved, following their second IVF cycle, evaluating exclusively patients who had the same stimulation protocol and used the same or higher initial dose of the same type of gonadotropin compared to their previous failed IVF attempt. Overall, our analysis included 160 patients treated with a fixed antagonist protocol in their second cycle with the same [53 (33.1%)] or higher [107 (66.9%)] starting dose of rFSH. The number of oocytes retrieved was significantly higher in the second IVF cycle [6 (5-8) vs. 9 (6-12), p < 0.001]. According to our results, a dose increment of rFSH remained the only significant predictor of the number of oocytes retrieved in the subsequent IVF cycle (coefficient 0.02, p-value = 0.007) after conducting GEE multivariate regression, while adjusting for relevant confounders. A regression coefficient of 0.02 for the starting dose implies that an increase of 50 IU of the initial rFSH dose would lead to 1 more oocyte.
Collapse
Affiliation(s)
- Panagiotis Drakopoulos
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Reproductive Medicine, University of Liège, Liège, Belgium
| | - Samuel Santos-Ribeiro
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
| | - Ernesto Bosch
- Instituto Valenciano de Infertilidad (IVI-RMA), Valencia, Spain
| | - Juan Garcia-Velasco
- Instituto Valenciano de Infertilidad (IVI-RMA), Madrid, Spain
- Department of Obstetrics and Gynecology, Rey Juan Carlos University, Madrid, Spain
| | - Christophe Blockeel
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Obstetrics and Gynaecology, University of Zagreb-School of Medicine, Zagreb, Croatia
| | - Alessia Romito
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Herman Tournaye
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nikolaos P. Polyzos
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- *Correspondence: Nikolaos P. Polyzos ;
| |
Collapse
|
22
|
Melado L, Lawrenz B, Sibal J, Abu E, Coughlan C, Navarro AT, Fatemi HM. Anti-müllerian Hormone During Natural Cycle Presents Significant Intra and Intercycle Variations When Measured With Fully Automated Assay. Front Endocrinol (Lausanne) 2018; 9:686. [PMID: 30542322 PMCID: PMC6278633 DOI: 10.3389/fendo.2018.00686] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 11/13/2022] Open
Abstract
Anti-Müllerian hormone (AMH) is an important ovarian reserve marker for baseline assessment and therapeutic strategy in fertility treatments, which is considered reliable when measured on any day of the cycle. Recent data have pointed toward significant fluctuations of AMH and questioned whether a single measurement is reliable for clinical decision-making. The aim of this study was to evaluate whether the AMH does have significant variations during a natural cycle when a fully automated assay is used for the sample analysis. We performed a prospective study including healthy volunteers with regular cycles, from April to December 2017. Blood samples for AMH, FSH, LH, estradiol, and progesterone were obtained on day 2/3, day 10, day of LH surge, luteal phase and day 2/3 of subsequent menses. AMH analysis was performed with Elecsys® AMH automated assay. Trial was registered with clinical.trials.gov: NCT03106272. One hundred samples from 22 women with a mean age of 30.74 ± 0.11 years and a BMI of 23.23 ± 0.63 kg/m2 were analyzed. There was a substantial longitudinal fluctuation in AMH levels, indicated by the coefficient of variation (CV) intra-cycle of 0.2070 ± 0.143. A positive correlation between LH and AMH concentrations was found at the moment of LH rise (p < 0.0001). Absolute intra-individual inter-cyclic variability was 0.75 ng/mL (range: 0.03-2.81 ng/mL) and inter-cycle CV was 0.28 (Confidence interval: 0.16-0.39; p < 0.0001). According to our results, with the use of a fully automated assay in natural cycle, AMH shows significant intra- and inter-cycle variations, which are not caused by analytical variability. Future investigations, evaluating AMH dynamics and the best time for AMH assessment should be conducted.
Collapse
Affiliation(s)
- Laura Melado
- IVF department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
- *Correspondence: Laura Melado
| | - Barbara Lawrenz
- IVF department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
- Women's University Hospital Tuebingen, Tuebingen, Germany
| | - Junard Sibal
- IVF department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - Emmanuel Abu
- IVF department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - Carol Coughlan
- IVF department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | | | - Human Mousavi Fatemi
- IVF department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| |
Collapse
|
23
|
Establishment and validation of a score to predict ovarian response to stimulation in IVF. Reprod Biomed Online 2017; 36:26-31. [PMID: 29111311 DOI: 10.1016/j.rbmo.2017.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022]
Abstract
This study aimed to integrate clinical and biological parameters in a score able to predict ovarian response to stimulation for IVF in gonadotrophin-releasing hormone (GnRH) antagonist protocols. A progressive discriminant analysis to establish a score including the main clinical and biological parameters predicting ovarian response was performed by retrospectively analysing data from the first ovarian stimulation cycle of 494 patients. The score was validated in a prospectively enrolled, independent set of 257 patients undergoing their first ovarian stimulation cycle. All ovarian stimulations were performed using a combination of GnRH antagonist and recombinant FSH. Ovarian response was assessed through ovarian sensitivity index (OSI). Parameters from the patients' database were classified according to correlation with OSI: the progressive discriminant analysis resulted in the following calculation: score = 0.192 - (0.004 × FSH (IU/l)) + (0.012 × LH:FSH ratio) + (0.002 × AMH (ng/ml)) - (0.002 × BMI (kg/m2)) + (0.001 × AFC) - (0.002 × age (years)). This score was significantly correlated with OSI in the retrospective (r = 0.599; P < 0.0001) and prospective (r = 0.584; P < 0.0001) studies. In conclusion, the score including clinical and biological parameters could explain 60% of the variance in ovarian response to stimulation.
Collapse
|
24
|
Kutlu T, Özkaya E, Kumru P, Ayvacı H, Devranoğlu B, Sanverdi İ, Şahin Y, Sağlam B, Karateke A. Clinical analyses of successful and previously failed intracytoplasmic sperm injection cycle parameters in patients with poor ovarian reserve. Turk J Obstet Gynecol 2017; 14:58-63. [PMID: 28913136 PMCID: PMC5558319 DOI: 10.4274/tjod.04382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/15/2017] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine some major characteristic differences between two consecutive successful and unsuccessful intracytoplasmic sperm injection (ICSI) cycles in poor responders. Materials and Methods: Sixty women with poor ovarian response as determined using the Bologna criteria underwent ICSI cycles following an unsuccessful trial. Some parameters of both cycles including age, body mass index (BMI), serum follicle-stimulating hormone (FSH) and estradiol levels, antral follicle count, gonadotropin dosage, duration of stimulation, antagonist starting day, duration of antagonist administration, endometrial thickness at trigger day, number of total and fertilized oocytes, embryo transfer day, number of embryo cells, and fertilization rate were compared in the same patients to identify predictors of cycles with clinical pregnancy. Results: The mean age, BMI, serum FSH, estradiol concentrations, and antral follicle count were 35.9 years (range, 30-42 years), 25.9 kg/m2 (range, 18.4-33.5 kg/m2), 10.9 IU/mL (range, 7-13 IU/mL), 52.9 pg/mL (range, 11.6-75 pg/mL), and 4.7 (range, 2-10), respectively. A comparison of cycle characteristics showed a significantly higher total number of mature and fertilized oocytes in successful cycles. The fertilization rate was also significantly higher in cycles with clinical pregnancy. Early initiation of antagonist was shown to result in favorable outcomes. A comparison of embryo characteristics showed that transfer of higher-stage embryos and embryos with higher numbers of cells had a significant impact on cycle outcomes. Conclusion: Our comparison of parameters of failed and successful ICSI cycles in poor responders revealed significantly earlier antagonist initiation, higher total number of mature and fertilized oocytes, fertilization rate, and significantly higher stage of embryo development and cell numbers at transfer in cycles that resulted in clinical pregnancy.
Collapse
Affiliation(s)
- Tayfun Kutlu
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Enis Özkaya
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Pınar Kumru
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Habibe Ayvacı
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Belgin Devranoğlu
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - İlhan Sanverdi
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Yavuz Şahin
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Beyhan Sağlam
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ateş Karateke
- Zeynep Kamil Maternity and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| |
Collapse
|