1
|
Ye H, Shi L, Quan X, Hou M, Ma H, Xue S, Yu Z, Chen Q, Sun L. Cumulative live birth rate of in vitro fertilization cycle via progestin-primed ovarian stimulation versus gonadotropin-releasing hormone antagonist protocol in infertile women with normal ovarian reserve: an open-label, randomized controlled trial. HUM FERTIL 2024; 27:2316005. [PMID: 38357937 DOI: 10.1080/14647273.2024.2316005] [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: 08/24/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
This study aimed to evaluate the cumulative live birth rate (cLBR) of progestin-primed ovarian stimulation (PPOS) protocol versus gonadotropin-releasing hormone antagonist (GnRH-ant) protocol for in vitro fertilization (IVF) cycle in infertile women with normal ovarian reserve (NOR). Infertile women with NOR who underwent their first IVF cycle were enrolled in an open-label randomized controlled trial. Patients were randomly assigned 1:1 to receive a freeze-all strategy with delayed embryo transfer (PPOS group, n = 174) and fresh embryo transfer first (GnRH-ant group, n = 174). The primary outcome was the cLBR per aspiration. The cLBR between the PPOS group and GnRH-ant group were comparable (55.75% vs. 52.87%, p = 0.591). A premature luteinizing hormone surge was not observed in the PPOS group, while there were six cases (3.45%) in the GnRH-ant group, but no premature ovulation in either of the groups. The pregnancy outcomes, including implantation rate, clinical pregnancy rate and miscarriage rate, were all comparable. In addition, the number of retrieved oocytes, mature oocytes and viable embryos were similar (all p > 0.05) between the two groups.
Collapse
Affiliation(s)
- Hongjuan Ye
- School of Life Sciences and Technology, Tongji University, Shanghai, China
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Liya Shi
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Xinxin Quan
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Min Hou
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Huilan Ma
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Songguo Xue
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhao Yu
- School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Qiuju Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lihua Sun
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University, Shanghai, China
| |
Collapse
|
2
|
Zacà C, Coticchio G, Calesini C, Vigiliano V, Tarozzi N, Lagalla C, Borini A. Towards a more sustainable balance between optimal live birth rate and supernumerary embryos in ART treatments. J Assist Reprod Genet 2024; 41:939-946. [PMID: 38321266 PMCID: PMC11052976 DOI: 10.1007/s10815-024-03043-7] [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: 08/07/2023] [Accepted: 01/21/2024] [Indexed: 02/08/2024] Open
Abstract
PURPOSE To assess the relation between number of inseminated oocytes and cumulative live birth rate (CLBR) in order to provide guidance for limiting the number of surplus blastocysts. METHODS The study was a retrospective, single-center cohort analysis of 1223 ART complete cycles. Cycles were stratified according to female age (≤ 34, 35-38, and 39-42 years) and number of inseminated oocytes (1-5, 6-10, and > 10). Inclusion criteria were indication for IVF/ICSI with own spermatozoa and blastocyst culture up to day 6 of all embryos. RESULTS In patients younger than 35 years, insemination of more than ten oocytes produced an increase in overall blastocyst number, CLBR (40.3%, 54.3%, and 75.8%, respectively, for each oocyte group) and surplus embryo rate (12.9%, 27.8%, and 49.7% of cases for each group). Instead, in the middle age group, the use of more than ten oocytes was solely associated with an increase in the rate of surplus embryos (1.25%, 21.33%, and 28.68% of cases after stratification for oocyte number). In older patients, neither CLBR (9.1%, 23.9%, and 24.7%, respectively) nor rate of surplus embryos (2.0%, 7.1%, and 13.4% of cases for each group) were higher in cycles with more than ten inseminated oocytes. CONCLUSION In women up to 38 years, sustainable CLBR are achieved while limiting the number of inseminated oocytes and the resulting blastocysts remaining unused. Based on this notion, novel treatment strategies could pursue high outcome rates, while alleviating the problems derived from surplus stored embryos.
Collapse
Affiliation(s)
- Carlotta Zacà
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy
| | - Giovanni Coticchio
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy.
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy.
| | | | - Vincenzo Vigiliano
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | | | | | - Andrea Borini
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy
| |
Collapse
|
3
|
Oron G, Ronen M, Hochberg A, Wertheimer A, Altman E, Sapir O, Ben-Haroush A, Shufaro Y. Does the outcome of fresh embryo transfer affect the outcome of subsequent thawed embryo transfers from sibling oocytes in patients that utilized all their embryos? HUM FERTIL 2022; 25:947-953. [PMID: 34227924 DOI: 10.1080/14647273.2021.1947531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The association between fresh embryo transfer (ET) outcome and the subsequent frozen-thawed (FET) cycles that follow is not clear, mainly because of incomplete embryo cohort utilization. The aim of this study was to determine if the outcome of a fresh ET affects the frozen cumulative clinical pregnancy (CP) and live birth (LB) rates resulting from the utilization of all surplus embryos from sibling oocytes. Outcome measures were the FET cumulative CP and LB rates. Multivariate logistic regression was performed for the frozen cumulative CP rate and adjusted for age, the number of oocytes, fresh ET outcome and other confounders. A total of 1313 cycles met the inclusion criteria. The FET cumulative CP and LB rates were not affected by the outcome of the fresh ET. The FET cumulative CP rate increased with the number of oocytes collected regardless of whether a pregnancy was achieved in the fresh cycle or not. In multivariate analysis, age (OR = 0.96, 95% CI 0.94-0.98), protocol (OR = 0.13, 95% CI 0.03-0.57) and the number of oocytes (OR = 1.05, 95% CI 1.02-1.07) were associated with the frozen cumulative CP rate. It is concluded that fresh ET does not impact the outcome of the vitrified-thawed embryos from the same oocyte cohort.
Collapse
Affiliation(s)
- Galia Oron
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Ronen
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alyssa Hochberg
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avital Wertheimer
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Altman
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onit Sapir
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Ben-Haroush
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Shufaro
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Zacà C, Coticchio G, Vigiliano V, Lagalla C, Nadalini M, Tarozzi N, Borini A. Fine-tuning IVF laboratory key performance indicators of the Vienna consensus according to female age. J Assist Reprod Genet 2022; 39:945-952. [PMID: 35338418 PMCID: PMC9050984 DOI: 10.1007/s10815-022-02468-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To test the validity of the Vienna consensus laboratory key performance indicators (KPIs) to monitor the outcome of treatments involving women of different age ranges. METHODS The retrospective cohort study included 862 complete IVF/ICSI cycles carried out between January 2014 and May 2021. All embryos of each cycle cohort were subject to extended culture. The overall population was divided into two groups according to female age: the Vienna consensus (≤ 39 years) and older female age (≥ 40 years). We compared outcomes of a selection of the Vienna performance indicators (PIs) and KPIs, with a focus on measures relevant to embryo cleavage and blastocyst formation. A possible association between total good blastocyst development rate (TGBDR) and cumulative clinical pregnancy rate (CPR) was also assessed. RESULTS No differences were observed in fertilization and embryo cleavage KPIs between the Vienna consensus and the older female age group (standard IVF fertilization, 67.2 vs. 67.3; ICSI fertilization, 72.3 vs. 75.3; day 2 development, 57.6% vs 58.7%; day 3 development, 52.4% vs. 50.7%, respectively). TGBDR was lower in the older female age group (45.5% vs. 33.4% p < 0.001). Multivariate logistic regression analysis indicated female age as a factor independently associated with TGBDR. Clinical outcomes significantly decreased with increasing female age. CONCLUSION The study suggests that, while most laboratory outcome measures are reliably applicable irrespective of female age, KPIs describing extended embryo culture should be fine-tuned in consideration of older female age.
Collapse
Affiliation(s)
| | | | - Vincenzo Vigiliano
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | | | | | | | | |
Collapse
|
5
|
OUP accepted manuscript. Hum Reprod 2022; 37:1388-1393. [DOI: 10.1093/humrep/deac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Indexed: 11/14/2022] Open
|
6
|
Duarte-Filho OB, Podgaec S. Freeze-all policy for in vitro fertilization in women with normal response to ovarian stimulation. EINSTEIN-SAO PAULO 2021; 19:eAO6290. [PMID: 34644745 PMCID: PMC8483637 DOI: 10.31744/einstein_journal/2021ao6290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To answer the question if the freeze-all strategy and subsequent frozen embryo transfer is preferable to fresh embryo transfer for patients with normal response to ovarian stimulation (4 to 15 oocytes recovered) during in vitro fertilization treatments. Methods A retrospective cohort from two human reproduction centers between 2013 and 2017. A total of 471 frozen embryo transfers from freeze-all cycles, and 3,208 fresh transfers were included. Results After propensity score matching adjustment for age and number of eggs, 467 freeze-all cycles and 934 fresh cycles were analyzed, revealing no statistically significant difference between groups in relation to clinical pregnancy rate (32.5% in the Freeze-all Group and 32.3% in the Fresh Group, p=0.936). For women aged 40 years and older, we observed a statistically significant higher clinical pregnancy rate when freeze-all strategy was used (29.3% in the Freeze-all Group and 19.8% in the Fresh Group, p=0.04). Conclusion Freeze-all strategy was not superior to fresh transfer for all patients with normal response to ovarian stimulation. However, women aged 40 years and older could benefit from this strategy. This deserves further investigation in future research, preferable in a prospective randomized study.
Collapse
Affiliation(s)
| | - Sérgio Podgaec
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| |
Collapse
|
7
|
Lawrenz B, Fatemi HM. Is the 'freeze-all' strategy really inferior to a 'fresh embryo transfer' strategy? Critical assessment of a randomized controlled trial. Hum Reprod 2021; 36:2418-2419. [PMID: 33993250 DOI: 10.1093/humrep/deab116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Lawrenz
- IVF Department, ART Fertility Clinic, Abu Dhabi, United Arab Emirates
- Obstetrical Department, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - H M Fatemi
- IVF Department, ART Fertility Clinic, Abu Dhabi, United Arab Emirates
| |
Collapse
|
8
|
Scaravelli G, Zacà C, Levi Setti PE, Livi C, Ubaldi FM, Villani MT, Greco E, Coccia ME, Revelli A, Ricci G, Fusi F, Vigiliano V, De Luca R, Bolli S, Borini A. Fertilization rate as a novel indicator for cumulative live birth rate: a multicenter retrospective cohort study of 9,394 complete in vitro fertilization cycles. Fertil Steril 2021; 116:766-773. [PMID: 33972085 DOI: 10.1016/j.fertnstert.2021.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To appraise the fertilization rate as a predictive factor for cumulative live birth rate (CLBR). DESIGN Multicenter retrospective cohort study. SETTING Ten in vitro fertilization clinics, whose data were collected and processed by the assisted reproductive technology (ART) Italian National Registry. PATIENT(S) 7,968 couples undergoing 9,394 complete intracytoplasmic sperm injection cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcome measure was the CLBR in association with the fertilization rate intervals (<65%-group 1; 65%-80%-group 2; and >80%-group 3). Further data stratification was performed on the basis of maternal age (<34, 35-38, and 39-42 years) and number of retrieved oocytes (5-7, 8-10, and > 10 oocytes). RESULT(S) The CLBR was progressively higher in relation to the fertilization rate in groups 1, 2, and 3 (20.1%, 34.7%, and 41.3%, respectively). The number of recovered oocytes, embryo number per cycle, and cumulative pregnancy rate followed the same trend. The decrease in CLBR with increasing maternal age was significantly correlated with the fertilization rate and CLBR in all 3 maternal age groups. Multivariate logistic regression analysis showed fertilization rate as a factor independently associated with CLBR. CONCLUSION(S) The present data indicated a positive association between the fertilization rate and the CLBR, suggesting the predictive clinical relevance of this parameter and its adoption as a key performance indicator.
Collapse
Affiliation(s)
- Giulia Scaravelli
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Carlotta Zacà
- 9.Baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | - Paolo Emanuele Levi Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Fertility Center. Humanitas Clinical and Research Center (IRCCS), Rozzano (Milan), Italy
| | - Claudia Livi
- Demetra Assisted Reproductive Center, Florence, Italy
| | | | - Maria Teresa Villani
- Department of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Emilia, Italy
| | - Ermanno Greco
- Center for Reproductive Medicine, European Hospital, Rome, Italy
| | | | - Alberto Revelli
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Torino, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesco Fusi
- Department of Maternal Fetal and Pediatric Medicine, ASST, Papa Giovanni XXIII, Bergamo, Italy
| | - Vincenzo Vigiliano
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Roberto De Luca
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Simone Bolli
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Andrea Borini
- 9.Baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy.
| |
Collapse
|
9
|
Le MT, Nguyen TTT, Nguyen TV, Dang HNT, Nguyen QHV. Blastocyst transfer after extended culture of cryopreserved cleavage embryos improves in vitro fertilization cycle outcomes. Cryobiology 2021; 100:26-31. [PMID: 33872609 DOI: 10.1016/j.cryobiol.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
Cryopreserved blastocyst embryo transfer has been reported to result in better pregnancy outcomes than those by cleavage embryo transfer. Women who had previously failed in the cleavage-stage embryo transfer, underwent extended culture of their warmed cleavage embryos to the blastocyst stage, thereby improving cryopreserved embryo transfer (CET) outcomes, although the ability of embryos to reach the extended blastocyst as well as the value of the prolonged culture was limited. This study aimed to investigate the effectiveness of blastocyst transfer by extending the culture of vitrified-warmed cleavage embryos. CET cycles were collected from January 2018 to June 2020. Pregnancy outcomes were analyzed and compared between three groups: day 2 embryo transfer using cryopreserved embryos (D2 CET), blastocyst transfer (D5 CET), and extended culture vitrified day 2 embryo transfer (D2-5 CET). A total of 52.77% of vitrified-warmed cleavage embryos developed into blastocysts in D2-5 CET group. Although D2-5 CET had a lower number of transferred embryos and grade A embryos, the pregnancy outcomes were significantly better than those in D2 CET, with respect to hCG positivity, clinical pregnancy and implantation rates (59.62% vs. 24.64%, 46.15% vs. 21.71%, 27.18% vs. 9.09%, respectively, P < 0.05). There were no significant different outcomes between the D2-5 CET and D5 CET groups. This study demonstrated a way of achieving better pregnancy outcomes in 8CET cycles by means of extended culture to blastocysts in patients with vitrified cleavage embryo failure.
Collapse
Affiliation(s)
- Minh Tam Le
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Viet Nam; Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Viet Nam.
| | - Thai Thanh Thi Nguyen
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| | - Trung Van Nguyen
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| | - Hong Nhan Thi Dang
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| | - Quoc Huy Vu Nguyen
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| |
Collapse
|
10
|
Høyer S, Kesmodel US, Aagaard J. Conditional and cumulative live birth rates after blastocyst transfer. Eur J Obstet Gynecol Reprod Biol 2021; 261:46-51. [PMID: 33892208 DOI: 10.1016/j.ejogrb.2021.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to investigate live birth rate (LBR), cumulative live birth rate (CLBR) for consecutive fresh and frozen-thawed in vitro fertilization (IVF) cycles, and CLBR after an entire IVF programme involving multiple ovarian stimulations using blastocyst transfer only. STUDY DESIGN From January 1 st 2014 to December 31 st 2018, we included women aged 18-45 years who initiated IVF or intracytoplasmic sperm injection at Aagaard Fertility Clinic, Denmark. The primary outcome was live birth, and secondary outcomes were a positive hCG blood test and ongoing pregnancy confirmed by ultrasonography. All proportions were estimated for initiated and transferred cycles with 95 % confidence intervals (CI). We used a conservative strategy, assuming that none of the women who did not return for further treatments had a live birth. RESULTS 871 women contributed 2236 initiated/1670 transferred fresh and/or frozen-thawed cycles. LBRs for first fresh cycles were 22.8 % (95 %-CI: 19.8-26.0) and 35.7 % (95 %-CI: 31.4-40.2) for initiated and transferred cycles, respectively. LBRs for first frozen-thawed cycles were 30.6 % (95 %-CI: 26.4-35.1) and 31.7 % (95 %-CI: 27.4-36.3) for initiated and transferred cycles, respectively. CLBRs for consecutive cycles were 18.2 % (95 %-CI: 16.2-20.3) for fresh initiated cycles, 29.7 % (95 %-CI: 26.6-32.9) for fresh transferred cycles, 25.5 % (95 %-CI: 22.6-28.5) for frozen-thawed initiated cycles, and 26.4 % (95 %-CI: 23.5-29.6) for frozen-thawed transferred cycles. For 436 women who contributed with an entire IVF programme we found a CLBR of 64.0 % (95 %-CI: 59.3-68.5). CONCLUSION Compared to other studies of CLBR after multiple ovarian stimulations using cleavage stage transfer, our study presents a considerable effect in the IVF success rate when using blastocyst transfer only. In a clinical setting, transfer of blastocysts seems to be a viable method.
Collapse
Affiliation(s)
- Sidse Høyer
- Aagaard Fertility Clinic, Hedeager, 35 8200, Aarhus, Denmark.
| | - Ulrik Schiøler Kesmodel
- Aagaard Fertility Clinic, Hedeager, 35 8200, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, 9000, Aalborg, Denmark.
| | - Jørn Aagaard
- Aagaard Fertility Clinic, Hedeager, 35 8200, Aarhus, Denmark.
| |
Collapse
|
11
|
Coticchio G, Pennetta F, Rizzo R, Tarozzi N, Nadalini M, Orlando G, Centonze C, Gioacchini G, Borini A. Embryo morphokinetic score is associated with biomarkers of developmental competence and implantation. J Assist Reprod Genet 2021; 38:1737-1743. [PMID: 33821429 DOI: 10.1007/s10815-021-02162-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/18/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To study embryo morphokinetics in relation to release in spent media of molecules with possible roles in development and implantation (miR-20a, miR-30c, and sHLA-G). METHODS Data were obtained from embryos generated in standard IVF and ICSI cycles. The Eeva system was used for embryo assessment, based on early morphokinetic parameters and producing a score (1-5, best-worst) corresponding to higher/medium/lower chances of development to blastocyst. miRNAs - mm miR-20a-5p and miR-30c-5p - and sHLA-G were quantified in 25 μl of spent blastocyst media (SBM) collected before vitrification or transfer. Statistical analyses were performed applying Kolmogorov-Smirnov, Shapiro-Wilk, and Spearman's correlation coefficient tests, where appropriate. RESULTS SBM were collected from a total of 172 viable blastocysts. Their analysis showed that concentration of miR-20a was progressively lower as Eeva score increased and probability of development to blastocyst decreased (P = 0.016). The opposite trend was observed in the case of miR-30c, i.e., concentration was higher as score increased and chances of development to blastocyst decreased (P = 0.004). Analysis of sHLA-G revealed a negative correlation with Eeva score, i.e., levels were progressively lower as Eeva score increased and probability of development to blastocyst decreased (R = - 0.388, N = 141, P = 0.001). CONCLUSION Our data suggest that morphokinetic algorithms that predict development to blastocyst stage, in fact, also identify embryos with molecular and cellular profiles more consistent with developmental functions.
Collapse
Affiliation(s)
- Giovanni Coticchio
- 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy.
| | - Francesca Pennetta
- 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy
- Simple Departmental Operative Unit, Reproductive Pathophysiology, Anastasia Guerriero Hospital, Marcianise, Caserta, Italy
| | - Roberta Rizzo
- Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Nicoletta Tarozzi
- 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy
| | - Marco Nadalini
- 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy
| | | | | | - Giorgia Gioacchini
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Borini
- 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy
| |
Collapse
|
12
|
Coticchio G, Fiorentino G, Nicora G, Sciajno R, Cavalera F, Bellazzi R, Garagna S, Borini A, Zuccotti M. Cytoplasmic movements of the early human embryo: imaging and artificial intelligence to predict blastocyst development. Reprod Biomed Online 2020; 42:521-528. [PMID: 33558172 DOI: 10.1016/j.rbmo.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/27/2020] [Accepted: 12/18/2020] [Indexed: 12/23/2022]
Abstract
RESEARCH QUESTION Can artificial intelligence and advanced image analysis extract and harness novel information derived from cytoplasmic movements of the early human embryo to predict development to blastocyst? DESIGN In a proof-of-principle study, 230 human preimplantation embryos were retrospectively assessed using an artificial neural network. After intracytoplasmic sperm injection, embryos underwent time-lapse monitoring for 44 h. For comparison, standard embryo assessment of each embryo by a single embryologist was carried out to predict development to blastocyst stage based on a single picture frame taken at 42 h of development. In the experimental approach, in embryos that developed to blastocyst or destined to arrest, cytoplasm movement velocity was recorded by time-lapse monitoring during the first 44 h of culture and analysed with a Particle Image Velocimetry algorithm to extract quantitative information. Three main artificial intelligence approaches, the k-Nearest Neighbour, the Long-Short Term Memory Neural Network and the hybrid ensemble classifier were used to classify the embryos. RESULTS Blind operator assessment classified each embryo in terms of ability to develop to blastocyst, with 75.4% accuracy, 76.5% sensitivity, 74.3% specificity, 74.3% precision and 75.4% F1 score. Integration of results from artificial intelligence models with the blind operator classification, resulted in 82.6% accuracy, 79.4% sensitivity, 85.7% specificity, 84.4% precision and 81.8% F1 score. CONCLUSIONS The present study suggests the possibility of predicting human blastocyst development at early cleavage stages by detection of cytoplasm movement velocity and artificial intelligence analysis. This indicates the importance of the dynamics of the cytoplasm as a novel and valuable source of data to assess embryo viability.
Collapse
Affiliation(s)
- Giovanni Coticchio
- 9.baby Family and Fertility Center, Via Dante, 15, Bologna 40125, Italy.
| | - Giulia Fiorentino
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Via Ferrata, 9 27100, Italy; Centre for Health Technology, University of Pavia, Pavia, Italy
| | - Giovanna Nicora
- Centre for Health Technology, University of Pavia, Pavia, Italy; Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Raffaella Sciajno
- 9.baby Family and Fertility Center, Via Dante, 15, Bologna 40125, Italy
| | - Federica Cavalera
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Via Ferrata, 9 27100, Italy
| | - Riccardo Bellazzi
- Centre for Health Technology, University of Pavia, Pavia, Italy; Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Silvia Garagna
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Via Ferrata, 9 27100, Italy; Centre for Health Technology, University of Pavia, Pavia, Italy
| | - Andrea Borini
- 9.baby Family and Fertility Center, Via Dante, 15, Bologna 40125, Italy
| | - Maurizio Zuccotti
- Department of Biology and Biotechnology 'Lazzaro Spallanzani', University of Pavia, Via Ferrata, 9 27100, Italy; Centre for Health Technology, University of Pavia, Pavia, Italy.
| |
Collapse
|
13
|
The freeze-all strategy after IVF: which indications? Reprod Biomed Online 2020; 42:529-545. [PMID: 33384269 DOI: 10.1016/j.rbmo.2020.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/09/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
The freeze-all strategy is gaining popularity worldwide as an alternative to the conventional fresh embryo transfer. It consists of cryopreservation of the entire embryo cohort and the embryo transfer in a subsequent cycle that takes place separately from ovarian stimulation. The freeze-all strategy was initially a 'rescue' strategy for women at high risk of ovarian hyperstimulation syndrome; however, this approach has been extended to other indications as a scheduled strategy to improve implantation rates. This assumes that ovarian stimulation can alter endometrial receptivity in fresh cycles owing to the effect of supraphysiological levels of steroids on endometrial maturation. The procedure, however, has not been associated with increased live birth rates in all infertile couples, and concerns have been raised about the occurrence of several adverse perinatal outcomes. It is, therefore, crucial to identify in which subgroups of patients a freeze-all strategy could be beneficial. The aim of this review is to summarize current scientific research in this field to highlight potential indications for this strategy and to guide clinicians in their daily practice.
Collapse
|
14
|
Frozen–thawed cleavage stage versus blastocyst stage embryo transfer in high responder patients. ZYGOTE 2020; 28:511-515. [DOI: 10.1017/s0967199420000428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryClinical outcomes following frozen–thawed cleavage embryo transfer versus frozen–thawed blastocyst transfer in high responder patients undergoingin vitrofertilisation/intracytoplasmic sperm injection cycles are still debated. In a retrospective study, 106 high responder patients who were candidate for ‘freeze-all embryos’ were recruited. Frozen–thawed embryos were transferred at the cleavage stage (n= 53) or the blastocyst stage (n= 53). Clinical pregnancy was considered as the primary outcome and chemical pregnancy, ongoing pregnancy, implantation rate, and fertilization rate, as well as miscarriage rate, were measured as the secondary outcome. Clinical (47.2% vs. 24.5%), chemical (56.6% vs. 32.1%), and ongoing pregnancy rates (37.7% vs. 17%) as well as implantation rates (33.6% vs. 13.5%) were significantly higher in the blastocyst group compared with the cleavage group respectively (P< 0.05). Miscarriage rate was comparable between groups (P> 0.05). Transfer of frozen–thawed embryos at the blastocyst stage was preferable in the high responder patients to increase implantation, pregnancy and live birth rates compared with cleavage stage embryo transfer.
Collapse
|
15
|
Boynukalin FK, Turgut NE, Gultomruk M, Ecemis S, Yarkiner Z, Findikli N, Bahceci M. Impact of elective frozen vs. fresh embryo transfer strategies on cumulative live birth: Do deleterious effects still exist in normal & hyper responders? PLoS One 2020; 15:e0234481. [PMID: 32589634 PMCID: PMC7319321 DOI: 10.1371/journal.pone.0234481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022] Open
Abstract
Background Is freeze-all strategy effective in terms of cumulative live birth rates (CLBRs) in all patients? Methods This retrospective single-center study analyzed the CLBRs of 2523 patients undergoing fresh or electively frozen blastocyst transfer cycles. In 1047, cycles, the fresh embryo transfer (ET) strategy was applied for the 1st ET, whereas electively frozen ET (e-FET) was performed in 1476 cycles. Female age ≤ 37 and blastocysts frozen via vitrification were included. The patients in each arm were further stratified into four subgroups according to the number of oocytes retrieved as follows: Group A: 1–5, group B: 6–10, group C: 11–15 and group D: 16–25 oocytes retrieved. The primary endpoint was the CLBR. The secondary endpoints were the ovarian hyperstimulation syndrome (OHSS) rate and the live birth rates (LBRs) following fresh ETs and e-FETs for the first transfers. Result(s) The CLBR was similar between the fresh ET and e-FET arms in group A (35/76 (46.1%) vs 29/67 (43.3%), p = 0.74) and group B (165/275 (60%) vs 216/324 (66.7%), p = 0.091), whereas significantly higher rates were detected in favor of the e-FET arm within group C (328/460 (71.3%) vs 201/348 (57.8%), p<0.001) and group D (227/348 (65.2%), vs 446/625 (71.5%), p<0.001). The OHSS rate was also found to be higher in the fresh ET arm among group C (12/348 (3.4%) vs 0/460 (0%), p<0.001) and group D (38/348 (10.9%) vs 3/625 (0.5%), p<0.001) patients than e-FET arm. Perinatal and obstetrical outcomes were nonsignificantly different between fresh and e-FET arms. However, the birth weights were significantly lower for fresh ET, 3064 versus 3201 g for singletons (p<0.001) Conclusion Compared with a fresh-transfer strategy, the e-FET strategy resulted in a higher CLBR among patients with >10 oocytes retrieved during stimulated cycles.
Collapse
Affiliation(s)
- Fazilet Kubra Boynukalin
- Department of Reproductive Endocrinology and IVF Center, Bahceci Health Group, Istanbul, Turkey
- * E-mail:
| | - Niyazi Emre Turgut
- Department of Reproductive Endocrinology and IVF Center, Bahceci Health Group, Istanbul, Turkey
| | - Meral Gultomruk
- Department of Embryology and R&D Center, Bahceci Health Group, Istanbul, Turkey
| | - Selen Ecemis
- Department of Reproductive Endocrinology and IVF Center, Bahceci Health Group, Istanbul, Turkey
| | | | - Necati Findikli
- Department of Embryology and R&D Center, Bahceci Health Group, Istanbul, Turkey
- Department of Biomedical Engineering, Beykent University, Istanbul, Turkey
| | - Mustafa Bahceci
- Department of Reproductive Endocrinology and IVF Center, Bahceci Health Group, Istanbul, Turkey
| |
Collapse
|
16
|
Sperm count affects cumulative birth rate of assisted reproduction cycles in relation to ovarian response. J Assist Reprod Genet 2020; 37:1653-1659. [PMID: 32405898 DOI: 10.1007/s10815-020-01807-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To explore the possible influence of sperm quality, as assessed by prewash total sperm count (TSC), on cumulative success rates in assisted reproduction cycles. METHODS Retrospective study carried out in private IVF centre. Seven hundred sixty-five couples undergoing complete ICSI cycles, i.e. whose all embryos were transferred or disposed of. Couples were characterised by male infertility and female age younger than 36 years. Couples with a combination of female and male infertility factors were excluded. The primary outcome measure was cumulative live birth rate. Secondary outcomes were cumulative pregnancy and miscarriage rates. No specific interventions were made. RESULTS Higher TSC values have a positive impact on cumulative success rates in cycles characterised by few retrieved oocytes (1 to 5), while does not influence the outcome of cycles with a normal (6 to 10) or high (> 10) number of retrieved oocytes. CONCLUSIONS The study highlights the importance of sperm quality for the efficacy of assisted reproduction treatments. This influence may remain relatively cryptic in association with normal or high ovarian response, but emerge decisively in cases of reduced ovarian response, suggesting a relationship between ovarian response and oocyte ability to compensate for paternal-derived deficiencies.
Collapse
|
17
|
Alternative patterns of partial embryo compaction: prevalence, morphokinetic history and possible implications. Reprod Biomed Online 2020; 40:347-354. [DOI: 10.1016/j.rbmo.2019.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022]
|
18
|
Zhao Z, Shi H, Li J, Zhang Y, Chen C, Guo Y. Cumulative live birth rates according to the number of oocytes retrieved following the "freeze-all" strategy. Reprod Biol Endocrinol 2020; 18:14. [PMID: 32087702 PMCID: PMC7035702 DOI: 10.1186/s12958-020-00574-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In recent years, some studies have shown that there is a positive association between the number of oocytes retrieved and the cumulative live birth rate (CLBR) after fresh and frozen cycles of one oocyte retrieval. However, almost no studies have examined the association between the number of oocytes retrieved and the CLBR when using the "freeze-all" strategy. We performed this study to investigate the effects of an extreme oocyte yield during the first "freeze-all" cycle on the cumulative live birth rate among patients younger than 35 years old. METHODS This was a retrospective cohort study performed in a university-affiliated reproductive medicine centre. Data obtained from 3276 women aged younger than 35 years who underwent their first "freeze-all" cycle (IVF/ICSI) were collected between January 2009 and December 2016. In all, 5025 frozen cycles took place during the follow-up period from January 2009 to December 2018. Patients were divided into five groups according to oocytes retrieved (group 1: 4-10 oocytes; group 2: 11-20 oocytes; group 3: 21-30 oocytes; group 4: 31-40 oocytes; group 5: > 40 oocytes). The primary outcome was the cumulative live birth rate. RESULTS Unadjusted results showed that the cumulative live birth rate significantly increased as the number of oocytes retrieved increased and reached up to 93.82% in cases with yields of 21-30 oocytes (P < 0.05), after which it did not have a significant increase (P > 0.05). After adjusting for confounders, our results showed that the number of oocytes retrieved is an independent positive predictor of cumulative live birth rate when using a "freeze-all" strategy. (P < 0.001). In addition, the fertilization rate and the gonadotropin dose also influenced the cumulative live birth rate (P<0.05). CONCLUSIONS Among women younger than 35 years old who underwent the "freeze-all" strategy, the number of oocytes retrieved positively correlated with the cumulative live birth rate. Taking both efficacy and safety into account, ovarian stimulation should be rational, and the upper limit of the oocyte yield should be no more than 30.
Collapse
Affiliation(s)
- Zhonghua Zhao
- Center of Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, 450052, People's Republic of China
| | - Hao Shi
- Center of Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, 450052, People's Republic of China
| | - Jing Li
- Center of Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, 450052, People's Republic of China
| | - Yile Zhang
- Center of Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, 450052, People's Republic of China
| | - Caihong Chen
- Center of Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, 450052, People's Republic of China
| | - Yihong Guo
- Center of Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
- Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, 450052, People's Republic of China.
| |
Collapse
|
19
|
Wei D, Legro RS, Chen ZJ. The cumulative live birth rate after a freeze-only strategy versus a conventional fresh embryo transfer strategy: a call for more level 1 evidence. BMC Med 2020; 18:12. [PMID: 31969160 PMCID: PMC6977243 DOI: 10.1186/s12916-019-1479-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Daimin Wei
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250001, China
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, 17033, USA
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250001, China.
| |
Collapse
|
20
|
Male factor infertility impacts the rate of mosaic blastocysts in cycles of preimplantation genetic testing for aneuploidy. J Assist Reprod Genet 2019; 36:2047-2055. [PMID: 31630313 DOI: 10.1007/s10815-019-01584-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/06/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE In this study, we tested the hypothesis that, in PGT-A cycles, decreased semen quality is associated with increased rates of mosaic blastocysts. METHODS In a retrospective analysis, three hundred and forty PGT-A cycles are divided into study groups according to semen quality. Cycles were initially divided into two groups, discerning couples with absence of male factor of infertility (non-male factor: NMF; N = 146 cycles) from couples with a male factor of infertility (MF; N = 173 cycles). Couples with severe male factor (SMF) infertility (n = 22) were assessed separately. Embryos were cultured to the blastocyst stage and chromosomally assessed by array comparative genomic hybridization (aCGH). The study did not involve specific interventions. RESULTS The reproductive outcome of MF and NMF groups did not indicate statistically significant differences. However, while no differences were found between MF and NMF groups in terms of euploid or aneuploid blastocysts rates, a significantly higher rate of mosaic blastocysts was observed in the MF group (3.6% vs. 0.5%, respectively; P = 0.03). A similar pattern of results was observed in the SMF group when compared with those of the other PGT-A cycles taken together (no SMF). In particular, a significantly higher rate of mosaic blastocysts was observed in the SMF group (7.7% and 1.8%, respectively; P = 0.008). CONCLUSIONS The study outcome strongly suggests that compromised semen quality is associated with increased rates of mosaic blastocysts analysed in PGT-A cycles. Sperm assessment appears therefore as an important factor in the determination of embryo development and for a more precise prognostic assessment of PGT-A cases.
Collapse
|
21
|
Vaiarelli A, Cimadomo D, Argento C, Ubaldi N, Trabucco E, Drakopoulos P, Venturella R, Conforti A, Alviggi C, Rienzi L, Ubaldi FM. Double stimulation in the same ovarian cycle (DuoStim) is an intriguing strategy to improve oocyte yield and the number of competent embryos in a short timeframe. ACTA ACUST UNITED AC 2019; 71:372-376. [PMID: 30848112 DOI: 10.23736/s0026-4784.19.04390-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Proper ovarian stimulation regimens are crucial for any patient undergoing in-vitro fertilization (IVF). However, maximizing the oocyte yield in advanced maternal age patients with poor or suboptimal response is still a challenge. In fact, no standard treatment has been outlined yet to manage these women. Across the last years, an improved efficiency of the IVF units via blastocyst culture, vitrification and reliable embryo selection approaches paved the way to the investigation of novel unconventional stimulation protocols, like double stimulation in a single ovarian cycle (DuoStim). DuoStim, by conjugating follicular phase stimulation (FPS) and luteal phase stimulation (LPS) in the same ovarian cycle, allows to maximize the number of oocytes obtained in a short timeframe, a precious outcome when we aim at shortening time to pregnancy. In this regard, LPS seems to contribute to conventional stimulation with more oocytes with a comparable competence as FPS, retrieved per ovarian cycle. Although any stimulation protocol which exploits anovulatory waves of follicular growth needs a thorough investigation, no evidence has been produced to question the safety of DuoStim, which to date represents the most intriguing strategy to treat poor prognosis in IVF.
Collapse
Affiliation(s)
- Alberto Vaiarelli
- G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy -
| | - Danilo Cimadomo
- G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Cindy Argento
- G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | | | | | | | - Roberta Venturella
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Laura Rienzi
- G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Filippo M Ubaldi
- G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| |
Collapse
|
22
|
Ding W, Zhang FL, Liu XC, Hu LL, Dai SJ, Li G, Kong HJ, Guo YH. Impact of Female Obesity on Cumulative Live Birth Rates in the First Complete Ovarian Stimulation Cycle. Front Endocrinol (Lausanne) 2019; 10:516. [PMID: 31428050 PMCID: PMC6687867 DOI: 10.3389/fendo.2019.00516] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Female overweight/obesity has been reported to be associated with compromised pregnancy outcomes in fresh embryo transfer cycles. It is unclear whether the cumulative live birth rate (CLBR) is adversely affected after all viable embryos are transferred from the first ovarian stimulation cycle. Objectives: To investigate whether the CLBR was compromised in obese women. Method: A total of 9,772 young women underwent their first IVF/ICSI cycles from January 2012 to October 2017. Pregnancy outcomes were compared according to female BMI. Results: Among 1,671 women with polycystic ovary syndrome (PCOS), those with a BMI ≥ 28 kg/m2 had a lower cumulative clinical pregnancy rate (CCPR) and CLBR during the first complete ovarian stimulation cycle. Additionally, the pregnancy loss rate was increased in this group, although the difference was not significant. Among the 8,101 women without PCOS, the CCPR and CLBR of obese patients was also significantly decreased, and this group also showed increased pregnancy loss rates. Moreover, overweight women also had a decreased CLBR. Conclusions: Female obesity adversely affected the CLBR after utilizing the viable embryos from first oocytes retrieval.
Collapse
Affiliation(s)
- Wen Ding
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fu-li Zhang
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-cong Liu
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin-li Hu
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan-jun Dai
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Li
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui-juan Kong
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi-hong Guo
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yi-hong Guo
| |
Collapse
|