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Parisi F, Fenizia C, Introini A, Zavatta A, Scaccabarozzi C, Biasin M, Savasi V. The pathophysiological role of estrogens in the initial stages of pregnancy: molecular mechanisms and clinical implications for pregnancy outcome from the periconceptional period to end of the first trimester. Hum Reprod Update 2023; 29:699-720. [PMID: 37353909 PMCID: PMC10628507 DOI: 10.1093/humupd/dmad016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/12/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Estrogens regulate disparate female physiological processes, thus ensuring reproduction. Altered estrogen levels and signaling have been associated with increased risks of pregnancy failure and complications, including hypertensive disorders and low birthweight babies. However, the role of estrogens in the periconceptional period and early pregnancy is still understudied. OBJECTIVE AND RATIONALE This review aims to summarize the current evidence on the role of maternal estrogens during the periconceptional period and the first trimester of pregnancies conceived naturally and following ART. Detailed molecular mechanisms and related clinical impacts are extensively described. SEARCH METHODS Data for this narrative review were independently identified by seven researchers on Pubmed and Embase databases. The following keywords were selected: 'estrogens' OR 'estrogen level(s)' OR 'serum estradiol' OR 'estradiol/estrogen concentration', AND 'early pregnancy' OR 'first trimester of pregnancy' OR 'preconceptional period' OR 'ART' OR 'In Vitro Fertilization (IVF)' OR 'Embryo Transfer' OR 'Frozen Embryo Transfer' OR 'oocyte donation' OR 'egg donation' OR 'miscarriage' OR 'pregnancy outcome' OR 'endometrium'. OUTCOMES During the periconceptional period (defined here as the critical time window starting 1 month before conception), estrogens play a crucial role in endometrial receptivity, through the activation of paracrine/autocrine signaling. A derailed estrogenic milieu within this period seems to be detrimental both in natural and ART-conceived pregnancies. Low estrogen levels are associated with non-conception cycles in natural pregnancies. On the other hand, excessive supraphysiologic estrogen concentrations at time of the LH peak correlate with lower live birth rates and higher risks of pregnancy complications. In early pregnancy, estrogen plays a massive role in placentation mainly by modulating angiogenic factor expression-and in the development of an immune-tolerant uterine micro-environment by remodeling the function of uterine natural killer and T-helper cells. Lower estrogen levels are thought to trigger abnormal placentation in naturally conceived pregnancies, whereas an estrogen excess seems to worsen pregnancy development and outcomes. WIDER IMPLICATIONS Most current evidence available endorses a relation between periconceptional and first trimester estrogen levels and pregnancy outcomes, further depicting an optimal concentration range to optimize pregnancy success. However, how estrogens co-operate with other factors in order to maintain a fine balance between local tolerance towards the developing fetus and immune responses to pathogens remains elusive. Further studies are highly warranted, also aiming to identify the determinants of estrogen response and biomarkers for personalized estrogen administration regimens in ART.
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Affiliation(s)
- F Parisi
- Department of Woman, Mother and Neonate, 'V. Buzzi' Children Hospital, ASST Fatebenefratelli Sacco, Milan, via L. Castelvetro 32, Milan, Italy
| | - C Fenizia
- Department of Pathophysiology and Transplantation, University of Milan, Milan, via F. Sforza 35, Milan 20122, Italy
- Department of Biomedical and Clinical Sciences, "L.Sacco" Hospital, University of Milan, Milan, via G.B. Grassi 74, Milan 20157, Italy
| | - A Introini
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Nobels väg 5, Stockholm, Sweden
| | - A Zavatta
- Department of Woman, Mother and Neonate, 'V. Buzzi' Children Hospital, ASST Fatebenefratelli Sacco, Milan, via L. Castelvetro 32, Milan, Italy
| | - C Scaccabarozzi
- Department of Biomedical and Clinical Sciences, "L.Sacco" Hospital, University of Milan, Milan, via G.B. Grassi 74, Milan 20157, Italy
| | - M Biasin
- Department of Biomedical and Clinical Sciences, "L.Sacco" Hospital, University of Milan, Milan, via G.B. Grassi 74, Milan 20157, Italy
| | - V Savasi
- Department of Biomedical and Clinical Sciences, "L.Sacco" Hospital, University of Milan, Milan, via G.B. Grassi 74, Milan 20157, Italy
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Wang M, Jin L, Shi J, Mao Y, Zhang C, Huang R, Liang X. Estradiol on trigger day: Irrelevant to live birth rates of fresh cycles but positively associated with cumulative live birth rates. Int J Gynaecol Obstet 2023; 163:627-638. [PMID: 37222253 DOI: 10.1002/ijgo.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 02/04/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess the effects of estradiol (E2) on trigger day on cumulative live birth rates (CLBRs), and pregnancy outcomes after fresh and frozen-thawed embryo transfer (FET). METHODS This multicenter retrospective cohort study included 42 315 patients from five reproductive centers. Six subgroups were divided according to E2 on trigger day (<1000, 1000-2000, 2000-3000, 3000-4000, 4000-5000, >5000 pg/mL). Smooth curve fitting and nonlinear mixed-effects models were used. RESULTS When E2 was <5500 pg/mL, the CLBR increased by 10% for every 1000 pg/mL increase in E2. When E2 was between 5500 and 13 281 pg/mL, CLBR increased by 1.8% for every 1000 pg/mL increase in E2. When E2 was >13 281 pg/mL, CLBR decreased by 3% for every 1000 pg/mL increase in E2. From group E2 < 1000 to group E2 > 5000 pg/mL, pregnancy and live birth rates in fresh cycles were not related to E2. The live birth rate after FET was higher in the E2 ≥ 5000 pg/mL group than in the E2 < 1000 pg/mL group (odds ratio [OR] 4.03, and 95% confidence interval [CI] 3.74-4.35; adjusted OR 1.20, 95% CI 1.05-1.37). CONCLUSION CLBR is associated with E2 on trigger day in a segmented manner. Pregnancy and live birth rates in fresh cycles were not associated with E2. The live birth rate in FET cycles was highest when E2 ≥ 5000 pg/mL.
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Affiliation(s)
- Meng Wang
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Juanzi Shi
- Reproductive Medicine Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Yundong Mao
- Reproductive Medicine Center, State Key Laboratory of Reproductive Medicine, Center of Clinical Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cuilian Zhang
- Reproductive Medicine Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Rui Huang
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Liang
- Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Zhang J, Ge X, Bu Z. Duration of late-follicular elevated progesterone and in vitro fertilization outcomes in pituitary down-regulation treatment cycles. Front Endocrinol (Lausanne) 2023; 14:1186146. [PMID: 37404305 PMCID: PMC10315613 DOI: 10.3389/fendo.2023.1186146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Background The objective of this study was to explore whether the duration of LFEP (late-follicular elevated progesterone) affected pregnancy outcomes in IVF (in vitro fertilization) patients treated with pituitary downregulation protocols. Method Patients with their first IVF/ICSI cycles between January 2016 and December 2016 were included. LFEP was set either at P > 1.0ng/ml or P > 1.5ng/ml. Clinical pregnancy rate was compared among three different groups (no LFEP; LFEP for 1 day; LFEP for ≥ 2 days). Then multivariate logistic regression analysis was performed to explore the influencing factors of clinical pregnancy rate. Results This retrospective analysis involved 3,521 first IVF/ICSI cycles with fresh embryo transfers. Clinical pregnancy rate was the lowest in patients with a LFEP duration of ≥ 2 days, irrespective of whether LFEP was defined as P > 1.0 ng/ml (68.79% vs. 63.02% vs. 56.20%; P = 0.000) or as P > 1.5 ng/ml (67.24% vs. 55.95% vs. 45.51%; P = 0.000). In addition, LFEP duration was significantly associated with clinical pregnancy outcomes in unadjusted logistic regression analysis. However, in multivariate regression models after adjusting confounders, adjusted OR for LFEP duration (≥ 2 days) in the two models was 0.808 (P = 0.064; LFEP as P > 1.0 ng/ml) and 0.720 (P = 0.098; LFEP as P > 1.5 ng/ml), respectively. Conclusion LFEP adversely affects clinical pregnancy outcomes. However, the duration of LFEP seems to have no influence on the clinical pregnancy rate in pituitary downregulation treatment cycles.
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George JS, Keefe KW, Lanes A, Yanushpolsky E. Premature progesterone elevation during the early and mid-follicular phases in fresh in vitro fertilization (IVF) cycles is associated with lower live birth, clinical pregnancy, and implantation rates. J Assist Reprod Genet 2023; 40:1029-1035. [PMID: 37012450 PMCID: PMC10239424 DOI: 10.1007/s10815-023-02786-z] [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: 01/10/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
PURPOSE Evaluate follicular phase progesterone elevation (≥ 1.5 ng/mL) prior to trigger during IVF stimulation and its effects on live birth rate (LBR), clinical pregnancy rate (CPR), and implantation rate (IR) in fresh IVF cycles. METHODS This was a retrospective cohort study within an academic clinic. A total of 6961 fresh IVF and IVF/ICSI cycles from October 1, 2015 to June 30, 2021 were included and grouped by progesterone (PR) prior to trigger: PR < 1.5 ng/mL (low PR group) and PR ≥ 1.5 ng/mL (high PR group). Main outcome measures included LBR, CPR, and IR. RESULTS Among all cycle starts, 1568 (22.5%) were in the high PR group and 5393 (77.5%) were in the low PR group. Of the cycles which proceeded to an embryo transfer, 416 (11.1%) were in the high PR group and 3341 (88.9%) were in the low PR group. The high PR group had significantly lower IR (RR 0.75; 95% CI 0.64-0.88), CPR (aRR 0.74; 95% CI 0.64-0.87), and LBR (aRR 0.71; 95% CI 0.59-0.85) compared to the low PR group. When stratified by progesterone on the day of trigger (TPR), there was a clinically notable decrease in IR (16.8% vs 23.3%), CPR (28.1% vs 36.0%), and LBR (22.8% vs 28.9%) in the high PR group compared to the low PR group even when TPR < 1.5 ng/mL. CONCLUSIONS In fresh IVF cycles in which TPR < 1.5 ng/mL, progesterone elevation ≥ 1.5 ng/mL at any point in time prior to trigger negatively impacts IR, CPR, and LBR. This data supports testing of serum progesterone in the follicular phase prior to trigger, as these patients may benefit from a freeze-all approach.
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Affiliation(s)
- Jenny S George
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Kimberly W Keefe
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrea Lanes
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Elena Yanushpolsky
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Huang LJ, Wan Q, Li T, Lv XY, Geng LH, He QQ, Zhong ZH, Li Y, Tang XJ. Effect of serum progesterone on human chorionic gonadotropin trigger day / metaphase II oocyte ratio on pregnancy and neonatal outcomes in women undergoing ICSI cycle. BMC Pregnancy Childbirth 2023; 23:224. [PMID: 37016365 PMCID: PMC10071741 DOI: 10.1186/s12884-023-05549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/26/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The serum progesterone on human chorionic gonadotropin trigger day / metaphase II oocyte (P/MII) ratio might be a more predictable indicator of pregnancy and neonatal outcomes as compare to P/estradiol (E2) or P alone. Hence, we conducted a larger population study to compare the pregnancy and neonatal outcomes in the low and high P/MII ratio. METHODS A retrospective, single-center, larger population cohort study between January 2015 and August 2021. Calculate the threshold effect of P/MII ratio on clinical pregnancy rate according to the construct smooth curve fitting. Divide data into two groups by threshold for comparison. RESULTS 3566 fresh ICSI-ET cycles were included, in which 929 singleton delivery and 676 twin deliveries. Compare to P/MII ≤ 0.367 group, it indicated that the P/MII > 0.367 group had a lower clinical pregnancy rate and live birth rate, furthermore, a significantly higher rate of LBW and SGA were observed in the singleton and twin deliveries. No deleterious impact of high P/MII ratio on embryo quality and undesirable pregnancy outcomes was shown. CONCLUSIONS When P/MII is higher than 0.367, may have adverse impacts on pregnancy and neonatal outcomes for ICSI cycle.
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Affiliation(s)
- Li-Juan Huang
- Research Center for Medical and Social Development, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Qi Wan
- Xinan Gynecological Hospital, Chengdu, 610011, China
| | - Tian Li
- The Department of Reproductive Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xing-Yu Lv
- Xinan Gynecological Hospital, Chengdu, 610011, China
| | - Li-Hong Geng
- Xinan Gynecological Hospital, Chengdu, 610011, China
| | - Qi-Qi He
- Xinan Gynecological Hospital, Chengdu, 610011, China
| | - Zhao-Hui Zhong
- Research Center for Medical and Social Development, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Yuan Li
- Xinan Gynecological Hospital, Chengdu, 610011, China.
| | - Xiao-Jun Tang
- Research Center for Medical and Social Development, School of Public Health, Chongqing Medical University, Chongqing, 400016, China.
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Li J, Cui Y, Shi H, Bu Z, Wang F, Sun B, Zhang Y. Effects of trigger-day progesterone in the preimplantation genetic testing cycle on the embryo quality and pregnancy outcomes of the subsequent first frozen-thawed blastocyst transfer. Front Endocrinol (Lausanne) 2023; 14:990971. [PMID: 36950680 PMCID: PMC10025458 DOI: 10.3389/fendo.2023.990971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Objective To assess whether progesterone (P) levels on the trigger day during preimplantation genetic testing (PGT) cycles are associated with embryo quality and pregnancy outcomes in the subsequent first frozen-thawed blastocyst transfer (FET) cycle. Methods In this retrospective analysis, 504 eligible patients who underwent ICSI followed by frozen-thawed embryo transfer (FET) with preimplantation genetic test (PGT) between December 2014 and December 2019 were recruited. All patients adopted the same protocol, namely, the midluteal, short-acting, gonadotropin-releasing hormone agonist long protocol. The cutoff P values were 0.5 and 1.5 ng/ml when serum P was measured on the day of human chorionic gonadotropin (HCG) administration, and cycles were grouped according to P level on the day of HCG administration. Furthermore, the effect of trigger-day progesterone on embryo quality and the subsequent clinical outcome of FET in this PGT population was evaluated. Results In total, 504 PGT cycles were analyzed. There was no significant difference in the number of euploid blastocysts, top-quality blastocysts, euploidy rate, or miscarriage rate among the three groups (P>0.05). The 2PN fertilization rate (80.32% vs. 80.17% vs. 79.07%) and the top-quality blastocyst rate (8.71% vs. 8.24% vs. 7.94%) showed a downward trend with increasing P, and the between-group comparisons showed no significant differences (P>0.05). The clinical pregnancy rate (41.25% vs. 64.79%; P<0.05) and live birth rate (35.00% vs. 54.93%; P<0.05) in subsequent FET cycles were substantially lower in the high-P group than in the P ≤ 0.5 ng/ml group. After adjustments were made for confounding variables, multivariate logistic regression analysis revealed that the high-P group had a lower clinical pregnancy rate (adjusted OR, 0.317; 95% CI, 0.145-0.692; P=0.004) and live birth rate (adjusted OR, 0.352; 95% CI, 0.160-0.773; P=0.009) than the low-P group in subsequent FET cycles, and the differences were significant. Conclusions This study demonstrates that in the PGT population, elevated P on the trigger day may diminish the top-quality blastocyst rate (although there is no difference in the euploidy rate). Trigger-day P is an important factor influencing clinical outcomes in subsequent FET cycles.
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Affiliation(s)
- Jingdi Li
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yueyue Cui
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Shi
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiqin Bu
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Wang
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Sun
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yile Zhang
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Jiang W, Li D, Zhu L, Wang J, Chen L, Zhang N, Wang S. Elevated serum progesterone levels on the hCG trigger day have a negative impact on the live birth rate in the first fresh IVF-ET cycle. J OBSTET GYNAECOL 2022; 42:3503-3508. [PMID: 36451550 DOI: 10.1080/01443615.2022.2151345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
To investigate whether there is a relationship between elevated serum progesterone (PROG) on the hCG trigger day and the live birth rate (LBR) in IVF/ICSI cycles, the retrospective analysis was carried out from the patients undergoing the first ART cycles throughout 2016. The PROG levels were measured on the hCG trigger day. The LBR, clinical pregnancy rate (CPR), implantation rate (IR) and other parameter rate values were compared among the three different PROG elevations. A total of 2550 IVF/ICSI cycles fulfilling all the inclusion and exclusion criteria were selected. Finally, three groups [PROG <0.40 ng/mL, 0.40 ≤ PROG < 1.5 ng/mL, PROG ≥ 1.5 ng/mL] were categorised based on the serum PROG levels. LBR, CPR and IR declined as the PROG value increased, while there was no difference in the embryo utilisation rates. Serum PROG levels on the day of hCG administration were negatively associated with the LBR, even in ETs with a good prognosis.Impact StatementWhat is already known on this subject? The clinical effects of PROG are still controversial. Some studies have confirmed that there was not too much association between premature elevation of PROG and live birth, some are still convincing that there is a negative correlation and will result in ART cycles of pregnancy and LBR reduction.What do the results of this study add? Our data substantiated that the high serum PROG level had the lowest LBR, IR and CPR, but the embryo utilisation rate may not have too much to do with the elevated PROG.What are the implications of these findings for clinical practice and/or further research? This study further strengthens the negative impact of elevated PROG levels on pregnancy outcomes, and suggests that frozen thawed embryo transfer appears to be a reasonable and advantageous approach for this subset of patients.
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Affiliation(s)
- Weihua Jiang
- Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
| | - Dong Li
- Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
| | - Lihua Zhu
- Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
| | - Jie Wang
- Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
| | - Linjun Chen
- Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
| | - Ningyuan Zhang
- Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
| | - Shanshan Wang
- Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
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Mahutte N, Hartman M, Meng L, Lanes A, Luo ZC, Liu KE. Optimal endometrial thickness in fresh and frozen-thaw in vitro fertilization cycles: an analysis of live birth rates from 96,000 autologous embryo transfers. Fertil Steril 2022; 117:792-800. [PMID: 35109980 DOI: 10.1016/j.fertnstert.2021.12.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To study the effect of increasing endometrial thickness on live birth rates in fresh and frozen-thaw embryo transfer (FET) cycles. DESIGN Retrospective cohort study. SETTING National data from Autologous in vitro fertilization (IVF) embryo transfer and FET cycles in Canada from the Canadian Assisted Reproductive Technology Registry Plus (CARTR Plus) database for records between January 2013 and December 2019. PATIENTS Thirty-three Canadians clinics participated in voluntary reporting of IVF and pregnancy outcomes to the Canadian Assisted Reproductive Technology Registry Plus database, and a total of 43,383 fresh and 53,377 frozen transfers were included. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical pregnancy, pregnancy loss, and live birth rates. RESULTS In fresh IVF-embryo transfer cycles, increasing endometrial thickness is associated with significant increases in the mean number of oocytes retrieved, peak estradiol levels, number of usable embryos, clinical pregnancy rates, live birth rates, and mean term singleton birth weights, and a decrease in pregnancy loss rates. However, live birth rates plateau after 10-12 mm. In contrast, in FET cycles live birth rates plateau after the endometrium measures 7-10 mm. The improvement in live birth rates with increasing endometrial thickness was independent of patient age, timing of embryo transfer (e.g., cleavage stage vs. blastocyst stage), or the number of oocytes at retrieval. CONCLUSIONS In cycles with a fresh embryo transfer, live birth rates increase significantly until an endometrial thickness of 10-12 mm, while in FET cycles live birth rates plateau after 7-10 mm. However, an endometrial thickness <6 mm was associated clearly with a dramatic reduction in live birth rates in fresh and frozen embryo transfer cycles.
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Affiliation(s)
- Neal Mahutte
- The Montreal Fertility Centre, Montreal, Québec.
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Xu X, Yang A, Han Y, Wang W, Hao G, Cui N. The Association Between Serum Estradiol Levels on hCG Trigger Day and Live Birth Rates in Non-PCOS Patients: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:839773. [PMID: 35592781 PMCID: PMC9112425 DOI: 10.3389/fendo.2022.839773] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To retrospectively analyze the association of serum estradiol (E2) levels on human chorionic gonadotropin (hCG) trigger day and live birth rates (LBRs) in women undergoing fresh embryo transfer and not exhibiting polycystic ovary syndrome. DESIGN Retrospective cohort study. METHODS Analysis of 13,950 patients who had fresh embryo transfer between December 2013 and December 2019. The main outcome measurement was LBRs. Multivariable regression analysis was performed to investigate associations between E2 levels on the hCG trigger day and LBRs. Stratification analysis was performed to test for effect modification in subgroups. Furthermore, a two-piecewise linear regression model was established to find nonlinear relationships. RESULTS Multivariable regression analysis showed a significant association between serum E2 levels on the hCG trigger day and LBRs, adjusting for covariates [relative risk (RR) 1.027, 95% confidence interval (CI) 1.007, 1.049]. Stratification analysis showed that the LBRs were positively associated (RR 1.052, 95% CI 1.004, 1.102) with every 1 ng/ml increase of serum E2 on the hCG trigger day for the subgroup with low antral follicle counts on the trigger day. Specifically, a two-piecewise linear regression model showed that there was a positive association (RR 1.188, 95% CI 1.057, 1.334) between serum E2 and LBR for every increase of 1 ng/ml E2 when the concentration of serum E2 was lower than 2.1 ng/ml. However, there was no significant association (RR 1.002, 95% CI 0.971, 1.032) between E2 levels and LBRs when the concentration of E2 was higher than the 2.1ng/ml inflection point. CONCLUSIONS Serum E2 levels on the hCG trigger day were segmentally connected with LBRs.
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Zhang J, Du M, Wu Y, Wei Z, Guan Y. Effect of serum progesterone levels on hCG trigger day on pregnancy outcomes in GnRH antagonist cycles. Front Endocrinol (Lausanne) 2022; 13:982830. [PMID: 36246920 PMCID: PMC9554087 DOI: 10.3389/fendo.2022.982830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The present study analyzed the effect of hCG trigger day progesterone (P) levels on the live birth rate (LBR) in the gonadotropin-releasing hormone (GnRH) antagonist protocol. MATERIALS AND METHODS This study was a single-center retrospective study. In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles performed from January 2017 to December 2020 were included in the analysis. This study included people with a normal ovarian response to fresh embryo transfer of GnRH antagonist protocols. All cycles were divided into 2 groups by P level on the day of human chorionic gonadotropin (hCG) trigger, P<1.0 ng/ml and P≥1.0 ng/ml. The primary outcome measure was LBR. RESULT A total of 867 cycles with P<1.0 ng/ml and 362 cycles with P≥1.0 ng/ml were included in the analysis. The clinical pregnancy rate (CPR) was higher in the P<1.0 ng/ml group than the P≥1.0 ng/ml group (44.9% vs. 37.6%, P=0.02). The early spontaneous abortion rate was comparable between the groups (14.4% vs. 14.7%, P=0.93). For live birth, the rate for the P<1.0 ng/ml group was 35.3%, which was significantly higher than the 29.0% in the P≥1.0 ng/ml group (P=0.03). After binary logistic regression analysis, the P level on the hCG trigger day (adjusted odds ratio=0.74, 95% CI=0.55-0.99, P=0.04) was an independent risk factor for LBR. For the P level on the hCG trigger day, the LBR was lower in the P≥1.0 ng/ml group compared to the P<1.0 ng/ml group. CONCLUSION For normal ovarian response patients using the GnRH antagonist protocol, serum P≥1.0 ng/ml on the hCG trigger day resulted in a lower LBR than the P<1.0 ng/ml group. When P≥1.0 ng/ml, whole embryo freezing may be considered.
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Luo X, Li L, Lin N, Ma R, Li Y, Wu Z. Low Endogenous LH on the COS Initiation Day of a GnRH-Agonist Regimen Increases the Risk of Early Pregnancy Loss and Adverse ART Outcomes. Front Endocrinol (Lausanne) 2022; 13:830567. [PMID: 35265040 PMCID: PMC8898906 DOI: 10.3389/fendo.2022.830567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/28/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the impact of serum luteinizing hormone (LH) levels on the day of initiation of controlled ovarian stimulation (COS) after pituitary suppression on early pregnancy loss and assisted reproductive technology (ART) outcomes. DESIGN Retrospective cohort study. SETTING University-affiliated hospital. PATIENTS A total of 9540 normogonadotrophic patients were treated with a GnRH agonist for in vitro fertilization (IVF). Based on the serum concentration of LH on the COS initiation day, patients were divided into low (<1 mIU/mL, n=2838), medium (1-1.49 mIU/mL, n=3357), or high (≥1.5 mIU/mL, n=3345) LH groups and received either fresh embryo transfer (ET) or frozen ET (women with high ovarian response, insufficient endometrial thickness, or requesting frozen ET). A total of 6279 cycles were fresh ET (1960, 2222, and 2097 in the low, medium, and high LH groups, respectively). INTERVENTIONS During IVF/ICSI, a GnRH agonist was used to suppress pituitary function in the midluteal phase or follicular phase, and then gonadotropin was used to induce COS. MAIN OUTCOME MEASURES The early pregnancy loss rate (ePLR) and live-birth rate (LBR) for fresh ET, as well as the cumulative ePLR and LBR for the entire ovarian stimulation cycle, were compared. RESULTS In the fresh ET cycles, the high, medium and low LH groups had an ePLR of 8.6%, 11.9% and 12.5%, respectively, and LBR of 42.1%, 37.9% and 37.5%, respectively. There were no significant differences in terms of clinical pregnancy rate (CPR), late pregnancy loss rate (lPLR), and ectopic pregnancy rate (EPR) among the three LH groups. For the entire ovarian stimulation cycle, the high LH group had a greater number of retrieved oocytes compared with the low and medium LH groups. Among the groups of high, medium and low LH, the cumulative CPR were 72.8%, 69.8% and 68.8%, respectively, and the cumulative LBR were 63.4%, 60.4% and 58.5%, respectively. There were no significant differences in the cumulative ePLR, lPLR, or EPR. After multivariable logistic regression, compared with the high LH group, the adjusted odds ratio of early pregnancy loss in the low and medium LH group were 1.429 (1.065-1.919, P = 0.018) and 1.389 (1.041-1.853, P = 0.026). CONCLUSIONS After pituitary suppression by a GnRH-agonist during IVF, a low LH level (<1.5 mIU/mL) on the COS initiation day was associated with adverse ART outcomes-including fewer oocytes, higher ePLR and lower LBR in fresh ET-and lower cumulative CPR and LBR in the entire ovarian-stimulation cycle. And LH on the COS initiation day was an independent factor affecting ePLR after multivariate regression.
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Affiliation(s)
- Xi Luo
- Department of Reproductive Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
- Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Lei Li
- Department of Reproductive Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
- Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Na Lin
- Department of Reproductive Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
- Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Rui Ma
- Department of Reproductive Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
- Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yonggang Li
- Department of Reproductive Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
- Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- *Correspondence: Ze Wu, ; Yonggang Li,
| | - Ze Wu
- Department of Reproductive Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
- Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- *Correspondence: Ze Wu, ; Yonggang Li,
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Yang Y, Liu B, Wu G, Yang J. Exploration of the value of progesterone and progesterone/estradiol ratio on the hCG trigger day in predicting pregnancy outcomes of PCOS patients undergoing IVF/ICSI: a retrospective cohort study. Reprod Biol Endocrinol 2021; 19:184. [PMID: 34893087 PMCID: PMC8665570 DOI: 10.1186/s12958-021-00862-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/21/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine disorder with the disorders of estrogen(E2) and progesterone(P) secretion. The purpose of this study was to evaluate the association between the progesterone level or progesterone/estradiol(P/E2) ratio on human chorionic gonadotropin (hCG) trigger day and the outcome of in vitro fertilization in PCOS patients and explore the value of progesterone and P/E2 ratio for predicting the clinical pregnancy. METHODS The clinical data of 1254 PCOS patients who satisfied the inclusion criteria were retrospectively analyzed, including baseline characteristics such as age, body mass index, basal sex hormone levels, et al., as well as ovarian stimulation data and clinic outcome. RESULTS The number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001) was greater in the high progesterone group (progesterone ≥ 0.92 ng/mL). In the high P/E2 group(P/E2 ratio ≥ 0.3), the number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001), as well as the rate of high-quality embryos (P = 0.040) were significantly decreased. In ultralong GnRH agonist protocol, the implantation rate(P < 0.001), hCG positive rate (P < 0.001), clinical pregnancy rate (P < 0.001) and live birth rate (P < 0.001) were all significantly higher than long GnRH agonist protocol and GnRH antagonist protocol. The clinical pregnancy rate of high progesterone group was significantly lower than that of low progesterone group in ultralong GnRH agonist (P = 0.008). The progesterone level could be used as an indicator to predict the positive clinical pregnancy (long GnRH agonist: P = 0.001; ultralong GnRH agonist: P < 0.001) except in cycles using GnRH antagonist (P = 0.169). In the ultralong GnRH agonist, the value of progesterone level in the prediction of clinical pregnancy was significantly higher than that of the P/E2 ratio (P = 0.021). CONCLUSIONS In PCOS patients, the progesterone level is associated with clinical pregnancy rate while P/E2 ratio is not. In subgroup analysis using three different COS protocols, a significant association between progesterone level and clinical pregnancy rate can be observed in the long GnRH agonist protocol and ultralong GnRH agonist protocol. The progesterone level is significantly better than the P/E2 ratio in predicting the pregnancy outcome of PCOS patients, especially in ultralong GnRH agonist cycles.
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Affiliation(s)
- Yiqing Yang
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Clinical Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, 430060, People's Republic of China
| | - Bowen Liu
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Clinical Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, 430060, People's Republic of China
| | - Gengxiang Wu
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.
- Hubei Clinical Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, 430060, People's Republic of China.
| | - Jing Yang
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.
- Hubei Clinical Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, 430060, People's Republic of China.
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Tokgoz VY, Tekin AB. Serum progesterone level above 0.85 ng/mL and progesterone/estradiol ratio may be useful predictors for replacing cleavage-stage with blastocyst-stage embryo transfer in fresh IVF/ICSI cycles without premature progesterone elevation. Arch Gynecol Obstet 2021; 305:1011-1019. [DOI: 10.1007/s00404-021-06304-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/18/2021] [Indexed: 12/01/2022]
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Tokgoz VY, Ekici GC, Tekin AB. The efficiency of progesterone/estradiol and progesterone/follicle ratio without elevated trigger-day progesterone levels on the reproductive outcomes of GnRH antagonist IVF/ICSI cycles. Gynecol Endocrinol 2021; 37:885-890. [PMID: 33517800 DOI: 10.1080/09513590.2021.1878137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AIM To assess the predictive value of serum progesterone/estradiol (P/E2) and serum progesterone/follicle (P/F) ratios on the reproductive outcomes of women without elevated trigger-day progesterone levels undergoing GnRH-antagonist IVF (in vitro fertilization)/ICSI (intracytoplasmic sperm injection) cycles. MATERIALS AND METHODS This was a retrospective cohort study in a university teaching hospital conducted between January 2017 and December 2019. Couples who underwent assisted reproduction cycles were evaluated. Initially, 978 cycles were evaluated and only GnRH antagonist cycles (n = 505) without elevated trigger-day progesterone levels were analyzed after respecting exclusion criteria. RESULTS A total of 505 cycles were analyzed after the exclusion criteria were met. The clinical pregnancy rate, ongoing pregnancy rate, and live birth rate were 45.5%, 30.9%, and 27.8%, respectively. Cutoff values of P/E2 and P/F ratios that were discriminative for achieving or not achieving clinical pregnancy were 0.36 and 0.17, respectively. The clinical pregnancy rates were found to be significantly different between below and above P/E2 cutoff values (49.8% vs. 40.1%, respectively, p = .031), while there were no significant differences between below and above P/F cutoff values regarding the pregnancy outcomes. CONCLUSION The P/E2 and P/F ratios were found to be more efficient and reliable markers than serum progesterone level alone in predicting the reproductive outcomes of assisted reproduction cycles without a premature rise in serum progesterone levels. A P/E2 ratio ≤0.36 and a P/F ratio ≤0.17 significantly improved the cycle outcomes.
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Affiliation(s)
- Vehbi Yavuz Tokgoz
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Gizem Ceren Ekici
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ahmet Basar Tekin
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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Hu L, Xiong Y, Wang M, Shi H, Sun Y. Effect of progesterone on hCG day-to-basal progesterone ratio on live birth rate in long agonist fresh IVF/ICSI cycles: a 5-year, single-center study of more than 10,000 cycles. Gynecol Endocrinol 2021; 37:706-710. [PMID: 33438480 DOI: 10.1080/09513590.2020.1832067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate whether the ratio of the serum progesterone level on the day of human chorionic gonadotrophin (hCG) administration to the basal serum progesterone level (PhCG/Pbasal) is a predictor of pregnancy outcome during in vitro fertilization (IVF). METHODS A total of 12,708 cycles were performed in 9747 patients between 19 and 36 years of age who were undergoing controlled ovarian stimulation from October 2011 to July 2016 for their first or second attempts at IVF followed by fresh embryo transfer (ET). hCG was administered 36 h before oocyte retrieval to trigger final oocyte maturation. The serum progesterone level was measured on menstrual cycle days 2-4 (basal progesterone, Pbasal) and on the day of hCG administration (PhCG). PhCG/Pbasal was calculated. Live birth rates were compared among various ordinal PhCG/Pbasal intervals (< 0.5, 0.5-1.0, 1.0-1.5, 1.5-2.0, 2.0-2.5, > 2.5). RESULTS The average age of the patients recruited was 29.9 years. The average basal progesterone level was 0.8 ng/ml, while the average progesterone level on the day of hCG administration was 0.9 ng/ml. The live birth rates (according to the abovementioned ordinal PhCG/Pbasal intervals) were 47.3, 49.9, 47.8, 46.3, 45.5 and 44.0%, respectively. The live birth rates were significantly higher for patients with PhCG/Pbasal between 0.5-1.0 (OR = 1.14, 95% CI, 1.02-1.27, p = .02). CONCLUSIONS PhCG/Pbasal between 0.5-1.0 predicts a higher live birth rate in IVF. Both PhCG/Pbasal and P on hCG day is less predictive value for predicting live birth rate.
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Affiliation(s)
- Linli Hu
- Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yujing Xiong
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mengying Wang
- Department of Obstetrics and Gynaecology, Medical Faculty, Cologne University, Cologne, Germany
| | - Hao Shi
- Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ying Y, Lu X, Zhang H, Arhin SK, Hou X, Wang Z, Wu H, Lu J, Tang Y. Clinical and perinatal outcomes of fresh single-blastocyst-transfer cycles under an early follicular phase prolonged protocol according to day of trigger estradiol levels. PeerJ 2021; 9:e11785. [PMID: 34395072 PMCID: PMC8320517 DOI: 10.7717/peerj.11785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
Backgroud This study’s objectives were to compare the clinical, perinatal, and obstetrical outcomes of patients with different estradiol (E2) levels in fresh single-blastocyst-transfer (SBT) cycles under an early follicular phase prolonged regimen on the day of trigger. Methods We recruited patients in fresh SBT cycles (n = 771) undergoing early follicular phase prolonged protocols with β-hCG values above 10 IU/L between June 2016 and December 2018. Patients who met the inclusion and exclusion criteria were divided into four groups according to their serum E2 level percentages on the day of trigger: <25th, 25th–50th, 51st–75th, and >75th percentile groups. Results Although the rates of clinical pregnancy (85.57% (166/194)), embryo implantation 86.60% (168/194), ongoing pregnancy (71.13% (138/194)), and live birth (71.13% (138/194)) were lowest in the >75th percentile group, we did not observe any significant differences (all P > 0.05). We used this information to predict the rate of severe ovarian hyperstimulation syndrome (OHSS) area under the curve (AUC) = 72.39%, P = 0.029, cut off value of E2 = 2,893 pg/ml with the 75% sensitivity and 70% specificity. The 51st–75th percentile group had the highest rates of low birth weight infants (11.73% (19/162), P = 0.0408), premature delivery (11.43% (20/175), P = 0.0269), admission to the neonatal intensive care unit (NICU) (10.49% (17/162), P = 0.0029), twin pregnancies (8.57% (15/175), P = 0.0047), and monochorionic diamniotic pregnancies (8.57% (15/175); P = 0.001). We did not observe statistical differences in obstetrics complications, including gestational diabetes mellitus (GDM), gestational hypertension, placenta previa, premature rupture of membranes (PROM), and preterm premature rupture of membranes (PPROM). Conclusion We concluded that serum E2 levels on the day of trigger were not good predictors of live birth rate or perinatal and obstetrical outcomes. However, we found that high E2 levels may not be conducive to persistent pregnancies. The E2 level on the day of trigger can still be used to predict the incidence of early onset severe OHSS in the fresh SBT cycle.
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Affiliation(s)
- Yingfen Ying
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaosheng Lu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huina Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Samuel Kofi Arhin
- School of Allied Health Sciences, University of Cape Coast, PMB, Cape Coast, Ghana
| | - Xiaohong Hou
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zefan Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Han Wu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jieqiang Lu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunbing Tang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Hussein RS, Elnashar I, Abou-Taleb HA, Zhao Y, Abdelmagied AM, Abbas AM, Abdalmageed OS, Abdelaleem AA, Farghaly TA, Youssef AA, Badran E, Ibrahim MN, Amin AF. Progesterone/Oestradiol ratio can Better Predict Intracytoplasmic Sperm Injection Outcomes than Absolute Progesterone Level. J Hum Reprod Sci 2021; 14:28-35. [PMID: 34083989 PMCID: PMC8057156 DOI: 10.4103/jhrs.jhrs_57_20] [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: 04/05/2020] [Revised: 08/10/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Several parameters were proposed to predict the impact of premature luteinization on intracytoplasmic sperm injection (ICSI) outcomes such as isolated progesterone (P) level, progesterone to oocyte ratio, and progesterone/estradiol ratio (P/E2). Aim: The aim of this study is to compare the predictive value of P/E2 ratio and isolated P level on the ovulation triggering day for pregnancy outcomes in fresh GnRH antagonist ICSI cycles. Settings and Design: A retrospective cohort study conducted in a university-affiliated in vitro fertilization center between January 2017 and April 2019. Methods: The study included women who underwent their first- or second-ranked GnRH antagonist ICSI cycles with day-3 embryo transfer. P/E2 ratio was calculated as (P [ng/mL] × 1000)/E2 (pg/mL). Cutoff values of ≥1.5 ng/ml for high P (HP) and ≥0.55 for HP/E2 ratio were chosen based on the literature. Statistical Analysis: A receiver operating curve was performed to detect the predictability of serum P/E2 and P for the ongoing pregnancy rate. First, patients were divided according to either P level (low P < 1.5 ng/mL and HP ≥1.5 ng/mL) or P/E2 ratio (low P/E2 <0.55 and HP/E2 ≥ 0.55). Patients were further divided into four subgroups: (Group A: HP and HP/E2 ratio, Group B: low P and low P/E2 ratio, Group C: HP only, and Group D: HP/E2 only). A multivariate regression analysis models were used to account for the effect of the cycle confounders on the likelihood of pregnancy. Results: A total of 402 ICSI cycles were analyzed. The area under the curve was 0.67 and 0.59 for P/E2 and P, respectively. P/E2 showed a significant association with ongoing pregnancy (adjusted odds ratios [aOR]: 0.409, 95% confidence interval [CI] 0.222–0.753, P = 0.004) while HP revealed no significant predictive value (aOR: 0.542, 95% CI 0.284–1.036, P = 0.064) after the multivariate analysis. Conclusions: P elevation may not present as an independent predictor for cycle outcomes. P/E2 ratio has a better prognostic value than P alone in predicting pregnancy of GnRH antagonist cycles.
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Affiliation(s)
- Reda S Hussein
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ihab Elnashar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abou-Taleb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yulian Zhao
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed M Abdelmagied
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Taibah University, Medina, KSA
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Osama S Abdalmageed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Abdelaleem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tarek A Farghaly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Youssef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa Badran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mostafa N Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed F Amin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Supraphysiological estradiol levels on the hCG trigger day are associated with SGA for singletons born from fresh embryo transfer. J Dev Orig Health Dis 2021; 13:244-251. [PMID: 33971999 DOI: 10.1017/s2040174421000234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The effects of supraphysiological estradiol (E2) on neonatal outcomes and the significance of specific E2 concentrations remain unclear. The purpose of this study was to investigate whether supraphysiological E2 levels on the human chorionic gonadotropin (hCG) trigger day are associated with small size for gestational age (SGA) in singletons born from fresh embryo transfer (ET) cycles. Patients with singleton pregnancies who delivered after the transfer of fresh embryos, during the period from July 2012 to December 2017, at our center were included. We excluded cycles involving a vanishing twin, maternal age >35 years, basal follicle-stimulating hormone ≥10 mIU/ml, or anti-Müllerian hormone ≤1 ng/ml. We then divided all cycles into five groups by E2 level on trigger day: group A, <2000 pg/ml (reference group); group B, 2000 pg/ml≤E2<2999 pg/ml; group C, 3000 pg/ml≤E2<3999 pg/ml; group D, 4000 pg/ml≤E2<4999 pg/ml; and group E, ≥5000 pg/ml. The prevalence of SGA among singletons from fresh ET was the primary outcome. The SGA rate significantly increased when the E2 level was ≥4000 pg/ml, as observed by comparing groups D (odds ratio [OR]: 1·79, 95% confidence interval [CI]: 1·16-2·76, P = 0·01) and E (OR: 1·68, 95% CI: 1·10-2·56, P = 0·02) with the reference group. Multivariate logistic regression indicated that a serum E2 level of at least 4000 pg/ml on the hCG trigger day was associated with increased SGA and with significant differences for groups D (adjusted OR [AOR]: 1·65, 95% CI: 1·05-2·59, P = 0·03) and E (AOR: 1·60, 95% CI: 1·03-2·53, P = 0·04) relative to the reference group. In conclusion, in fresh ET cycles, the supraphysiological E2 ≥4000 pg/ml on the hCG trigger day increases the risk of SGA.
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Mahran A, Khairy M, Elkhateeb R, Hegazy AR, Abdelmeged A, Batiha GES, Alsharif KF, Hetta HF, Bahaa HA. The value of serum progesterone level on day of human chorionic gonadotrophin administration / metaphase II oocyte ratio in predicting IVF/ICSI outcome in patients with normal ovarian reserve. J Ovarian Res 2021; 14:52. [PMID: 33794989 PMCID: PMC8017661 DOI: 10.1186/s13048-021-00800-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background The clinical implication of the increased serum progesterone level on the day of HCG administration in assisted reproduction treatment (ART) is still controversial. The current study aimed to compare the predictive value of serum progesterone on day of HCG administration / metaphase II oocyte (P/MII) ratio on IVF/ ICSI outcome to serum progesterone (P) level alone and the ratio of serum progesterone/estradiol level (P/E2) ratio in prediction of pregnancy rates after ART. Material & methods Two hundred patients admitted to the IVF/ICSI program at Minia IVF center in Egypt in the period from October 2016 to May 2018 were included in this study. Serum Progesterone (P) and Estradiol (E2) levels were estimated on the day of HCG administration. The ratio between serum P and the number of MII oocytes (P/MII ratio) was calculated and the predictive values of the three parameters (P, P/E2 ratio and P/MII ratio) in prediction of cycle outcomes were measured. Results P/ MII oocyte ratio was significantly lower in patients who attained clinical pregnancy (n = 97) as compared with those who couldn’t whilst there was no significant difference in P and P/E2 ratio between the two groups. Using a cut off value of 0.125, the sensitivity and specificity of progesterone/ MII ratio in prediction of no pregnancy in IVF/ICSI were 75.7 and 77.1% respectively with the area under The Receiver operating curve (ROC-AUC) = 0.808. The respective values of the ROC-AUC for the P and P/E2 ratio were 0.651 and 0.712 with sensitivity and specificity of 71.2 and 73.5%for P level and of 72.5 and 75.3% for P/E2 ratio. Implantation or clinical pregnancy rates were significantly different between patients with high and low P/MII ratio irrespective of day of embryo transfer (day 3 or 5). Conclusions In patients with normal ovarian response, serum progesterone on day of HCG / MII oocyte ratio can be a useful predictor of pregnancy outcomes and in deciding on freezing of all embryos for later transfer instead of high progesterone level alone.
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Affiliation(s)
- Ahmad Mahran
- Department of Obsterics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohammed Khairy
- Department of Obsterics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Reham Elkhateeb
- Department of Obsterics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Abdel Rahman Hegazy
- Department of Obsterics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ayman Abdelmeged
- Department of Obsterics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt.
| | - Khalaf F Alsharif
- Department of Clinical laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Haitham Ahmed Bahaa
- Department of Obsterics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
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20
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Luo X, Yang R, Bai Y, Li L, Lin N, Sun L, Liu J, Wu Z. Binding of microRNA-135a (miR-135a) to homeobox protein A10 ( HOXA10) mRNA in a high-progesterone environment modulates the embryonic implantation factors beta3-integrin (ITGβ3) and empty spiracles homeobox-2 (EMX2). ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:662. [PMID: 33987360 PMCID: PMC8106024 DOI: 10.21037/atm-21-596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Patients with elevated circulating progesterone concentrations on the day of the human chorionic gonadotropin (hCG) trigger had relatively low implantation rates during assisted reproductive treatments. In this study, we assess the hypothesis that different concentrations of progesterone regulate the expression of homeobox protein A10 (HOXA10) and its downstream genes through miRNA-135a. Methods MicroRNA-135a (miR-135a), HOXA10, beta3-integrin (ITGβ3), and empty spiracles homeobox-2 (EMX2) expression levels in endometrial tissues from patients with elevated progesterone were measured. To determine the threshold of progesterone level which can impair implantation, Ishikawa cells were used to determine the expression of the aforementioned 4 genes after exposure to 5 graded concentrations of progesterone. The dual-luciferase reporter assay was used to verify whether miR-135a regulated the expression of HOXA10. Furthermore, the effects of HOXA10 on the expression of key endometrial receptivity genes ITGβ3 and EMX2 were confirmed. Results High progesterone levels promoted miR-135a expression in vivo, and miR-135a bound to the 3'-untranslated region (3'-UTR) of HOXA10 mRNA to inhibit HOXA10 expression. Reduction of HOXA10 promoted EMX2 expression and inhibited ITG-3 production. Progesterone promoted the expression of HOXA10 in vitro at low concentrations. However, when the concentration was greater than 10−7 ng/mL, progesterone inhibited HOXA10 by promoting miR-135a expression, thereby altering the expression of related genes and affecting endometrial receptivity. Conclusions In vitro, the trend in miR-135a expression (which first decreased and then increased) was in direct contrast to that of HOXA10 expression (which first increased and then decreased) as progesterone levels increased. The key factors regulating endometrial receptivity included ITGβ3 and EMX2, which were confirmed to be regulated by HOXA10. High progesterone levels affected miR-135a expression, and miR-135a inhibited HOXA10 expression, thereby affecting endometrial receptivity.
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Affiliation(s)
- Xi Luo
- Faculty of Life science and Technology, Kunming University of Science and Technology, Kunming, China.,Medical School, Kunming University of Science and Technology, Kunming, China.,Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Renxiang Yang
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Yun Bai
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lei Li
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Na Lin
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lan Sun
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Jianjun Liu
- Yunnan Key Laboratory of Stem Cell and Regenerative Medicine, Research Center of Biomedical Engineering, Kunming Medical University, Kunming, China
| | - Ze Wu
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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21
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Liu Y, Li J, Zhang W, Guo Y. Association between serum oestradiol level on the hCG administration day and neonatal birthweight after IVF-ET among 3659 singleton live births. Sci Rep 2021; 11:6084. [PMID: 33727635 PMCID: PMC7966761 DOI: 10.1038/s41598-021-85692-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/02/2021] [Indexed: 11/09/2022] Open
Abstract
Oestradiol, an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization-embryo transfer (IVF-ET) cycles. A supraphysiologic E2 level is inevitable during controlled ovarian hyper-stimulation (COH), and its effect on the outcome of IVF-ET is controversial. The aim of this retrospective study is to evaluate the association between elevated serum oestradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and neonatal birthweight after IVF-ET cycles. The data of 3659 infertile patients with fresh IVF-ET cycles were analysed retrospectively between August 2009 and February 2017 in First Hospital of Zhengzhou University. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 230), group 2 (serum E2 levels between 1001 and 2000 pg/mL, n = 524), group 3 (serum E2 levels between 2001 and 3000 pg/mL, n = 783), group 4 (serum E2 levels between 3001 and 4000 pg/mL, n = 721), group 5 (serum E2 levels between 4001 and 5000 pg/mL, n = 548 ), and group 6 (serum E2 levels > 5000 pg/mL, n = 852). Univariate linear regression was used to evaluate the independent correlation between each factor and outcome index. Multiple logistic regression was used to adjust for confounding factors. The LBW rates were as follows: 3.0% (group 1), 2.9% (group 2), 1.9% (group 3), 2.9% (group 4), 2.9% (group 5), and 2.0% (group 6) (P = 0.629), respectively. There were no statistically significant differences in the incidences of neonatal LBW among the six groups. We did not detect an association between peak serum E2 level during ovarian stimulation and neonatal birthweight after IVF-ET. The results of this retrospective cohort study showed that serum E2 peak levels during ovarian stimulation were not associated with birth weight during IVF cycles. In addition, no association was found between higher E2 levels and increased LBW risk. Our observations suggest that the hyper-oestrogenic milieu during COS does not seem to have adverse effects on the birthweight of offspring after IVF. Although this study provides some reference, the obstetric-related factors were not included due to historical reasons. The impact of the high estrogen environment during COS on the birth weight of IVF offspring still needs future research.
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Affiliation(s)
- Yu Liu
- Reproductive Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jing Li
- Reproductive Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Wanyu Zhang
- Reproductive Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yihong Guo
- Reproductive Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
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22
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Modest AM, Johnson KM, Aluko A, Joshi A, Wise LA, Fox MP, Hacker MR, Sakkas D. Elevated serum progesterone during in vitro fertilization treatment and the risk of ischemic placental disease. Pregnancy Hypertens 2021; 24:7-12. [PMID: 33618055 DOI: 10.1016/j.preghy.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/22/2021] [Accepted: 02/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Elevated progesterone on the day of human chorionic gonadotropin (hCG) administration is associated with decreased live birth rates in IVF cycles. The association with adverse pregnancy outcomes is unknown. OBJECTIVES Assess the association between serum progesterone on the day of hCG administration and the risk of ischemic placental disease [IPD; preeclampsia, placental abruption, and/or small for gestational age (SGA)]. METHODS We conducted a retrospective cohort study of autologous fresh IVF cycles resulting in delivery between 2005 and 2018. All IVF procedures were conducted at a large, university-affiliated infertility center. Patients were divided into tertiles based on their serum progesterone level on the day of hCG administration; the lowest tertile served as the reference group. We identified pregnancies complicated by preeclampsia and placental abruption using ICD-9/10 codes and medical record review. We defined SGA as < 10th percentile using U.S. growth curves. RESULTS The cohort included 166 deliveries in the lowest tertile of progesterone (0.2-0.73 ng/ml), 166 deliveries in the middle (0.64-1.05 ng/ml) and 167 deliveries in the highest tertile (1.05-5.6 ng/ml). Compared with the lowest tertile, the risk of IPD was greater in the middle (RR 1.6; 95% CI 1.1-2.5) tertile after adjustment for age, parity, number of oocytes retrieved, and estradiol. The highest tertile was also not associated with an increased risk of IPD. CONCLUSION In an IVF population, elevated serum progesterone in the range of 0.64-1.05 ng/mL on the day of hCG administration was associated with a small increased risk of IPD.
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Affiliation(s)
- Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
| | - Katherine M Johnson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Ashley Aluko
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | | | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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23
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Mitra S, Patil M, Patil M, Nayak P. Pre-ovulatory hormones on day of human chorionic gonadotropin trigger and assisted reproductive technique outcomes in different ovarian response groups. J Hum Reprod Sci 2021; 14:406-414. [PMID: 35197687 PMCID: PMC8812392 DOI: 10.4103/jhrs.jhrs_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Aims: Setting and Design: Materials and Methods: Statistical Analysis: Results: Conclusion:
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24
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Jwa SC, Seto S, Takamura M, Kuwahara A, Kajihara T, Ishihara O. Ovarian stimulation increases the risk of ectopic pregnancy for fresh embryo transfers: an analysis of 68,851 clinical pregnancies from the Japanese Assisted Reproductive Technology registry. Fertil Steril 2020; 114:1198-1206. [PMID: 33081977 DOI: 10.1016/j.fertnstert.2020.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the risk of ectopic pregnancies (EPs) for fresh cycles according to different ovarian stimulation protocols. DESIGN Registry-based retrospective cohort study. SETTING Not applicable. PATIENT(S) A total of 68,851 clinical pregnancies after fresh single embryo transfer between 2007 and 2015. INTERVENTION (S) None MAIN OUTCOME MEASURE(S): Ectopic pregnancies. Odds ratios and 95% confidence intervals for EPs were calculated by using generalized estimating equations adjusted for potential maternal and treatment characteristics. RESULT(S) Among 68,851 clinical pregnancies, 1,049 (1.46%) cases of EP were reported. Compared with natural cycles, all ovarian stimulation protocols were associated with a significantly increased risk of EP. Ovarian stimulation with clomiphene (CC) demonstrated the highest odds ratios for EPs. Significant associations between ovarian stimulation protocols and EP compared with natural cycles were prominent when the number of retrieved oocytes was low (1-3) to moderate (4-7), but there were no significant associations when the number of retrieved oocytes was high (≥8). CONCLUSION(S) Ovarian stimulation protocols were significantly associated with an increased risk of EP. In particular, ovarian stimulation with CC had the highest risk of EP compared with other stimulation protocols. Further studies are essential to investigate possible confounding factors for different ovarian stimulation protocols, especially CC, and the risk of EP.
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Affiliation(s)
- Seung Chik Jwa
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan.
| | - Sachie Seto
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Akira Kuwahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Takeshi Kajihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
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25
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Merviel P, Menard M, Cabry R, Scheffler F, Lourdel E, Le Martelot MT, Roche S, Chabaud JJ, Copin H, Drapier H, Benkhalifa M, Beauvillard D. Can Ratios Between Prognostic Factors Predict the Clinical Pregnancy Rate in an IVF/ICSI Program with a GnRH Agonist-FSH/hMG Protocol? An Assessment of 2421 Embryo Transfers, and a Review of the Literature. Reprod Sci 2020; 28:495-509. [PMID: 32886340 DOI: 10.1007/s43032-020-00307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
None of the models developed in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is sufficiently good predictors of pregnancy. The aim of this study was to determine whether ratios between prognostic factors could predict the clinical pregnancy rate in IVF/ICSI. We analyzed IVF/ICSI cycles (based on long GnRH agonist-FSH protocols) at two ART centers (the second to validate externally the data). The ratios studied were (i) the total FSH dose divided by the serum estradiol level on the hCG trigger day, (ii) the total FSH dose divided by the number of mature oocytes, (iii) the serum estradiol level on the trigger day divided by the number of mature oocytes, (iv) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day, (v) the serum estradiol level on the trigger day divided by the number of mature oocytes and then by the number of grade 1 or 2 embryos obtained, and (vi) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day and then by the number of grade 1 or 2 embryos obtained. The analysis covered 2421 IVF/ICSI cycles with an embryo transfer, leading to 753 clinical pregnancies (31.1% per transfer). Four ratios were significantly predictive in both centers; their discriminant power remained moderate (area under the receiver operating characteristic curve between 0.574 and 0.610). In contrast, the models' calibration was excellent (coefficients: 0.943-0.978; p < 0.001). Our ratios were no better than existing models in IVF/ICSI programs. In fact, a strongly discriminant predictive model will be probably never be obtained, given the many factors that influence the occurrence of a pregnancy.
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Affiliation(s)
- Philippe Merviel
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France. .,Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France.
| | - Michel Menard
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | - Rosalie Cabry
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Florence Scheffler
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Emmanuelle Lourdel
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | | | - Sylvie Roche
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | | | - Henri Copin
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Hortense Drapier
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | - Moncef Benkhalifa
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Damien Beauvillard
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
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26
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Clinical and genetic analysis of cytochrome P450 oxidoreductase (POR) deficiency in a female and the analysis of a novel POR intron mutation causing alternative mRNA splicing : Overall analysis of a female with POR deficiency. J Assist Reprod Genet 2020; 37:2503-2511. [PMID: 32725309 DOI: 10.1007/s10815-020-01899-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To characterize the clinical features of a female with P450 oxidoreductase (POR) deficiency and to investigate the underlying mechanisms of POR inactivation. METHODS The proband was a 35-year-old woman with primary infertility and menstrual irregularity. The reproductive endocrine profile was evaluated. DNA sequencing was conducted for the identification of POR gene mutation. RT-PCR was performed to confirm the impact of the mutation on POR mRNA. A molecular model was built for the structural analysis of mutant POR protein. RESULTS The evaluation of reproductive endocrine profile revealed elevation of serum follicle-stimulating hormone (11.48 mIU/ml), progesterone (11.00 ng/ml), 17α-hydroxyprogesterone (24.24 nmol/l), dehydroepiandrosterone (6300 nmol/l), and androstenedione (3.89 nmol/l) and decreased estradiol (36.02 pg/ml). Sequencing of the POR gene showed the female was a compound heterozygote of the paternal P399_E401 deletion and a novel maternal IVS14-1G>C mutation. Functional analysis revealed IVS14-1G>C mutation caused alternative splicing of POR mRNA, with the loss of 12 nucleotides in exon 15 (c.1898_1909delGTCTACGTCCAG). Also, the resulting mutant POR protein had a V603_Q606 deletion, which inactivated the nucleotide-binding domain of NADPH in POR protein (K602_Q606). CONCLUSION The mutation IVS14-1G>C of the POR gene could cause alternative splicing of POR mRNA and dysfunction of the resulting POR protein. Under proper IVF strategy with glucocorticoid therapy and endometrial preparation, females with mild POR deficiency still have the opportunity to have a live birth.
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27
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Cai J, Liu L, Jiang X, Li P, Sha A, Ren J. Low body mass index is associated with ectopic pregnancy following assisted reproductive techniques: a retrospective study. BJOG 2020; 128:540-550. [PMID: 32575153 DOI: 10.1111/1471-0528.16378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the association between body mass index (BMI) and ectopic pregnancy (EP) following embryo transfer (ET). DESIGN Retrospective cohort study. SETTING University-affiliated hospital. POPULATION A total of 16 378 pregnancies derived from either fresh ET or frozen-thawed ET between January 2008 and December 2017. METHODS We used the generalised estimating equation (GEE) to analyse the association between BMI categories and EP, as one woman may contribute to more than one pregnancy. Generalised additive models were also used to demonstrate the non-linear association. Models were adjusted for age, parity, gravidity, previous history of ectopic pregnancy, duration of infertility, polycystic ovary syndrome, endometriosis, diagnosis of tubal problems, ovarian reserve markers, ovarian stimulation parameters, insemination protocol, endometrial thickness and embryo transfer policies. MAIN OUTCOME MEASURES Ectopic pregnancy. RESULTS According to the WHO criteria, the number of cycles with low (<18.5 kg/m2 ), normal (18.5-24.9 kg/m2 ) and high (≥25 kg/m2 ) BMI were 2155, 13 447 and 776, respectively. In comparison with the normal BMI group, the rate of EP was significantly increased in the low BMI group (2.92% versus 2.02%, relative risk 1.45, 95% CI 1.11-1.90), but not in the high BMI group (2.84%, relative risk 1.41, 95% CI 0.92-2.20). Adjusted for confounding factors, the odds ratio for EP comparing low BMI versus normal BMI was 1.61 (95% CI 1.19-2.16) and that comparing high BMI versus normal BMI was 1.12 (95% CI 0.72-1.76). CONCLUSIONS Low BMI is associated with an increased risk of EP. TWEETABLE ABSTRACT The ectopic pregnancy rate after embryo transfer for lean women is higher than that for women of normal weight.
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Affiliation(s)
- J Cai
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China.,School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - L Liu
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China.,School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - X Jiang
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - P Li
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - A Sha
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - J Ren
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
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28
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Racca A, De Munck N, Santos-Ribeiro S, Drakopoulos P, Errazuriz J, Galvao A, Popovic B, Mackens S, De Vos M, Verheyen G, Tournaye H, Blockeel C. Do we need to measure progesterone in oocyte donation cycles? A retrospective analysis evaluating cumulative live birth rates and embryo quality. Hum Reprod 2020; 35:167-174. [DOI: 10.1093/humrep/dez238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/19/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
STUDY QUESTION
Does late follicular-phase elevated serum progesterone (LFEP) during ovarian stimulation for oocyte donation have an impact on embryo quality (EQ) and cumulative live birth rate (CLBR)?
SUMMARY ANSWER
LFEP does not have an influence on EQ nor CLBR in oocyte donation cycles.
WHAT IS KNOWN ALREADY
Ovarian stimulation promotes the production of progesterone (P) which, when elevated during the follicular phase, has been demonstrated to have a deleterious effect in autologous fresh IVF outcomes. While there is robust evidence that this elevation results in impaired endometrial receptivity, the impact on EQ remains a matter of debate. The oocyte donation model is an excellent tool to assess the effects of LFEP on EQ from those on endometrium receptivity separately. Previous studies in oocyte donation cycles investigating the influence of elevated P on pregnancy outcomes in oocyte recipients showed conflicting results.
STUDY DESIGN, SIZE, DURATION
This is a retrospective analysis including all GnRH antagonist down-regulated cycles for fresh oocyte donation taking place in a tertiary referral university hospital between 2010 and 2017. A total of 397 fresh donor-recipient cycles were included. Each donor was included only once in the analysis and could be associated to a single recipient.
PARTICIPANTS/MATERIALS, SETTING, METHODS
The sample was stratified according to serum P levels of ≤1.5 and >1.5 ng/mL on the day of ovulation triggering. The primary endpoint of the study was the top-quality embryo rate on Day 3, and the secondary outcome measure was CLBR defined as a live-born delivery beyond 24 weeks.
MAIN RESULTS AND THE ROLE OF CHANCE
Three hundred ninety-seven fresh oocyte donation cycles were included in the analysis, of which 314 (79%) had a serum P ≤ 1.5 ng/mL and 83 (20.9%) had a serum P > 1.5 ng/mL. The average age of the oocyte donors was 31.4 ± 4.7 and 29.9 ± 4.5 years, respectively, for normal and elevated P (P = 0.017). The mean number of oocytes retrieved was significantly higher in the elevated P group with 16.6 ± 10.6 vs 11.5 ± 6.9 in the P ≤ 1.5 group (P < 0.001).
In parallel, the total number of embryos on Day 3, as well as the number of good-quality embryos at this stage, was significantly higher in the elevated P group (6.6 ± 5.6 vs 4.15 ± 3.5 and 8.7 ± 6.3 vs 6.1 ± 4.4; respectively, P < 0.001). However, maturation and fertilization rates did not vary significantly between the two study groups and neither did the top- and good-quality embryo rate and the embryo utilization rate, all evaluated on Day 3 (P = 0.384, P = 0.405 and P = 0.645, respectively). A multivariable regression analysis accounting for P groups, age of the donor, number of retrieved oocytes and top-quality embryo rate as potential confounders showed that LFEP negatively influenced neither the top-quality embryo rate nor the CLBR.
LIMITATIONS, REASONS FOR CAUTION
This is an observational study based on a retrospective data analysis. Better extrapolation of the results could be validated by performing a prospective trial. Furthermore, this study was focused on oocyte donation cycles and hence the results cannot be generalized to the entire infertile population.
WIDER IMPLICATIONS OF THE FINDINGS
This is the first study providing evidence that LFEP does not influence CLBR and is adding strong evidence to the existing literature that LFEP does not harm EQ in oocyte donation programs.
STUDY FUNDING/COMPETING INTERESTS
Not applicable.
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Affiliation(s)
- A Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - N De Munck
- IVI-RMA Middle East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - S Santos-Ribeiro
- Instituto Valenciano de Infertilidade (IVI-RMA, Lisboa 1800-282, Portugal
| | - P Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - J Errazuriz
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
- Departamento de Ginecología y Obstetricia, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - A Galvao
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
- Department of Obstetrics and Gynecology, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - B Popovic
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - S Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - M De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - G Verheyen
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - C Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
- Department of Obstetrics and Gynaecology, University of Zagreb-School of Medicine, Šalata 3, Zagreb 10000, Croatia
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Hussein RS, Elnashar I, Amin AF, Abou-Taleb HA, Abbas AM, Abdelmageed AM, Farghaly T, Zhao Y. Revisiting debates of premature luteinization and its effect on assisted reproductive technology outcome. J Assist Reprod Genet 2019; 36:2195-2206. [PMID: 31650455 PMCID: PMC6885458 DOI: 10.1007/s10815-019-01598-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022] Open
Abstract
The impact of the prematurely elevated serum progesterone on the late follicular phase, commonly known as premature luteinization (PL), is a matter of continuing debate. Available evidence supports that serum progesterone ≥ 1.5 ng/ml on the day of ovulation triggering could reduce the pregnancy potential in fresh in vitro fertilization (IVF) cycles by jeopardizing endometrial receptivity. Causes of PL during ovarian stimulation are unclear. Recent studies point toward the daily follicle-stimulating hormone dosage, duration of controlled ovarian stimulation, number of oocytes retrieved, and peak estradiol level as factors affecting the incidence of PL. Emerging data show additional influence on embryo quality. The prevention of PL has been challenging. The key elements in preventing PL include individualization of ovarian stimulation according to patient's ovarian reserve, proper ovulation trigger timing, and use of medications such as corticosteroids and metformin. Embryo cryopreservation with deferred embryo transfer is the established strategy to overcome PL, yet it is an extra burden to the IVF laboratory and increased cost for patients. Herein, we review the up-to-date knowledge of this frequent IVF problem including causes, proposed diagnostic criteria, and its impact on endometrial receptivity, embryo quality, and pregnancy outcomes. The preventive measures and rescue strategies are also discussed.
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Affiliation(s)
- Reda S Hussein
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ihab Elnashar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed F Amin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abou-Taleb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
- Women Health Hospital, Assiut, 71511, Egypt.
| | - Ahmed M Abdelmageed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tarek Farghaly
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Yulian Zhao
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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30
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Ramezanali F, Arabipoor A, Hafezi M, Salman-Yazdi R, Zolfaghari Z, Asharfi M. Serum estradiol level on trigger day impacts clinical pregnancy rate in modified natural frozen embryo transfer cycles. Int J Gynaecol Obstet 2019; 145:312-318. [PMID: 30916782 DOI: 10.1002/ijgo.12806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/15/2018] [Accepted: 03/19/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the predictive value of serum estradiol and progesterone on the day of human chorionic gonadotropin (hCG) administration and embryo transfer for clinical pregnancy rate in modified natural-cycle frozen embryo transfer (NC-FET). METHODS In a longitudinal prospective study, all eligible women who underwent NC-FET cycles with hCG triggering in Royan Institute, Tehran, Iran, from June 1, 2015, to December 31, 2016, were evaluated. Serum estradiol and progesterone levels were measured at menstrual cycle initiation, on day of trigger with hCG, on day of embryo transfer, and in pregnant women every 7 days until the observation of a gestational sac with embryonic heartbeat. RESULTS In total, 101 modified natural FET cycles were assessed, and the clinical pregnancy and live birth rates achieved were 34 (33.6%) and 32 (31.6%), respectively. The changes in estradiol level during early pregnancy showed an increase by an average of 200 pg/mL per week. Multivariable logistic regression analysis showed that only the estradiol level on the hCG day was a significant predictive variable for clinical pregnancy following NC-FET (P=0.04). CONCLUSION Estradiol level on the day of hCG trigger predicted the clinical pregnancy rates after modified NC-FET; this likely mirrored the developmental competence of the corpus luteum and an appropriate luteal structure-function.
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Affiliation(s)
- Fariba Ramezanali
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
| | - Maryam Hafezi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
| | - Reza Salman-Yazdi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Zolfaghari
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mahnaz Asharfi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran.,Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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31
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Wu Z, Dong Y, Ma Y, Li Y, Li L, Lin N, Li Y, Zhuan L, Bai Y, Luo X, Kang X. Progesterone elevation on the day of hCG trigger has detrimental effect on live birth rate in low and intermediate ovarian responders, but not in high responders. Sci Rep 2019; 9:5127. [PMID: 30914679 PMCID: PMC6435811 DOI: 10.1038/s41598-019-41499-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/11/2019] [Indexed: 02/04/2023] Open
Abstract
Progesterone elevation (PE) on the day of hCG trigger is associated with decreased pregnancy outcome in fresh cycles. Evidence for this comes from overall patient estimates that mostly ignore different ovarian responses. To compare the impacts of PE on the day of hCG trigger on live birth rates (LBs) in low, intermediate and high ovarian responders and to explore the cut-off value for PE in different populations according to the ovarian response, we retrospectively analyzed a total of 2,351 patients receiving fresh assisted reproduction technology (ART) transfer cycles with GnRH agonist using a long or short protocol. Trend and multivariate logistic regression analyses were performed to identify the cutoff values of PE and to evaluate the effects of PE on LB rates (LBRs) in different ovarian responders. The study found that PE has a detrimental effect on LBRs in low to intermediate ovarian responders rather than in high responders. The cut-off values for PE were 1.0 ng/mL and 2.0 ng/mL for low and intermediate ovarian responders, respectively. The different associations between PE and LBRs according to ovarian response could more accurately predict the prognosis of the IVF cycle and could be used to optimize the treatment of patients undergoing In Vitro Fertilization (IVF)/ Intracytoplasmic Sperm Injection (ICSI).
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Affiliation(s)
- Ze Wu
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yunhua Dong
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yanping Ma
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yonggang Li
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lei Li
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Na Lin
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yunxiu Li
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Li Zhuan
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yun Bai
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xi Luo
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China. .,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.
| | - Xiaomin Kang
- Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, China. .,Reproductive Medical Center of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.
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32
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The role of progesterone elevation in IVF. Reprod Biol 2019; 19:1-5. [DOI: 10.1016/j.repbio.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/24/2022]
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33
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Santos-Ribeiro S, Racca A, Roelens C, De Munck N, Mackens S, Drakopoulos P, Tournaye H, Blockeel C. Evaluating the benefit of measuring serum progesterone prior to the administration of HCG: effect of the duration of late-follicular elevated progesterone following ovarian stimulation on fresh embryo transfer live birth rates. Reprod Biomed Online 2018; 38:647-654. [PMID: 30593439 DOI: 10.1016/j.rbmo.2018.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/24/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION Progesterone overproduction during ovarian stimulation is associated with lower live birth rates (LBR) after fresh embryo transfer. Therefore, circulating P concentrations on the day of HCG administration are frequently measured in clinical practice and followed by an elective cryopreservation strategy whenever late-follicular elevated P (LFEP) occurs. A recent study concluded that the duration of LFEP >1.00 ng/mL prior to HCG administration may also affect clinical pregnancy rates. The objective of this current study was to assess whether this hypothesis was reproducible using LBR as the primary outcome. DESIGN Retrospective analysis including women undergoing IVF/ICSI between 2010-2015. LBR were compared among different P elevation duration subgroups (0, 1 or >1 day) using two LFEP thresholds (>1.00 ng/mL and >1.50 ng/mL). RESULTS The duration of LFEP >1.00 ng/mL was not associated with a significant decrease in LBR according to whether the patient had LFEP lasting for 0, 1 or >1 days (29.9%, 30.3% and 26.3%, respectively). Conversely, when using >1.50 ng/mL as the LFEP threshold, LBR decreased significantly (30.3% 20.4% and 20.5%, respectively). However, the relative frequency of having LFEP >1.50 ng/mL for >1 day was exceedingly rare (1.9%) and the additional benefit of evaluating LFEP beyond the day of HCG triggering no longer remained statistically significant after confounder-adjustment with multivariable regression analysis. CONCLUSION These results suggest a lack of benefit in measuring serum P in the days preceding HCG administration, since LBR in women with LFEP >1 day do not vary significantly from those with LFEP detected only on the day of HCG administration.
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Affiliation(s)
- Samuel Santos-Ribeiro
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Department of Obstetrics, Gynecology and Reproductive Medicine, Santa Maria University Hospital, Avenida Professor Egas Moniz, Lisbon 1649-035, Portugal.
| | - Annalisa Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, Genova 16132, Italy
| | - Caroline Roelens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Neelke De Munck
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Panagiotis Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels 1090, Belgium; Department of Reproductive Medicine, University of Liège, Boulevard du XIIième de Ligne 1, Liège 4000, Belgium
| | - Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia
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Ortega I, García-Velasco JA, Pellicer A. Ovarian manipulation in ART: going beyond physiological standards to provide best clinical outcomes. J Assist Reprod Genet 2018; 35:1751-1762. [PMID: 30056596 DOI: 10.1007/s10815-018-1258-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022] Open
Abstract
Current knowledge on ovarian physiology has challenged the traditional concept of folliculogenesis, creating the basis for novel ovarian stimulation protocols in assisted reproduction technology. The purpose of this review was to evaluate the efficacy of novel clinical interventions that could aid clinicians in individualizing their protocols to patients' characteristics and personal situations. We conducted a literature review of the available evidence on new approaches for ovarian stimulation from both retrospective and prospective studies in the PubMed database. Here, we present some of the most important interventions, including follicle growth in the gonadotropin-independent and dependent stage, manipulation of estradiol production throughout ovarian stimulation, control of mid-cycle gonadotropin surges, and luteal phase support after different stimulation protocols and trigger agents. The latest research on IVF has moved physicians away from the classical physiology, allowing the development of new strategies to decouple organ functions from the female reproductive system and challenging the traditional concept of IVF.
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Affiliation(s)
- Israel Ortega
- IVI-Madrid, Madrid, Spain. .,Instituto de Investigación Sanitaria La Fé, Valencia, Spain.
| | - Juan A García-Velasco
- IVI-Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria La Fé, Valencia, Spain.,Rey Juan Carlos University, Madrid, Spain.,IdiPAZ, Madrid, Spain
| | - Antonio Pellicer
- Instituto de Investigación Sanitaria La Fé, Valencia, Spain.,Rey Juan Carlos University, Madrid, Spain.,IdiPAZ, Madrid, Spain.,IVI-Roma, Rome, Italy
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35
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Kaponis A, Chronopoulou E, Decavalas G. The curious case of premature luteinization. J Assist Reprod Genet 2018; 35:1723-1740. [PMID: 30051348 DOI: 10.1007/s10815-018-1264-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/11/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Premature luteinization (PL) affects 12.3-46.7% of fresh in vitro fertilization cycles, and there is accumulating evidence confirming its negative effect on success rates. However, despite its clinical significance, PL is poorly understood and defined. This narrative review aims to provide a fresh look at the phenomenon of PL by summarizing the existing evidence and re-evaluating fundamental issues. METHODS A thorough electronic search was conducted covering the period from 1978 until January 2018 in PubMed, Embase, and Medline databases, and references of relevant studies were cross-checked. Meeting proceedings of the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine were also hand searched. RESULTS In the curious case of PL, one should go back to the beginning and re-consider every step of the way. The pathogenesis, definition, measurement methods, clinical implications, and management strategies are discussed in detail, highlighting controversies and offering "food for thought" for future directions. CONCLUSIONS Authors need to speak the same language when studying PL in order to facilitate comparisons. The terminology, progesterone cut-off, measurement methods and days of measurement should be standardized and globally accepted; otherwise, there can be no scientific dialog. Future research should focus on specific patient profiles that may require a tailored approach. Progesterone measurements throughout the follicular phase possibly depict the progesterone exposure better than an isolated measurement on the day of hCG. Adequately powered randomized controlled trials should confirm which the best prevention and management plan of PL is, before introducing any strategy into clinical practice.
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Affiliation(s)
- Apostolos Kaponis
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece
| | - Elpiniki Chronopoulou
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece.
| | - George Decavalas
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece
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36
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Bushaqer N, Mohawash W, Alrakaf F, Algaffli M, Rawah H, Dayoub N, Ayoub H, Alasmari N. Progesterone level significance in agonist versus antagonist protocols. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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37
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SWATH HM-Based Metabolomics of Follicular Fluid in Patients Shows That Progesterone Adversely Affects Oocyte Quality. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1780391. [PMID: 29951527 PMCID: PMC5987297 DOI: 10.1155/2018/1780391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/29/2018] [Indexed: 01/09/2023]
Abstract
Objective We reveal the relationship between progesterone level in follicular fluid and oocyte quality based on sequential window acquisition of all theoretical fragment-ion spectra (SWATH™), a powerful high-resolution mass spectrometric data independent acquisition technique. Method Follicular fluid samples were collected from 22 subjects (the level of progesterone > 1.5 ng/mL) of progesterone group, as well as from 22 subjects (the level of progesterone < 1.5 ng/mL) of control group, and analyzed using UPLC-Q-TOF. All methods were performed in accordance with ISO 9001:2008. Novel SWATH acquisition mode on an ultra-high performance liquid chromatography coupled with hybrid triple quadrupole time-of-flight mass spectrometry (with resolving power 20,000–40,000) was investigated for the analysis of human follicular fluid. The principal component variable grouping detects intersample variable correlation and groups variables with similar profiles which simplifies interpretation and highlights related ions and fragments. It can also extract product ion spectra from the data collected by fragmenting a wide precursor ion window. Results Follicular fluid from the two groups differed with respect to five metabolites. Follicular fluid from the progesterone group contained elevated levels of 8-hydroxyguanosine and 4-hydroxynonenal and reduced levels of ATP, estradiol, and L-carnitine. The increased progesterone level on the day of HCG injection could negatively impact oocyte quality, thus reducing the pregnancy rate of IVF patients.
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38
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Lepage J, Keromnes G, Epelboin S, Luton D, Yazbeck C. Premature progesterone rise on day of hCG negatively correlated with live birth rate in IVF cycles: An analysis of 1022 cycles. J Gynecol Obstet Hum Reprod 2018; 48:51-54. [PMID: 29783037 DOI: 10.1016/j.jogoh.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the relationship between serum P levels on the day of hCG administration and pregnancy outcomes in patients undergoing IVF. DESIGN Retrospective study. SETTING Teaching hospital. PATIENTS A total of 1022 IVF-ICSI cycles, frozen embryo transfer excluded. INTERVENTION(S) Patients-all types of responder - underwent IVF with agonist or antagonist protocols. Clinical outcomes of IVF were analyzed according to plasma P levels. MAIN OUTCOME MEASURE(S) Ongoing pregnancy rates. RESULTS We proposed a serum P level of 1.57ng/ml on day of hCG as a threshold for all types of responders and all protocols combined. Ongoing implantation rates were not affected by elevated progesterone. Live birth rate was inversely associated with serum P levels on day of hCG and more miscarriages were associated with P>1.57ng/ml. We have not found the progesterone>1.57ng/ml on the day of hCG as a prognostic factor for pregnancy. CONCLUSION(S) Elevated P level on the day of hCG administration negatively influence live birth rate and is correlated to an increase of miscarriage. The detrimental effect of P elevation on pregnancy seems not to be related substantially to endometrium receptivity. Thus, despite a comparable clinical pregnancy rate and an initial implantation rate, we demonstrate more spontaneous abortion and it would seem that the effect of progesterone is later.
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Affiliation(s)
- Julien Lepage
- Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Gwenola Keromnes
- Groupe hospitalier Diaconesses Croix Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France
| | - Sylvie Epelboin
- Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - Dominique Luton
- Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Paris 7 Denis Diderot University Paris, France
| | - Chadi Yazbeck
- Cherest Fertility Center, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France
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39
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Chen Y, Ma L, Wang S. The impact of an increased progesterone-to-follicle number ratio on live delivery rates in women with normal ovarian reserve. Int J Gynaecol Obstet 2017; 139:84-89. [PMID: 28685817 DOI: 10.1002/ijgo.12256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/18/2017] [Accepted: 07/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the relationship between progesterone-follicle number (P/F) ratio and live delivery rate in patients with normal ovarian reserve undergoing cleavage-stage embryo transfer with a long gonadotropin-releasing hormone agonist cycle. METHODS The present retrospective study included data from patients younger than 38 years with normal ovarian reserve who were undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer at Zhongnan Hospital, Wuhan University, China, between January 1, 2009 and December 31, 2015. Patients underwent cleavage-stage fresh embryo transfer with a long gonadotropin-releasing hormone agonist cycle, and associations between P/F ratios and fertility/pregnancy outcomes were analyzed. RESULTS Patients with a P/F ratio of 0.11 or above had higher serum progesterone levels (P<0.001) and lower serum estradiol levels (P<0.001) on the day of human chorionic gonadotropin administration in comparison with patients with lower P/F ratios; elevated P/F ratios were also associated with fewer follicles at least 14 mm in size (P<0.001) and lower live delivery rates (P<0.001). Multiple logistic regression confirmed that P/F ratio was an independent predictor of live delivery rate (P=0.001). CONCLUSION A P/F ratio of at least 0.11 was associated with lower live delivery rates in women with normal ovarian reserve undergoing cleavage-stage embryo transfer with a long gonadotropin-releasing hormone agonist cycle.
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Affiliation(s)
- Ya Chen
- School of Public Health, Wuhan University, Wuhan, China.,China Three Gorges University, Yichang, China
| | - Ling Ma
- Reproductive Medicine Centre, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Suqing Wang
- School of Public Health, Wuhan University, Wuhan, China
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The effect of elevated progesterone levels before oocyte retrieval in women undergoing ovarian stimulation for IVF treatment on the genomic profile of peri-implantation endometrium. J Reprod Immunol 2017; 121:17-25. [DOI: 10.1016/j.jri.2017.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/27/2017] [Accepted: 05/12/2017] [Indexed: 01/07/2023]
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Iaconelli CAR, Setti AS, Braga DPAF, Maldonado LGL, Iaconelli A, Borges E, Aoki T. Concomitant use of FSH and low-dose recombinant hCG during the late follicular phase versus conventional controlled ovarian stimulation for intracytoplasmic sperm injection cycles. HUM FERTIL 2017; 20:285-292. [PMID: 28325095 DOI: 10.1080/14647273.2017.1303197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this study was to investigate the effects of low-dose hCG supplementation on ICSI outcomes and controlled ovarian stimulation (COS) cost. Three hundred and thirty patients undergoing ICSI were split into groups according to the COS protocol: (i) control group (n = 178), including patients undergoing conventional COS treatment; and (ii) low-dose hCG group (n = 152), including patients undergoing COS with low-dose hCG supplementation. Lower mean total doses of FSH administered and higher mean oestradiol level and mature oocyte rates were observed in the low-dose hCG group. A significantly higher fertilization rate, high-quality embryo rate and blastocyst formation rate were observed in the low-dose hCG group as compared to the control group. The miscarriage rate was significantly higher in the control group compared to the low-dose hCG group. A significantly lower incidence of OHSS was observed in the low-dose hCG group. There was also a significantly lower gonadotropin cost in the low-dose hCG group as compared to the control group ($1235.0 ± 239.0×$1763.0 ± 405.3, p < 0.001). The concomitant use of low-dose hCG and FSH results in a lower abortion rate and increased number of mature oocytes retrieved, as well as improved oocyte quality, embryo quality and blastocyst formation and reduced FSH requirements.
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Affiliation(s)
- Carla Andrade Rebello Iaconelli
- a Fertility Medical Group, clinical department ; Sao Paulo , SP , Brazil.,b Faculdade de Ciências Médicas da Santa Casa de São Paulo, health sciences department ; Sao Paulo , SP , Brazil
| | - Amanda Souza Setti
- b Faculdade de Ciências Médicas da Santa Casa de São Paulo, health sciences department ; Sao Paulo , SP , Brazil.,c Instituto Sapientiae - Centro de Estudos e Pesquisa em Reproducão Assistida , Sao Paulo , SP , Brazil.,d Fertility Medical Group , scientific department ; Sao Paulo , SP , Brazil
| | - Daniela Paes Almeida Ferreira Braga
- c Instituto Sapientiae - Centro de Estudos e Pesquisa em Reproducão Assistida , Sao Paulo , SP , Brazil.,d Fertility Medical Group , scientific department ; Sao Paulo , SP , Brazil.,e Disciplina de Urologia, Area de Reproducão Humana, Departamento de Cirurgia , Universidade Federal de São Paulo , Sao Paulo , SP , Brazil
| | | | - Assumpto Iaconelli
- a Fertility Medical Group, clinical department ; Sao Paulo , SP , Brazil.,c Instituto Sapientiae - Centro de Estudos e Pesquisa em Reproducão Assistida , Sao Paulo , SP , Brazil.,d Fertility Medical Group , scientific department ; Sao Paulo , SP , Brazil
| | - Edson Borges
- a Fertility Medical Group, clinical department ; Sao Paulo , SP , Brazil.,c Instituto Sapientiae - Centro de Estudos e Pesquisa em Reproducão Assistida , Sao Paulo , SP , Brazil.,d Fertility Medical Group , scientific department ; Sao Paulo , SP , Brazil
| | - Tsutomu Aoki
- b Faculdade de Ciências Médicas da Santa Casa de São Paulo, health sciences department ; Sao Paulo , SP , Brazil
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Brady PC, Ginsburg ES. An Updated Review of Ectopic Pregnancies Resulting from Assisted Reproduction. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wang M, Hao C, Bao H, Huang X, Liu Z, Zhang W, Li F. Effect of elevated estradiol levels on the hCG administration day on IVF pregnancy and birth outcomes in the long GnRH-agonist protocol: analysis of 3393 cycles. Arch Gynecol Obstet 2016; 295:407-414. [PMID: 27858152 DOI: 10.1007/s00404-016-4242-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This retrospective study aimed to evaluate the association between elevated serum estradiol (E 2) levels on the human chorionic gonadotrophin (hCG) administration day and in vitro fertilization (IVF) pregnancy and birth outcomes in the long GnRH-agonist protocol. METHODS This study analyzed the data of 3393 infertile women who underwent initial fresh IVF. The patients were categorized into high and low E 2 groups based on their serum E 2 levels on the hCG day. Pregnancy and birth outcomes were compared. RESULTS The implantation rate, clinical pregnancy rate, and live birth rate were all significantly higher in the high E 2 group than in the low E 2 group (p < 0.05). The good-quality embryo rate and abortion rate did not significantly differ between the two groups. There were no significant differences in the mode of delivery, gestational age, birth weight, and fetal gender between the two groups. Furthermore, there were no differences in the risk of preterm birth, low birth weight, and fetal malformation between the two groups in 860 single live births. Subgroup analysis of singleton pregnancies in the high E 2 (E 2 ≥ 3757 pg/mL) group revealed a significant increase in abortion rate in the age group of ≥37 years. CONCLUSIONS Elevated serum E 2 levels associated with controlled ovarian stimulation did not increase the risks of preterm birth, low birth weight, and fetal malformation. High E 2 on the hCG day had no detrimental effect on the implantation rate, clinical pregnancy rate, and live birth rate.
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Affiliation(s)
- Meimei Wang
- Shandong University School of Medicine, Jinan, People's Republic of China.,Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Cuifang Hao
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China.
| | - Hongchu Bao
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Xin Huang
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Zhenteng Liu
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Wei Zhang
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Fenghua Li
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
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Freeze-all, oocyte vitrification, or fresh embryo transfer? Lessons from an egg-sharing donation program. Fertil Steril 2016; 106:615-22. [DOI: 10.1016/j.fertnstert.2016.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/08/2016] [Accepted: 05/09/2016] [Indexed: 11/23/2022]
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Impact of progesterone (on hCG day)/oocyte ratio on pregnancy outcome in long agonist non donor fresh IVF/ICSI cycles. Taiwan J Obstet Gynecol 2016; 55:503-6. [DOI: 10.1016/j.tjog.2015.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/20/2022] Open
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He Z, Ma Y, Li L, Liu J, Yang H, Chen C, Lin N, Bai Y, Ma R, Li R, Wu Z, Qiao J. Osteopontin and Integrin αvβ3 Expression during the Implantation Window in IVF Patients with Elevated Serum Progesterone and Oestradiol Level. Geburtshilfe Frauenheilkd 2016; 76:709-717. [PMID: 27365542 DOI: 10.1055/s-0041-111697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: To explore whether endometrial receptivity is determined by osteopontin (OPN) and integrin αvβ3 expression in women with elevated serum progesterone (P) and/or oestradiol (E2) who are undergoing in vitro fertilisation (IVF). Methods: According to serum hormone levels on the day of HCG administration, 33 infertile women were divided into 3 groups: the high E2, high P, and high E2 and P groups. The control group included 11 fertile, healthy women. Endometrial biopsy was performed on ovulation day + 7 to + 8 for all study participants, and the mRNA and protein expression levels of OPN and integrin αvβ3 were analyzed. Result: No statistically significant differences regarding OPN and integrin αvβ3 expression were found between infertile patients in the high P, high E2, high E2 and P and control groups. There was no significant correlation between OPN and integrin αvβ3 staining intensity during the implantation window biopsy in any of the groups studied. Conclusion: Endometrial OPN and integrant αvβ3 expression/co-expression is not impaired during the window of implantation in patients with high P, high E2, or high E2 and P levels. The clinical value of assessing endometrial receptivity with OPN and integrin αvβ3 seems to be uncertain.
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Affiliation(s)
- Z He
- Department of Reproduction and Genetics, Reproductive Medical Centre, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China
| | - Y Ma
- Department of Reproduction and Genetics, Reproductive Medical Centre, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China
| | - L Li
- Department of Reproduction and Genetics, Reproductive Medical Centre, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China
| | - J Liu
- Institute of Molecular and Clinical Medicine, Kunming Medical University, Chengong New District, Kunming, People's Republic of China
| | - H Yang
- Department of Pathology, The First People's Hospital of Yunnan Province, Kunming, People's Republic of China
| | - C Chen
- Department of Obstetrics and Gynecology, Reproductive Medical Centre, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
| | - N Lin
- Department of Reproduction and Genetics, Reproductive Medical Centre, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China
| | - Y Bai
- Department of Reproduction and Genetics, Reproductive Medical Centre, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China
| | - R Ma
- Department of Reproduction and Genetics, Reproductive Medical Centre, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China
| | - R Li
- Department of Obstetrics and Gynecology, Reproductive Medical Centre, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
| | - Z Wu
- Department of Reproduction and Genetics, Reproductive Medical Centre, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China
| | - J Qiao
- Department of Obstetrics and Gynecology, Reproductive Medical Centre, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
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Is it the egg or the endometrium? Elevated progesterone on day of trigger is not associated with embryo ploidy nor decreased success rates in subsequent embryo transfer cycles. J Assist Reprod Genet 2016; 33:1169-74. [PMID: 27262838 DOI: 10.1007/s10815-016-0752-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of our study was to determine if progesterone (P4) values on day of trigger affect certain cycle outcome parameters, ploidy status of embryos, as well as pregnancy outcomes in the subsequent first frozen embryo transfer cycle. METHODS Two hundred thirty-eight patients undergoing pre-gestational screening and freeze all protocol at our fertility center from 2013 to 2014 were included. Excluded patients were those whom had cancelled cycles prior to egg retrieval as well as cycles utilizing donor eggs. Once patients were identified as eligible for this study, frozen serum from the day of trigger was identified and analyzed using the Siemens Immulite 2000. Number of eggs retrieved, number of available embryos for biopsy, and number of euploid/aneuploid embryos were analyzed. The first frozen embryo transfer cycle was linked to the initial egg retrieval and outcomes including pregnancy rates, and live birth/ongoing pregnancy rates were calculated and analyzed. A discriminatory P4 value of 1.5 ng/ml was set. Group A had P4 values of less than 1.5 ng/ml and group B had P4 values greater than or equal to 1.5 ng/ml. T tests and chi-squared tests were used for statistical analysis. RESULTS Group A had an average trigger P4 value of 0.87 +/- 0.3 and group B had an average trigger P4 of 2.1 +/- 0.8. Table 1 shows the baseline characteristics of both group A and group B. The only significant difference between the two groups was total gonadotropin dosage (IU) with a p value of 0.02 and estradiol (pg/ml) at trigger, also with a p value of 0.02 (Table 1). Number of eggs retrieved, number of embryos biopsied, number euploid/aneuploid, and non-diagnosis embryos were all non-significant. Chi-square analysis was used to compare pregnancy rates between the two groups after the first frozen embryo transfer cycle. Group A had a pregnancy rate of 72 % and Group B had a pregnancy rate of 66.7 %, which was not significant. Ongoing pregnancy/live birth rates were 65.6 % in group A and 66.67 % in group B, also not significant (Table 2). CONCLUSIONS P4 values on day of trigger do not affect number of eggs retrieved and number of chromosomally normal embryos available for transfer in a subsequent embryo transfer cycle. Elevated P4 values (≥1.5 ng/ml) also do not affect pregnancy rates or live birth/ongoing pregnancy rates in the first subsequent frozen embryo transfer cycle.
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Weiss A, Beck-Fruchter R, Golan J, Lavee M, Geslevich Y, Shalev E. Ectopic pregnancy risk factors for ART patients undergoing the GnRH antagonist protocol: a retrospective study. Reprod Biol Endocrinol 2016; 14:12. [PMID: 27005813 PMCID: PMC4804527 DOI: 10.1186/s12958-016-0146-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/02/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In-vitro fertilization is a known risk factor for ectopic pregnancies. We sought to establish the risk factors for ectopic pregnancy in GnRH antagonist cycles examining patient and stimulation parameters with an emphasis on ovulation trigger. METHODS We conducted a retrospective, cohort study of 343 patients undergoing 380 assisted reproductive technology (ART) cycles with the GnRH antagonist protocol and achieving a clinical pregnancy from November 2010 through December 2015. RESULTS Significant risk factors for ectopic pregnancy in the univariate analysis included prior Cesarean section (CS), endometriosis, mechanical factor infertility, longer stimulation, elevated estradiol and progesterone levels, GnRH agonist trigger, higher number of oocytes aspirated, and insemination technique. Independent risk factors for ectopic pregnancy in the multivariate analysis included GnRH agonist trigger, higher number of oocytes aspirated, insemination technique, and prior Cesarean section. CONCLUSION Excessive ovarian response, IVF (as opposed to ICSI), prior Cesarean section and GnRH agonist trigger were found to be independent risk factors for ectopic pregnancy. Caution should be exercised before incorporating the GnRH agonist trigger for indications other than preventing OHSS. When excessive ovarian response leads to utilization of GnRH agonist trigger, strategies for preventing ectopic pregnancy, such as a freeze all policy or blastocyst transfer, should be considered. Further studies should elucidate whether adjusting the luteal support can reduce the ectopic pregnancy risk.
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Affiliation(s)
- A. Weiss
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - R. Beck-Fruchter
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - J. Golan
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - M. Lavee
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Y. Geslevich
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - E. Shalev
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Martinez F, Rodriguez I, Devesa M, Buxaderas R, Gómez MJ, Coroleu B. Should progesterone on the human chorionic gonadotropin day still be measured? Fertil Steril 2016; 105:86-92. [DOI: 10.1016/j.fertnstert.2015.09.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
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Siristatidis CS, Gibreel A, Basios G, Maheshwari A, Bhattacharya S. Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction. Cochrane Database Syst Rev 2015; 2015:CD006919. [PMID: 26558801 PMCID: PMC10759000 DOI: 10.1002/14651858.cd006919.pub4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gonadotrophin-releasing hormone agonists (GnRHa) are commonly used in assisted reproduction technology (ART) cycles to prevent a luteinising hormone surge during controlled ovarian hyperstimulation (COH) prior to planned oocyte retrieval, thus optimising the chances of live birth. OBJECTIVES To evaluate the effectiveness of the different GnRHa protocols as adjuncts to COH in women undergoing ART cycles. SEARCH METHODS We searched the following databases from inception to April 2015: the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2015, Issue 3), MEDLINE, EMBASE, CINAHL, PsycINFO, and registries of ongoing trials. Reference lists of relevant articles were also searched. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any two protocols of GnRHa used in in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles in subfertile women. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed trial eligibility and risk of bias, and extracted the data. The primary outcome measure was number of live births or ongoing pregnancies per woman/couple randomised. Secondary outcome measures were number of clinical pregnancies, number of oocytes retrieved, dose of gonadotrophins used, adverse effects (pregnancy losses, ovarian hyperstimulation, cycle cancellation, and premature luteinising hormone (LH) surges), and cost and acceptability of the regimens. We combined data to calculate odds ratios (OR) for dichotomous variables and mean differences (MD) for continuous variables, with 95% confidence intervals (CIs). We assessed statistical heterogeneity using the I² statistic. We assessed the overall quality of the evidence for the main comparisons using 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methods. MAIN RESULTS We included 37 RCTs (3872 women), one ongoing trial, and one trial awaiting classification. These trials made nine different comparisons between protocols. Twenty of the RCTs compared long protocols and short protocols. Only 19/37 RCTs reported live birth or ongoing pregnancy.There was no conclusive evidence of a difference between a long protocol and a short protocol in live birth and ongoing pregnancy rates (OR 1.30, 95% CI 0.94 to 1.81; 12 RCTs, n = 976 women, I² = 15%, low quality evidence). Our findings suggest that in a population in which 14% of women achieve live birth or ongoing pregnancy using a short protocol, between 13% and 23% will achieve live birth or ongoing pregnancy using a long protocol. There was evidence of an increase in clinical pregnancy rates (OR 1.50, 95% CI 1.18 to 1.92; 20 RCTs, n = 1643 women, I² = 27%, moderate quality evidence) associated with the use of a long protocol.There was no evidence of a difference between the groups in terms of live birth and ongoing pregnancy rates when the following GnRHa protocols were compared: long versus ultrashort protocol (OR 1.78, 95% CI 0.72 to 4.36; one RCT, n = 150 women, low quality evidence), long luteal versus long follicular phase protocol (OR 1.89, 95% CI 0.87 to 4.10; one RCT, n = 223 women, low quality evidence), when GnRHa was stopped versus when it was continued (OR 0.75, 95% CI 0.42 to 1.33; three RCTs, n = 290 women, I² = 0%, low quality evidence), when the dose of GnRHa was reduced versus when the same dose was continued (OR 1.02, 95% CI 0.68 to 1.52; four RCTs, n = 407 women, I² = 0%, low quality evidence), when GnRHa was discontinued versus continued after human chorionic gonadotrophin (HCG) administration in the long protocol (OR 0.89, 95% CI 0.49 to 1.64; one RCT, n = 181 women, low quality evidence), and when administration of GnRHa lasted for two versus three weeks before stimulation (OR 1.14, 95% CI 0.49 to 2.68; one RCT, n = 85 women, low quality evidence). Our primary outcomes were not reported for any other comparisons.Regarding adverse events, there were insufficient data to enable us to reach any conclusions except about the cycle cancellation rate. There was no conclusive evidence of a difference in cycle cancellation rate (OR 0.95, 95% CI 0.59 to 1.55; 11 RCTs, n = 1026 women, I² = 42%, low quality evidence) when a long protocol was compared with a short protocol. This suggests that in a population in which 9% of women would have their cycles cancelled using a short protocol, between 5.5% and 14% will have cancelled cycles when using a long protocol.The quality of the evidence ranged from moderate to low. The main limitations in the evidence were failure to report live birth or ongoing pregnancy, poor reporting of methods in the primary studies, and imprecise findings due to lack of data. Only 10 of the 37 included studies were conducted within the last 10 years. AUTHORS' CONCLUSIONS When long GnRHa protocols and short GnRHa protocols were compared, we found no conclusive evidence of a difference in live birth and ongoing pregnancy rates, but there was moderate quality evidence of higher clinical pregnancy rates in the long protocol group. None of the other analyses showed any evidence of a difference in birth or pregnancy outcomes between the protocols compared. There was insufficient evidence to make any conclusions regarding adverse effects.
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Affiliation(s)
- Charalampos S Siristatidis
- University of AthensAssisted Reproduction Unit, 3rd Department of Obstetrics and GynaecologyAttikon University Hospital,Rimini 1AthensChaidariGreece12462
| | - Ahmed Gibreel
- Faculty of Medicine, Mansoura UniversityObstetrics & GynaecologyMansouraEgypt
| | - George Basios
- University of AthensAssisted Reproduction Unit, 3rd Department of Obstetrics and GynaecologyAttikon University Hospital,Rimini 1AthensChaidariGreece12462
| | - Abha Maheshwari
- University of AberdeenDivision of Applied Health SciencesAberdeenUKAB25 2ZL
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