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Marchante M, Barrachina F, Piechota S, Fernandez-González M, Giovannini A, Smith T, Kats S, Paulsen B, González E, Calvente V, Silvan A, Abittan B, Klein J, Klatsky P, Ordonez D, Kramme CC. Donor side effects experienced under minimal controlled ovarian stimulation with in vitro maturation vs. conventional controlled ovarian stimulation for in vitro fertilization treatment. F&S SCIENCE 2024:S2666-335X(24)00029-6. [PMID: 38838957 DOI: 10.1016/j.xfss.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To evaluate oocyte retrieval experiences and side effects under minimally controlled ovarian stimulation (COS) treatment for in vitro maturation (IVM) of oocytes compared with conventional COS treatment. DESIGN A retrospective survey study. SETTING Clinical in vitro fertilization treatment center. PATIENT(S) Data were collected from subjects undergoing minimal COS treatment (n = 110; 600-800 IU follicle-stimulating hormone) for IVM of oocytes and conventional COS treatment for egg donation (n = 48; 1,800-2,600 IU follicle-stimulating hormone) from April 2022 to November 2023. INTERVENTION(S) Minimal and conventional COS treatments. MAIN OUTCOME MEASURE(S) The most common side effects experienced during ovarian stimulation and after oocyte pick-up, satisfaction level, and the likelihood of recommending or repeating minimal or conventional COS. Statistical analysis included Mann-Whitney U test and χ2 tests, with a significance level. RESULT(S) During minimal COS treatment, most subjects did not experience breast swelling (86%), pelvic or abdominal pain (76%), nausea or vomiting (96%), and bleeding (96%). After oocyte pick-up, the majority (75%) reported no pelvic or abdominal pain. The most common side effect was abdominal swelling (52%). Compared with conventional COS cycles, minimal COS subjects reported significantly less postretrieval pain, with 33% experiencing no pain (vs. 6%) and with a reduced severe level of pain (5% vs. 19%), leading to fewer subjects requiring pain medication (25% vs. 54%). Additionally, 85% of women were very satisfied with minimal stimulation treatment and would recommend or repeat the treatment. CONCLUSION(S) Reducing the hormonal dose for ovarian stimulation has a beneficial effect on subjects, suggesting the combination of minimal COS treatment with IVM techniques is a well-tolerated alternative for women who cannot or do not wish to undergo conventionally controlled ovarian hyperstimulation treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eva González
- Ruber Juan Bravo University Hospital, Eugin Group, Madrid, Spain
| | | | - Ana Silvan
- Ruber Juan Bravo University Hospital, Eugin Group, Madrid, Spain
| | | | | | | | - Daniel Ordonez
- Ruber Juan Bravo University Hospital, Eugin Group, Madrid, Spain
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Katsani D, Paraschou N, Panagouli E, Tsarna E, Sergentanis TN, Vlahos N, Tsitsika A. Social Egg Freezing-A Trend or Modern Reality? J Clin Med 2024; 13:390. [PMID: 38256524 PMCID: PMC10816669 DOI: 10.3390/jcm13020390] [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: 11/13/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Egg freezing for social reasons is a process in which women who want to preserve their ability to fertilize their own oocytes at an older age freeze their eggs. With the help of in vitro fertilization, the cryopreservation of oocytes for future use is achieved. The aim of this article is to study the reasons, the risks and the effectiveness of the method from a worldwide aspect. METHODS A literature search was conducted to evaluate pertinent studies, using data from the search engines PubMed, Google and UptoDate as well as the medical literature. RESULTS The reasons for delayed procreation are non-medical, with the lack of an appropriate partner for a family being first on the list. The success rate of this method differs with the age of the woman, the number of fertilized eggs and other factors. Like every medical procedure, this method carries risks that relate to the mother (being of advanced age), the embryo and the procedure of in vitro fertilization. The policies that apply in each country differ depending on respective social, economic, religious and cultural factors. Due to the high cost of the method, its selection remains a choice for only a few, reinforcing social inequality. The question of the medicalization of reproduction remains unanswered in the industry of assisted reproduction. CONCLUSIONS In conclusion, egg freezing for social reasons is gradually becoming more widely known, with the United States of America and Israel being at the top the list. Unfortunately, there is no official data registry, and consequently, no statistical results are yet available for Greece, even though it is a method that more and more women are considering. Nevertheless, there is an imperative need for a universal legal framework for all countries with respect for the needs of every woman and different social conditions. More research and data from the literature are needed in relation to the effectiveness of the method from moral and social perspectives.
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Affiliation(s)
- Dimitra Katsani
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Nefeli Paraschou
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Eleni Panagouli
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Ermioni Tsarna
- Second Department of Obstetrics and Gynecology, School of Medicine, ‘Aretaieion’ University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (N.V.)
| | - Theodoros N. Sergentanis
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
- Department of Public Health Policy, School of Public Health, University of West Attica, 12243 Aigaleo, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, School of Medicine, ‘Aretaieion’ University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (N.V.)
| | - Artemis Tsitsika
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
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Severe ovarian hyperstimulation syndrome requiring recurrent large-volume paracenteses until 21 weeks’ gestation: a case report. F S Rep 2022; 3:275-279. [PMID: 36212559 PMCID: PMC9532883 DOI: 10.1016/j.xfre.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Design Setting Patient(s) Intervention(s) Main Outcome Measures(s) Result(s) Conclusion(s)
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Rushing JS, Santoro N. Fertility Issues in Polycystic Ovarian Disease: A Systematic Approach. Endocrinol Metab Clin North Am 2021; 50:43-55. [PMID: 33518185 DOI: 10.1016/j.ecl.2020.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The triad of hirsutism, amenorrhea, and enlarged polycystic ovaries first was described in 1935 and later become known as polycystic ovarian syndrome (PCOS). Women with PCOS are more likely to have cardiometabolic challenges that also have an indirect relationship to their fertility and fertility outcomes. Despite these challenges, their fertile life span appears to be longer. Ovulation induction is considered first-line management of infertility in women with PCOS, with letrozole superior to clomiphene. Women with PCOS undergoing in vitro fertilization are high risk for ovarian hyperstimulation syndrome but also have a higher live birth rate compared with controls.
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Affiliation(s)
- John S Rushing
- Department of Obstetrics and Gynecology, University of Colorado, 12631 East 17th Avenue Suite B198-6, Aurora, CO 80045-2529, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, 12631 East 17th Avenue Suite B198-1, Aurora, CO 80045-2529, USA.
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5
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Abstract
In vitro fertilization is indicated for infertile women with polycystic ovarian syndrome (PCOS) after unsuccessful treatment with ovulation induction agents or in women deemed high-risk of multiple gestations who are ideal candidates for single embryo transfers. PCOS patients are at increased risk of ovarian hyperstimulation syndrome; therefore, attention should be made in the choice of in vitro fertilization treatment protocol, dose of gonadotropin utilized, and regimen to achieve final oocyte maturation. Adopting these strategies in addition to close monitoring may significantly reduce the ovarian hyperstimulation syndrome risk. Future developments may improve pregnancy outcomes and decrease complications in PCOS women undergoing fertility treatment.
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Zhao J, Xu B, Huang X, Yan Y, Li Y. Whether Letrozole could reduce the incidence of early ovary hyperstimulation syndrome after assisted reproductive technology? A systematic review and meta-analysis. Reprod Health 2020; 17:181. [PMID: 33218353 PMCID: PMC7678310 DOI: 10.1186/s12978-020-01042-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background Letrozole can significantly decrease the estrogen level, and has been administrated to prevent the incidence of early ovary hyperstimulation syndrome (OHSS). However, the effect of Letrozole on prevention of OHSS reached to controversial conclusions. The present meta-analysis aim to examine whether Letrozole could reduce the incidence of early OHSS after assisted reproductive technology (ART). Methods An exhaustive electronic literature search was conducted on MEDLINE, Google Scholar, CNKI and WANFANG MED ONLINE, from inception until May 2018. We include clinical trials that examined the effect of Letrozole on the prevention of early OHSS. The main outcome measures were the incidence of total early OHSS, mild early OHSS, moderate early OHSS, and severe early OHSS. Results Eight studies included in the review. Of these, five publications evaluated the effect of Letrozolel on the prevention of total, mild, moderate, and severe OHSS, respectively. The results indicated that there was a significantly decreased incidence of total OHSS with Letrozole compared with control group, and there were no significantly differences in the incidence of mild, moderate, and severe OHSS between study group with Letrozole and control group. Eight studies reported the incidence of moderate + severe OHSS. We found a significant decrease in incidence of moderate + severe OHSS in high-risk women with Letrozole. Conclusions Letrozole has no beneficial effect on the prevention of mild, moderate, and severe OHSS, individually; Letrozole should not be considered as the first-line treatment for prevention of OHSS. Further cohort studies are required to explore the effect of Letrozole on the prevention of OHSS. Plain English Summary This study aimed to examine whether Letrozole could reduce the incidence of early OHSS after assisted reproductive technology (ART). A meta-analysis including 8 studies was conducted. There were no significantly differences in the incidence of mild, moderate, and severe OHSS between study group with Letrozole and control group. Letrozole has no beneficial effect on the prevention of mild, moderate, and severe OHSS, individually.
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Affiliation(s)
- Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Bin Xu
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Xi Huang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Yi Yan
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China.
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Sood A, Goel A, Boda S, Mathur R. Prediction of significant OHSS by ovarian reserve and ovarian response - implications for elective freeze-all strategy. HUM FERTIL 2020; 25:390-396. [PMID: 32835544 DOI: 10.1080/14647273.2020.1809021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ovarian Hyperstimulation Syndrome (OHSS) remains a risk to women undergoing assisted conception despite available preventative measures, which are usually applied on the basis of ovarian response. We performed a retrospective cohort study with robust ascertainment of OHSS cases in women undergoing treatment using GnRH antagonist. FSH dose was based on Anti-Mullerian Hormone concentration. A total of 1492 cycles were carried out over 18 months. Moderate/severe OHSS occurred in 24 cycles (1.6%). AMH of 35 pmol/L and/or AFC of 20 or more identified 18/24 (76%) OHSS cases. The optimal thresholds for predicting OHSS were 22.5 pmol/L for AMH (sensitivity 87.5%, specificity 60.6%), 19.5 for AFC (sensitivity 70.8%, specificity 67%), and 9.5 for egg numbers (sensitivity 83.5%, specificity 62.7%). Peak oestradiol levels had no predictive value. The utility of egg number is limited as it is only known after the ovulatory trigger has been administered. Thus, ovarian reserve parameters are better than ovarian response at predicting the risk of significant OHSS in GnRH antagonist cycles in modern clinical practice. Patients with a high ovarian reserve are at risk of OHSS even if their ovarian response is not excessive. Decisions about preventative measures should be based on ovarian reserve rather than ovarian response.
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Affiliation(s)
- Akanksha Sood
- Department of Reproductive Medicine, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Akhil Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Raj Mathur
- Department of Reproductive Medicine, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
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Ng DYT, Ko JKY, Li HWR, Lau EYL, Yeung WSB, Ho PC, Ng EHY. Performance of ovarian response prediction index (ORPI) in predicting ovarian response and livebirth in the in-vitro fertilisation cycle using a standard stimulation with corifollitropin alpha in a GnRH antagonist protocol. HUM FERTIL 2020; 25:1-7. [PMID: 32787471 DOI: 10.1080/14647273.2020.1805517] [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: 12/13/2019] [Accepted: 06/10/2020] [Indexed: 01/22/2023]
Abstract
The objective of this study was to evaluate the performance of ovarian response prediction index (ORPI) in predicting ovarian response and livebirth of women undergoing their first in-vitro fertilisation (IVF) cycle. This is a retrospective analysis of 285 women from 2013 to 2016. The outcome measures were area (AUC) under the receiver-operator characteristic (ROC) curves for prediction of excessive and poor response, livebirth in the fresh cycle and cumulative livebirth. The ORPI was significantly correlated with the oocyte number. For prediction of excessive response, AUC for ORPI was comparable to AMH and significantly higher than AFC and female age. At a cut-off of 0.42, ORPI has a sensitivity and specificity of 84% and 77% respectively for prediction of excessive response. For prediction of poor response, AUC for ORPI was significantly higher than AFC, AMH and female age. At a cut-off of 0.12, ORPI has a sensitivity of 69% and specificity of 89% respectively for prediction of poor response. For prediction of livebirth, AUCs of ORPI were not significantly different from AFC and female age. Therefore, ORPI is not a good predictor of livebirth. Its prediction of excessive and poor ovarian response is comparable to that of serum AMH.
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Affiliation(s)
- Dorothy Yuet Tao Ng
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Jennifer Ka Yee Ko
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Estella Yee Lan Lau
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - William Shu Biu Yeung
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
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The influence of clinical and laboratory factors on the formation of monopronucleated zygotes after intracytoplasmic sperm injection (ICSI). ZYGOTE 2019; 27:64-68. [DOI: 10.1017/s0967199418000473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryThe aim of the present study was to determine whether clinical or laboratory factors can influence the development of single pronucleated zygotes (1PN) and two polar bodies (PB) after ICSI. In total, 341 ICSI cycles performed at FertiClinic-Villa Margherita from January 2012 to December 2014 were enrolled in the study. Group A included 240 cycles with no 1PN−2PB while group B included 101 cycles with one or more 1PN−2PB. Age, stimulation protocol, infertility factor, amount of gonadotropin administered, duration of therapy, peak estradiol levels, number of follicles at maturation triggering, oocytes retrieved and mature oocytes, time between retrieval and injection and sperm characteristics were compared between groups. In opposition to previous results showing no relationship between 1PN occurrence and clinical or laboratory variables, we observed that 1PN−2PB zygote formation seems to be associated with a lower female age, higher level of E2 and higher number of follicles on day of oocyte maturation triggering, higher number of astenozoospermic male patients, more oocytes retrieved at pick-up, more mature oocytes (MII) and longer time to injection.
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10
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Rare genetic variants potentially involved in ovarian hyperstimulation syndrome. J Assist Reprod Genet 2018; 36:491-497. [PMID: 30483911 DOI: 10.1007/s10815-018-1372-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE We aim to investigate whether there is a genetic predisposition in women who developed ovarian hyperstimulation syndrome (OHSS) after GnRH antagonist protocol with GnRH agonist trigger and freeze-all approach. METHODS Four patients with OHSS after GnRH agonist trigger and freeze-all approach were gathered from the worldwide patient population. These patients were analyzed through Whole Exome Sequencing. In this study known causes of OHSS were investigated and new causes present in at least two individuals were searched for. RESULTS In the first part of the study, we evaluated the presence of mutations in genes already known to be involved in OHSS. In PGR and TP53, heterozygous alterations were detected. PGR is predicted to be involved in progesterone resistance with a recessive inheritance pattern and is, therefore, not considered as being causal. The consequences of the variant detected in TP53 currently remain unknown. In part 2 of the study, we assessed the clinical significance of variants in genes previously not linked to OHSS. We especially focused on genes with variants present in ≥ 2 patients. Two patients have variants in the FLT4 gene. Mutations in this gene are linked to hereditary lymphedema, but no link to OHSS has been described. CONCLUSIONS Defining a genetic predisposition for OHSS is essential in view of prevention. In this study, a potential link between the FLT4 gene and OHSS has been suggested. Future functional studies are essential to define a more precise involvement of the detected variants in the development of OHSS.
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11
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Abbara A, Clarke SA, Dhillo WS. Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment. Endocr Rev 2018; 39:593-628. [PMID: 29982525 PMCID: PMC6173475 DOI: 10.1210/er.2017-00236] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/27/2018] [Indexed: 01/20/2023]
Abstract
Infertility affects one in six of the population and increasingly couples require treatment with assisted reproductive techniques. In vitro fertilization (IVF) treatment is most commonly conducted using exogenous FSH to induce follicular growth and human chorionic gonadotropin (hCG) to induce final oocyte maturation. However, hCG may cause the potentially life-threatening iatrogenic complication "ovarian hyperstimulation syndrome" (OHSS), which can cause considerable morbidity and, rarely, even mortality in otherwise healthy women. The use of GnRH agonists (GnRHas) has been pioneered during the last two decades to provide a safer option to induce final oocyte maturation. More recently, the neuropeptide kisspeptin, a hypothalamic regulator of GnRH release, has been investigated as a novel inductor of oocyte maturation. The hormonal stimulus used to induce oocyte maturation has a major impact on the success (retrieval of oocytes and chance of implantation) and safety (risk of OHSS) of IVF treatment. This review aims to appraise experimental and clinical data of hormonal approaches used to induce final oocyte maturation by hCG, GnRHa, both GnRHa and hCG administered in combination, recombinant LH, or kisspeptin. We also examine evidence for the timing of administration of the inductor of final oocyte maturation in relationship to parameters of follicular growth and the subsequent interval to oocyte retrieval. In summary, we review data on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.
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Affiliation(s)
- Ali Abbara
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Sophie A Clarke
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Waljit S Dhillo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Chen Y, Yang T, Hao C, Zhao J. A Retrospective Study of Letrozole Treatment Prior to Human Chorionic Gonadotropin in Women with Polycystic Ovary Syndrome Undergoing In Vitro Fertilization at Risk of Ovarian Hyperstimulation Syndrome. Med Sci Monit 2018; 24:4248-4253. [PMID: 29925074 PMCID: PMC6042308 DOI: 10.12659/msm.910743] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) are given letrozole before a trigger injection of human chorionic gonadotropin (hCG) to lower estrogen (E2) levels, but can experience ovarian hyperstimulation syndrome (OHSS). The aim of this study was to evaluate the effect of oral letrozole, prior to administration of hCG, on the outcome of IVF and development of OHSS. Material/Methods Retrospective clinical review included 181 cases of women with PCOS who underwent IVF cycles with intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) (IVF/ICSI-ET). The day before the use of hCG, cases were divided into a letrozole-treated group (N=78) and a non-letrozole group (N=103). An oral dose of 2.5 mg qd of letrozole was given when the peak level of E2 was ≥4000 pg/ml during ovarian stimulation and ceased before the day of egg retrieval. Results The letrozole-treated group had a significant increase in the number of retrieved oocytes, viable embryos, and fresh ET rate (P>0.05); peak levels of E2, and E2 levels on the day of the egg retrieval, were significantly higher, and the fertilization rate was significantly lower (P<0.001). No significant differences were found in the rates of pregnancy, abortion, or ectopic pregnancy between the two groups (P>0.05). The incidence OHSS was lower in the letrozole-treated group, but this difference did not reach statistical significance (P>0.05). Conclusions Women with PCOS who underwent IVF, oral treatment with letrozole a day prior to treatment with hCG lowered E2 levels, but did not significantly reduce the incidence of OHSS.
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Affiliation(s)
- Yilu Chen
- Shandong University School of Medicine, Shandong, China (mainland).,Reproductive Center, Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Tanchu Yang
- Reproductive Center, Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Cuifang Hao
- Shandong University School of Medicine, Shandong, China (mainland).,Department of Assisted Reproduction, Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Junzhao Zhao
- Reproductive Center, Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
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Abbara A, Islam R, Clarke S, Jeffers L, Christopoulos G, Comninos A, Salim R, Lavery S, Vuong T, Humaidan P, Kelsey T, Trew G, Dhillo W. Clinical parameters of ovarian hyperstimulation syndrome following different hormonal triggers of oocyte maturation in IVF treatment. Clin Endocrinol (Oxf) 2018; 88:920-927. [PMID: 29446481 PMCID: PMC6001461 DOI: 10.1111/cen.13569] [Citation(s) in RCA: 22] [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: 01/24/2018] [Revised: 01/24/2018] [Accepted: 02/11/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic condition, predominantly related to the hormone used to induce oocyte maturation during IVF treatment. Kisspeptin is a hypothalamic neuropeptide that has recently been demonstrated to safely trigger final oocyte maturation during IVF treatment even in women at high risk of OHSS. However, to date, the safety of kisspeptin has not been compared to current hormonal triggers of oocyte maturation. DESIGN We conducted a retrospective single-centre cohort study investigating symptoms and clinical parameters of early OHSS in women at high risk of OHSS (antral follicle count or total number of follicles on day of trigger ≥23) triggered with human chorionic gonadotrophin (hCG) (n = 40), GnRH agonist (GnRHa; n = 99) or kisspeptin (n = 122) at Hammersmith Hospital IVF unit, London, UK (2013-2016). RESULTS Clinical Parameters of OHSS: Median ovarian volume was larger following hCG (138 ml) than GnRHa (73 ml; P < .0001), and in turn kisspeptin (44 ml; P < .0001). Median ovarian volume remained enlarged 20-fold following hCG, 8-fold following GnRHa and 5-fold following kisspeptin compared to prestimulation ovarian volumes. Mean (±SD) ascitic volumes were lesser following GnRHa (9 ± 44 ml) and kisspeptin (5 ± 8 ml) than hCG (62 ± 84 ml; P < .0001). Symptoms of OHSS were most frequent following hCG and least frequent following kisspeptin. Diagnosis of OHSS: The odds ratio for OHSS diagnosis was 33.6 (CI 12.6-89.5) following hCG and 3.6 (CI 1.8-7.1) following GnRHa, when compared to kisspeptin. CONCLUSION Triggering oocyte maturation by inducing endogenous gonadotrophin release is preferable to the use of exogenous hCG in women at high risk of OHSS.
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Affiliation(s)
- A. Abbara
- Hammersmith HospitalImperial College LondonLondonUK
| | - R. Islam
- IVF UnitHammersmith HospitalLondonUK
| | - S.A. Clarke
- Hammersmith HospitalImperial College LondonLondonUK
| | - L. Jeffers
- Hammersmith HospitalImperial College LondonLondonUK
| | | | | | - R. Salim
- IVF UnitHammersmith HospitalLondonUK
| | | | - T.N.L. Vuong
- University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
- My Duc HospitalIVFMDHo Chi Minh CityVietnam
| | - P. Humaidan
- The Fertility ClinicSkive Regional Hospital and Faculty of Health Aarhus UniversityAarhusDenmark
| | - T.W. Kelsey
- School of Computer ScienceUniversity of St AndrewsSt AndrewsUK
| | - G.H. Trew
- IVF UnitHammersmith HospitalLondonUK
| | - W.S. Dhillo
- Hammersmith HospitalImperial College LondonLondonUK
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Kasaven LS, Goumenou A, Adegoke K. Multiorgan failure associated with severe ovarian hyperstimulation syndrome due to inadequate protocol optimisation: a rare but avoidable complication. BMJ Case Rep 2018; 2018:bcr-2017-223418. [PMID: 29507026 DOI: 10.1136/bcr-2017-223418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a well-recognised iatrogenic complication following controlled ovarian stimulation (COS). Mild to moderate cases are mostly managed conservatively. Severe cases of OHSS can be potentially fatal. For this reason, UK clinics providing licensed fertility treatment are obliged to follow Human Fertilisation and Embryology Authority guidelines for reporting severe incidents. We present an unusually severe complication of OHSS resulting in significant morbidity. A nulligravida woman aged 25, with a 4-year history of subfertility and multiple risk factors for the development of OHSS, underwent COS. Immediately following oocyte retrieval, the patient developed symptoms of early-onset severe OHSS. The subsequent clinical deterioration of the patient precipitated multiple organ failure, including renal and hepatic dysfunction. Despite supportive management in an intensive care unit, the patient required transfer to a tertiary liver centre for specialist treatment. OHSS is a preventable complication; therefore, such an uncommon presentation of the syndrome provides important clinical lessons to be discussed.
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Affiliation(s)
- Lorraine Sheena Kasaven
- Department of Obstetrics and Gynaecology, East Kent Hospitals University NHS Foundation Trust, Margate, UK
| | - Anastasia Goumenou
- Department of Obstetrics and Gynaecology, Queen Elizabeth the Queen Mother Hospital, Margate, UK
| | - Kenneth Adegoke
- Department of Anaesthetics, Queen Elizabeth the Queen Mother Hospital, Margate, UK
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15
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Fu H, Sun J, Tan Y, Zhou H, Xu W, Zhou J, Chen D, Zhang C, Zhu X, Zhang Y, Wu X, Xi Z. Effects of acupuncture on the levels of serum estradiol and pituitary estrogen receptor beta in a rat model of induced super ovulation. Life Sci 2018; 197:109-113. [DOI: 10.1016/j.lfs.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/25/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
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16
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Venous thromboembolism in assisted reproductive technologies: comparison between unsuccessful versus successful cycles in an Italian cohort. J Thromb Thrombolysis 2017; 45:234-239. [DOI: 10.1007/s11239-017-1584-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Aghahosseini M, Aleyasin A, Chegini V, Chegini V. Low-dose hCG as trigger day and 35 hr later have different ovarian hyperstimulation syndrome occurrence in females undergoing In vitro fertilization: An RCT. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.11.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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18
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Zhai J, Liu J, Zhao S, Zhao H, Chen ZJ, Du Y, Li W. Kisspeptin-10 inhibits OHSS by suppressing VEGF secretion. Reproduction 2017; 154:355-362. [DOI: 10.1530/rep-17-0268] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/08/2017] [Accepted: 07/04/2017] [Indexed: 11/08/2022]
Abstract
The aim of the present study was to elucidate the effects of kisspeptin-10 (Kp-10) on ovarian hyperstimulation syndrome (OHSS) and its related mechanism in OHSS rat models, human umbilical vein endothelial cells (HUVECs) and human luteinized granulosa cells. OHSS is a systemic disorder with high vascular permeability (VP) and ovarian enlargement. KISS1R (KISS1 receptor) is the specific receptor of kisspeptin. The kisspeptin/KISS1R system inhibits the expression of vascular endothelial growth factor (VEGF), which is the main regulator of VP. In our study, decreased expression of Kiss1r was observed in both ovaries and lung tissue of OHSS rats. Injection of exogenous Kp-10 inhibited the increase of VP and VEGF while promoting the expression of Kiss1r in both the ovarian and lung tissue of OHSS rats. Using HUVECs, we revealed that a high level of 17-β estradiol (E2), a feature of OHSS, suppressed the expression of KISS1R and increased VEGF and nitric oxide (NO) through estrogen receptors (ESR2). Furthermore, KISS1R mRNA also decreased in the luteinized human granulosa cells of high-risk OHSS patients, and was consistent with the results in rat models and HUVECs. In conclusion, Kp-10 prevents the increased VP of OHSS by the activation of KISS1R and the inhibition of VEGF.
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The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators. Reprod Biomed Online 2017; 35:494-510. [PMID: 28784335 DOI: 10.1016/j.rbmo.2017.06.015] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/21/2017] [Indexed: 11/19/2022]
Abstract
This proceedings report presents the outcomes from an international workshop supported by the European Society of Human Reproduction and Embryology (ESHRE) and Alpha Scientists in Reproductive Medicine, designed to establish consensus on definitions and recommended values for Indicators for the assisted reproductive technology (ART) laboratory. Minimum performance-level values ('competency') and aspirational ('benchmark') values were recommended for a total of 19 Indicators, including 12 Key Performance Indicators (KPIs), five Performance Indicators (PIs), and two Reference Indicators (RIs).
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The Vienna consensus: report of an expert meeting on the development of art laboratory performance indicators. Hum Reprod Open 2017; 2017:hox011. [PMID: 31486806 PMCID: PMC6276649 DOI: 10.1093/hropen/hox011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 06/15/2017] [Accepted: 08/03/2017] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION What are appropriate performance indicators (PIs) for ART laboratories for use in monitoring ‘fresh’ IVF and ICSI cycles? SUMMARY ANSWER Minimum performance (competence) levels and aspirational (benchmark) values were recommended for a total of 19 indicators, including 12 key PIs (KPIs), five PIs and two reference indicators (RIs). WHAT IS ALREADY KNOWN PIs are necessary for systematic monitoring of the laboratory and an important element within the Quality Management System. However, there are no established PIs for ART laboratories and there is very little evidence on the topic. STUDY DESIGN, SIZE, DURATION This is the report of a 2-day consensus meeting of expert professionals. As a starting point for the discussion, two surveys were organized to collect information on indicators used in IVF laboratories. During the meeting, the results of the surveys, scientific evidence (where available), and personal clinical experience where integrated into presentations by experts on specific topics. After presentation, each proposed indicator was discussed until consensus was reached within the panel. PARTICIPANTS/MATERIALS, SETTING, METHODS Expert professionals representing different countries and settings convened in the consensus meeting. MAIN RESULTS AND THE ROLE OF CHANCE The paper is divided in two parts: the workshop report and the recommendations of the expert panel. The second part reflects the discussion on each of the indicators, with the agreed definition, competence level and benchmark value for each of the 19 indicators, including 12 KPIs, 5 PIs and 2 RIs. LIMITATIONS, REASONS FOR CAUTION The KPIs are mainly based on expert opinion. Future research may warrant an update of the recommended KPIs, their definition and the competence level and benchmark values. WIDER IMPLICATIONS OF THE FINDINGS Based on the information presented, each ART laboratory should select its own set of KPIs founded on laboratory organization, and processes. STUDY FUNDING/COMPETING INTEREST(S) The consensus meeting and writing of the paper was supported by funds from ESHRE and Alpha. Alpha gratefully acknowledges the following organizations for their financial support, through the provision of unrestricted educational grants: Global Fertility Alliance, Merck, Origio and Vitrolife. There are no conflicts of interest to disclose,
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Affiliation(s)
| | - Alpha Scientists in Reproductive Medicine
- ALPHA Scientists in Reproductive Medicine, 19 Mayis Mah. 19 Mayis Cad. Nova Baran Center No:4 34360 Sisli, Istanbul, Turkey
- Correspondence address. E-mail: (G.C.)/ (Z.P.)
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21
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Barrière P, Dewailly D, Duhamel A, Gayet V. [Ovarian hyperstimulation syndrome after stimulation with highly purified hMGfor in vitro fertilization: Observational study SHOview]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:283-290. [PMID: 28461237 DOI: 10.1016/j.gofs.2017.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/10/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Data on the incidence and severity of ovarian hyperstimulation syndrome (OHSS) in France are limited. METHODS Prospective observational multicentric study (23 French centers of IVF) in a cohort of 421 women treated with highly purified hMG (HP-hMG) for the first or second cycle of IVF with or without ICSI. The primary objective was to assess the incidence of moderate to severe OHSS in this cohort. RESULTS At inclusion, 172 patients (40.9%) were considered at risk of OHSS by the physicians. The main measures for risk minimization taken by the physicians rested on initial dose of HP-hMG and protocol choice. At the end of the follow-up (4 months in average), the rate of OHSS moderate to severe was 2.4% (confidence interval 95%: 1.1-4.3%) for the studied IVF cycle. OHSS was severe for 3 women (0.7%) and moderate for 7 women (1.7%). CONCLUSION This rate of OHSS after IVF is at the lower limit of the rates reported in the literature for OHSS. This study brings reassuring epidemiological data on the rate of OHSS in women at risk. The measures taken by the physicians to minimize the risk of OHSS could have contributed to this low incidence.
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Affiliation(s)
| | - D Dewailly
- Gynécologie endocrinologie et médecine de la reproduction, hôpital Jeanne-de-Flandre, Lille university hospital, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
| | - A Duhamel
- Pharmacie et santé publique-plateforme d'aide méthodologique, hôpital Jeanne-de-Flandre, Lille university hospital, 59037 Lille, France
| | - V Gayet
- Groupe hospitalier Cochin-Saint-Vincent-de-Paul, 75014 Paris, France
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Nejabati HR, Mota A, Farzadi L, Ghojazadeh M, Fattahi A, Hamdi K, Nouri M. Follicular fluid PlGF/sFlt-1 ratio and soluble receptor for advanced glycation end-products correlate with ovarian sensitivity index in women undergoing A.R.T. J Endocrinol Invest 2017; 40:207-215. [PMID: 27664102 DOI: 10.1007/s40618-016-0550-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 09/06/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE Considering potential roles of soluble receptor for advanced glycation end products (sRAGE) and placental growth factor (PlGF) in ovarian function and embryo implantation, in the present study we have evaluated the association of these factors and also PlGF/sFlt-1 ratio with the ovarian response and implantation rate by dividing patients according to the OSI. METHODS In a cross-sectional study, 90 infertile women who were undergoing ICSI cycle using long protocol were recruited. The patients were divided according to ovarian sensitivity index (OSI). ICSI cycle outcomes were evaluated for each patient and PlGF, sFlt-1 and sRAGE levels of follicular fluid were assayed using commercial ELISA kits. RESULTS Follicular fluid (FF) sRAGE levels and PlGF/sFlt-1 ratio were statistically greater in high-responder women than other responders (p < 0.05). Positive correlations were obtained between sRAGE level with the number of oocytes, follicles and OSI level. sRAGE levels with cutoff value of 4.83 (ng/ml) for evaluating the pregnancy outcome showed 81.8 % sensitivity and 60.7 % specificity. Furthermore, there were positive associations between PlGF/sFlt-1 ratio with the number of oocytes, embryos and OSI level. CONCLUSION In conclusion, the results of current study supported that good ovarian response is independent of pregnancy outcome. Our results showed that FF levels of sRAGE and PlGF/sFlt-1 ratio could be used as markers for determining the high-responder women. Also, FF sRAGE levels could be a good predictor for ART outcome.
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Affiliation(s)
- H R Nejabati
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Mota
- Department of Clinical Biochemistry, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - L Farzadi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Fattahi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - K Hamdi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - M Nouri
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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AbdelAziz A, Joseph S, Salem W, Abed S, Rizk PB, Abuzeid MI. The effectiveness of Hespan in reducing the incidence of severe hyperstimulation syndrome in polycystic ovarian disease patients. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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24
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Are Patients with Polycystic Ovarian Syndrome Ideal Candidates for Oocyte Donation? BIOMED RESEARCH INTERNATIONAL 2016; 2016:5701609. [PMID: 27190994 PMCID: PMC4844867 DOI: 10.1155/2016/5701609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/16/2016] [Indexed: 11/17/2022]
Abstract
Background. The use of donated oocytes for in vitro fertilization treatment in patients with ovarian failure is universally recognized. But would patients with polycystic ovarian syndrome (PCOS) be a good choice for egg donation programs? Objective. Comparing the pregnancy rates of egg receptors from donor patients diagnosed with PCOS to receptors from donors without PCOS. Design. Retrospective cohort study. Methods. A total of 234 patients who had undergone egg reception program were separated into two groups: Group I, receptors from PCOS donors (n = 36); Group II, receptors from donors without PCOS (n = 198). Medical records were reviewed and the fertilization, implantation, and pregnancy rates were calculated. Results. PCOS patients had an average of 3.23 more oocytes retrieved, but there were no differences in the number of mature oocytes that were used for donation between the groups. We also observed that the number of transferred embryos was also not significantly different, as well as the fertilization and implantation rates. The clinical pregnancy rates were not significantly different: 28% and 26% in Group I and Group II, respectively. Conclusions. Women with PCOS should not be excluded from egg donation programs.
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Abstract
Several objections against the morality of researching or employing mitochondrial replacement techniques have been advanced recently. In this paper, I examine three of these objections and show that they are found wanting. First I examine whether mitochondrial replacement techniques, research and clinical practice, should not be carried out because of possible harms to egg donors. Next I assess whether mitochondrial replacement techniques should be banned because they could affect the study of genealogical ancestry. Finally, I examine the claim that mitochondrial replacement techniques are not transferring mitochondrial DNA but nuclear DNA, and that this should be prohibited on ethical grounds.
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Affiliation(s)
- César Palacios-González
- Centre of Medical Law and Ethics, The Dickson Poon School of Law, King's College London, Strand, London, WC2R 2LS, UK.
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26
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Şahin N, Apaydın N, Töz E, Sivrikoz ON, Genç M, Turan GA, Cengiz H, Eskicioğlu F. Comparison of the effects of letrozole and cabergoline on vascular permeability, ovarian diameter, ovarian tissue VEGF levels, and blood PEDF levels, in a rat model of ovarian hyperstimulation syndrome. Arch Gynecol Obstet 2015; 293:1101-6. [PMID: 26690356 DOI: 10.1007/s00404-015-3987-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effects of letrozole and cabergoline in a rat model of ovarian hyperstimulation syndrome (OHSS). STUDY DESIGN In this prospective, controlled experimental study, the 28 female Wistar rats were divided into four subgroups (one non-stimulated control and three OHSS-positive groups: placebo, letrozole, and cabergoline). To induce OHSS, rats were injected with 10 IU of pregnant mare serum gonadotropin from day 29 to day 32 of life, followed by subcutaneous injection of 30 IU hCG on day 33. Letrozole rats received with a single dose of 0.1 mg/kg letrozole via oral gavage, on the hCG day. Cabergoline rats received with a single dose of 100 µg/kg cabergoline via oral gavage, on the hCG day. All animals were compared in terms of body weight, vascular permeability (VP), ovarian diameter, ovarian tissue VEGF expression (assessed via immunohistochemical staining), and blood pigment epithelium-derived growth factor (PEDF) levels. RESULTS The OHSS-positive placebo group (group 2) exhibited the highest VP, ovarian diameter, extent of VEGF staining, and lowest PEDF level, as expected. No significant difference was evident between the letrozole and cabergoline groups in terms of any of body weight; VP; PEDF level; ovarian diameter; or the staining intensity of, or percentage staining for, VEGF in ovarian tissues. CONCLUSIONS Letrozole and cabergoline were equally effective to prevent OHSS, reducing the ovarian diameter, VP, and PEDF and VEGF levels to similar extents.
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Affiliation(s)
- Nur Şahin
- Department of Obstetrics and Gynecology, Sifa University Medicine School, Sanayi cad. No: 7 Bornova, Izmir, Turkey.
| | - Nesin Apaydın
- Department of Obstetrics and Gynecology, M.H. Tepecik Research and Education Hospital, Izmir, Turkey
| | - Emrah Töz
- Department of Obstetrics and Gynecology, M.H. Tepecik Research and Education Hospital, Izmir, Turkey
| | | | - Mine Genç
- Department of Obstetrics and Gynecology, Sifa University Medicine School, Sanayi cad. No: 7 Bornova, Izmir, Turkey
| | - Gülüzar Arzu Turan
- Department of Obstetrics and Gynecology, Sifa University Medicine School, Sanayi cad. No: 7 Bornova, Izmir, Turkey
| | - Hakan Cengiz
- Department of Biostatistics and Medical Informatics, Sifa University Medicine School, Izmir, Turkey
| | - Fatma Eskicioğlu
- Department of Obstetrics and Gynecology, M.H. Manisa Public Hospital, Manisa, Turkey
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27
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Wang YQ, Luo J, Xu WM, Xie QZ, Yan WJ, Wu GX, Yang J. Can steroidal ovarian suppression during the luteal phase after oocyte retrieval reduce the risk of severe OHSS? J Ovarian Res 2015; 8:63. [PMID: 26400057 PMCID: PMC4579791 DOI: 10.1186/s13048-015-0190-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 09/12/2015] [Indexed: 06/16/2024] Open
Abstract
Background Ovarian stimulation in IVF cycle results in luteal supraphysiological steroid concentrations especially for high response patients. The aim of this study was to evaluate the efficacy of ovarian steroid hormone suppression in luteal phase after oocyte retrieval for preventing severe ovarian hyperstimulation syndrome (OHSS) in high-risk patients with embryo cryopreservation. Methods 281 patients with high risk of OHSS were enrolled in this study among 4735 infertile women undergoing their first IVF treatment. The subjects were allocated into treatment and control group. The treatment group (n = 161) received letrozole (n = 43), mifepristone (n = 51), cetrotide (n = 39) and three-drug combinations (n = 28) during the luteal phase after oocyte retrieval, respectively. The control group (n = 120) received no medicine. Fertilization rate, good embryo rate, serum steroid concentration, clinical outcome, and incidence of severe OHSS were compared between the two groups. Results On days 2, 5 and 8 after oocyte retrieval, serum estradiol levels in the letrozole and three-drug combination therapy group were significantly lower than in the other three groups at the same time (P < 0.001, respectively). There were no significantly difference of serum luteinizing hormone concentration on days 2, 5 and 8 and progesterone concentration on day 8 after oocyte retreival among the five groups (P > 0.05, respectively). Compared with the control group, the incidence of severe OHSS, the paracentesis rate, the duration of hospitalization and the days of luteal phase in each subgroup of treatment groups was not significantly decreased (P > 0.05, respectively). Conclusions Our findings indicate that steroidal ovarian suppression in luteal phase after oocyte retrieval seems to be unable to prevent severe OHSS in high-risk patients with embryo cryopreservation.
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Affiliation(s)
- Ya-Qin Wang
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Jin Luo
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Wang-Min Xu
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Qin-Zhen Xie
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Wen-Jie Yan
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Geng-Xiang Wu
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
| | - Jin Yang
- Reproductive Medical center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
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Sousa M, Cunha M, Teixeira da Silva J, Oliveira C, Silva J, Viana P, Barros A. Ovarian hyperstimulation syndrome: a clinical report on 4894 consecutive ART treatment cycles. Reprod Biol Endocrinol 2015; 13:66. [PMID: 26100393 PMCID: PMC4477314 DOI: 10.1186/s12958-015-0067-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 06/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although a large number of studies have been dedicated to ovarian hyperstimulation syndrome (OHSS) none gave full embryological and clinical outcomes comparing oocyte trigger with human chorionic gonadotrophin (HCG) versus with a gonadotrophin-releasing hormone (GnRH) agonist (Buserelin) in cases with suspicious OHSS. The aim of the present study was thus to analyze 4894 consecutive assisted reproductive treatment cycles to undercover associated risk factors for development of OHSS, and the effects of the use of Buserelin as ovulation trigger on embryological and clinical outcomes. METHODS In the 51 cases that developed OHSS, ovulation trigger was performed with HCG as indicators were not suspicious for OHSS. These were compared against two types of groups: 71 cases where Buserelin was used for ovulation induction due to suspicious development of OHSS; and those remaining 4772 cases where ovulation trigger was currently performed with HCG (control). RESULTS Of the cases treated with Buserelin the oocyte maturation rate and the ongoing pregnancy rate were significantly lower, with higher rates of ectopic pregnancy and newborn malformations, but none developed OHSS. Of the OHSS cases, 23 needed hospitalization, with no major complications. CONCLUSIONS Young age, lower time of infertility, lower basal follicle stimulating hormone levels, higher number of cases with female factor and polycystic ovarian syndrome, high number of follicles and higher estradiol concentrations were the risk factors found associated with OHSS. Cases with OHSS also presented higher follicle count but the estradiol levels were within the normal range. It thus remains to develop more strict criteria to avoid all cases with OHSS.
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Affiliation(s)
- Mário Sousa
- Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
- Multidisciplinary Unit for Biomedical Research-UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
| | - Mariana Cunha
- Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal.
| | - José Teixeira da Silva
- Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal.
| | - Cristiano Oliveira
- Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal.
| | - Joaquina Silva
- Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal.
| | - Paulo Viana
- Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal.
| | - Alberto Barros
- Centre for Reproductive Genetics Alberto Barros, Av. do Bessa, 240, 1° Dto. Frente, 4100-012, Porto, Portugal.
- Department of Genetics, Faculty of Medicine, University of Porto (FMUP), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- Institute of Health Research an Innovation, University of Porto, Porto, Portugal.
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Rehman A, Ul-Ain Baloch N, Awais M. Severe ovarian hyperstimulation syndrome complicated by Stenotrophomonas maltophilia peritonitis: a case report and literature review. Intern Med 2015; 54:1149-52. [PMID: 25948367 DOI: 10.2169/internalmedicine.54.3564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic disorder resulting from ovulation induction. Although the occurrence of this disorder is rare, it can be potentially life-threatening in its most severe forms. We herein present the case of a young nulliparous woman who presented with features of abdominal compartment syndrome and was subsequently diagnosed with severe OHSS. All physicians, in particular critical care doctors, must be aware of this rare, but potentially life-threatening iatrogenic disorder.
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Affiliation(s)
- Abdul Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Pakistan
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30
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Bachmakova NV, Dubrovina OS, Lisovskaya TV, Melkozerova OA, Maysina EN, Sentiurina LB. The development of ovarian hyperstimulation syndrome in the implementation of assisted reproductive technology in women with a background of endocrine pathology. Gynecol Endocrinol 2014; 30 Suppl 1:25-9. [PMID: 25200824 DOI: 10.3109/09513590.2014.945780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Known factors of the development of ovarian hyperstimulation syndrome (OHSS) are not informative enough, if considered independently. This is confirmed by the absence of initial predictors in cases of severe OHSS and, in contrast, not clinically apparent manifestations in patients seemingly having high risk of this pathology. These circumstances demand investigation of additional prognostic parameters of the OHSS. PURPOSE To find out additional OHSS risk factors alongside with the previously known ones in the course of implementation of assisted reproductive technologies (ART) in patients having initial metabolic and hormonal disorders. INVESTIGATION DATA AND METHODS: Retrospective analysis of clinical laboratory and functional parameters of hormonal and metabolic state of 133 women suffering OHSS was held. Classification by Schenker, 1995, was used to detect the diagnosis. Control group consisted of 347 women with the unverified OHSS. Basic and control study groups were similar in age and in number of mild and long protocols of ovarian stimulation held. RESULTS AND THEIR DISCUSSION: A significant correlation dependence was revealed between the fact of the OHSS development and some indicators of hormonal and metabolic state: HOMA index of insulin resistance; thyroid parameters: thyroid stimulating hormone (TSH), free thyroxine (fT4), thyroid peroxidase antibodies (AbTPO); and level of prolactin. The revealed correlation dependence of the OHSS development on the above parameters allows to use them for determination of the OHSS risk group and taking measures to prevent this complication of the ART.
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Affiliation(s)
- N V Bachmakova
- Mother and Child Care Ural Research Institution of Russia Public Health Ministry , Ekaterinburg , Russian Federation and
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He Q, Liang L, Zhang C, Li H, Ge Z, Wang L, Cui S. Effects of different doses of letrozole on the incidence of early-onset ovarian hyperstimulation syndrome after oocyte retrieval. Syst Biol Reprod Med 2014; 60:355-60. [DOI: 10.3109/19396368.2014.957879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Baldwin K, Culley L, Hudson N, Mitchell H. Reproductive technology and the life course: Current debates and research in social egg freezing. HUM FERTIL 2014; 17:170-9. [DOI: 10.3109/14647273.2014.939723] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Li HWR, Lee VCY, Ho PC, Ng EHY. Ovarian sensitivity index is a better measure of ovarian responsiveness to gonadotrophin stimulation than the number of oocytes during in-vitro fertilization treatment. J Assist Reprod Genet 2013; 31:199-203. [PMID: 24317853 DOI: 10.1007/s10815-013-0144-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/25/2013] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To validate the use of the ovarian sensitivity index (OSI) as a measure of ovarian response during in-vitro fertilization (IVF) treatment. METHODS This is a retrospective study carried out in an assisted reproduction unit in a teaching hospital. We analysed data from 2,556 women undergoing the first IVF cycle between 2002 and 2009. OSI was calculated as the number of retrieved oocytes divided by total dose of FSH administered (per 1,000 IU). Its correlation to other parameters of ovarian response was compared to that of the oocyte number. RESULTS The correlation coefficients of OSI with age, AFC, AMH, total dose of gonadotrophin, average daily dose of gonadotrophin and duration of stimulation were significantly higher than that of oocyte number with these respective parameters. OSI demonstrated a higher intraclass correlation coefficient (ICC) than the oocyte number when comparing the two parameters across the first and second stimulated IVF cycles. CONCLUSIONS OSI is a better measure of ovarian responsiveness to gonadotrophin stimulation than the oocyte number, and is particularly useful when different subjects are treated with different stimulation regimens which would have confounding effect on the oocyte number.
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Affiliation(s)
- Hang Wun Raymond Li
- Centre of Assisted Reproduction and Embryology, Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, Hong Kong,
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Lin YH, Huang MZ, Hwang JL, Chen HJ, Hsieh BC, Huang LW, Tzeng CR, Seow KM. Combination of cabergoline and embryo cryopreservation after GnRH agonist triggering prevents OHSS in patients with extremely high estradiol levels--a retrospective study. J Assist Reprod Genet 2013; 30:753-9. [PMID: 23606010 DOI: 10.1007/s10815-013-9997-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Embryo cryopreservation after triggering oocyte maturation with GnRH agonist (GnRHa) in GnRH antagonist protocols has been proposed to prevent ovarian hyperstimulation syndrome (OHSS). However, a small percentage of patients still developed severe OHSS. The purpose of the study was to investigate the efficacy of preventing OHSS in patients at very high risk when cabergoline was given in addition to elective cryopreservation after GnRHa triggering. METHODS This is a retrospective observational study. The patients were stimulated with GnRH antagonist protocol. When serum E2 concentration was >6,000 pg/ml and there were more than 20 follicles ≥11 mm on the day of final oocyte maturation, GnRHa was used to trigger oocyte maturation. Cabergoline was given to augment the effect of preventing OHSS. The embryos were electively cryopreserved by vitrification and thawed in subsequent cycles. The primary outcome measure was the incidence of severe OHSS. The secondary outcome measure was the clinical pregnancy rate in the first frozen-thawed embryo transfer cycle. RESULTS One hundred and ten patients underwent 110 stimulated cycles were included for analysis. No patients developed moderate/severe OHSS. Mean E2 concentration on the day of final oocyte maturation was 7,873 pg/ml, and an average of 22.7 oocytes was obtained from each patient. One hundred and ten thawing cycles were performed, resulting in 69 clinical pregnancies (62.7 %). CONCLUSIONS Combining cabergoline and embryo cryopreservation after GnRHa triggering in GnRH antagonist protocol could prevent OHSS in patients at very high risk.
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Affiliation(s)
- Yu-Hung Lin
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih Lin District, Taipei, Taiwan
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Nelson SM. Venous thrombosis during assisted reproduction: Novel risk reduction strategies. Thromb Res 2013; 131 Suppl 1:S1-3. [DOI: 10.1016/s0049-3848(13)00023-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Halvorson SAC, Ricker MA, Barker AF, Patton PE, Harrison RA, Hunter AJ. Thoracic endometriosis unmasked by ovarian hyperstimulation for in vitro fertilization. J Gen Intern Med 2012; 27:603-7. [PMID: 22234445 PMCID: PMC3326110 DOI: 10.1007/s11606-011-1959-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/02/2011] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
Thoracic endometriosis syndrome is a well-described, rare manifestation of endometriosis. We present a case of a 35-year old woman undergoing controlled ovarian stimulation prior to in vitro fertilization (IVF) who developed bilateral hemorrhagic pleural effusions. She was initially diagnosed with ovarian hyperstimulation syndrome, a complication of infertility therapy; however, she was later found to have occult thoracic endometriosis. We describe ovarian hyperstimulation syndrome and review the manifestations of thoracic endometriosis syndrome. Although endometriosis is a hormone-dependent disease, the rate of IVF complications related to endometriosis is low.
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Affiliation(s)
- Stephanie A C Halvorson
- OHSU Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd BTE-119, Portland, Oregon 97239, USA.
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Vitthala S, Bouaziz J, Tozer A, Zosmer A, Al-Shawaf T. Serum FSH Levels in Coasting Programmes on the hCG Day and Their Clinical Outcomes in IVF ± ICSI Cycles. Int J Endocrinol 2012; 2012:540681. [PMID: 22518127 PMCID: PMC3296177 DOI: 10.1155/2012/540681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/12/2011] [Accepted: 10/17/2011] [Indexed: 11/17/2022] Open
Abstract
Introduction. Coasting is the most commonly used strategy in prevention of severe OHSS. Serum FSH levels measurements during coasting may aid in optimizing the duration of coasting. Objective(s). To study live birth rates (LBRs), clinical pregnancy rates (CPRs), and optimal duration of coasting based on serum FSH levels on the hCG day. Materials and Methods. It is a retrospective study performed between 2005 and 2008 at Barts and The London Centre for Reproductive Medicine, NHS Trust, London, UK, on 349-coasted women undergoing controlled ovarian stimulation (COS) for IVF ± ICSI. The serum FSH level measurements on the hCG day during coasting programme were analysed to predict the LBR and CPR. Result(s). LBR and CPR were significantly higher when the FSH levels on the hCG day were >2.5 IU/L (LBR: 32.5%, P = 0.045 and CPR: 36.9%, P = 0.027) compared to FSH <2.5 IU/L. The optimal FSH cut-off level for LBR and CPR is 5.6 IU/L on the hCG day. The optimal cutoff for coasting is 4 days. Conclusion(s). Coasting may be continued as long as either serum FSH level is > 2.5 IU/L on the hCG day without compromising the LBR and CPR or to maximum of 4 days.
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Affiliation(s)
- Srisailesh Vitthala
- Kamineni Fertility Centre, Kamineni Hospitals, King Koti, Hyderabad 500001, India
- *Srisailesh Vitthala:
| | - Jerome Bouaziz
- Services of Gynecology and Obstetrics-Reproduction, The Bow Hospital, Chu de Nice, Route Saint Anton, 06200 Nice, France
| | - Amanda Tozer
- Centre for Reproductive Medicine-Barts and The London NHS Trust, London EC 1A 7BE, UK
| | - Ariel Zosmer
- Centre for Reproductive Medicine-Barts and The London NHS Trust, London EC 1A 7BE, UK
| | - Talha Al-Shawaf
- Centre for Reproductive Medicine-Barts and The London NHS Trust, London EC 1A 7BE, UK
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[Ovarian hyperstimulation syndrome: pathophysiology, risk factors, prevention, diagnosis and treatment]. ACTA ACUST UNITED AC 2011; 40:593-611. [PMID: 21835557 DOI: 10.1016/j.jgyn.2011.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 12/26/2022]
Abstract
The ovarian hyperstimulation syndrome is a major complication of ovulation induction for in vitro fertilization, with severe morbidity and possible mortality. Whereas its pathophysiology remains ill-established, the VEGF may play a key role as well as coagulation disturbances. Risk factors for severe OHSS may be related to patients characteristics or to the management of the ovarian stimulation. Two types of OHSS are usually distinguished: the early OHSS, immediately following the ovulation triggering and a later and more severe one, occurring in case of pregnancy. As no etiologic treatment is available, the therapeutic management of OHSS should focus on its related-complications. Thrombotic complications that can occur in venous or arterial vessels represent the major risk of OHSS, possibly conducting to myocardial infarction and cerebrovascular accidents. Once the OHSS is diagnosed, prevention of thrombotic accidents remains the major issue.
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Devroey P, Polyzos NP, Blockeel C. An OHSS-Free Clinic by segmentation of IVF treatment. Hum Reprod 2011; 26:2593-7. [DOI: 10.1093/humrep/der251] [Citation(s) in RCA: 348] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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A single nucleotide polymorphism in BMP15 is associated with high response to ovarian stimulation. Reprod Biomed Online 2011; 23:97-104. [DOI: 10.1016/j.rbmo.2011.02.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 02/17/2011] [Accepted: 02/22/2011] [Indexed: 11/23/2022]
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Poppe K, Unuane D, D’Haeseleer M, Tournaye H, Schiettecatte J, Haentjens P, Velkeniers B. Thyroid function after controlled ovarian hyperstimulation in women with and without the hyperstimulation syndrome. Fertil Steril 2011; 96:241-5. [DOI: 10.1016/j.fertnstert.2011.04.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 04/13/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
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Lamazou F, Levaillant JM. Le monitorage échographique dans le cadre de la fécondation in vitro. IMAGERIE DE LA FEMME 2011. [DOI: 10.1016/j.femme.2011.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
To elaborate guidelines for the use of different treatment and different protocols for ovarian stimulation. SEARCHED STRATEGY: We searched for all publications which described randomised controlled trial evaluating different ovarian stimulation protocols and different indications on PubMed, Medline and Cochrane Database. The keywords were: ovulation induction, citrate of clomiphene, gonadotropin, metformin, anti estrogens, anti aromatase, pulsatile GnRH administration, cancer, ovarian hyperstimulation, thrombosis, multiple pregnancies, and complications. Randomised controlled trials were first considered. Then was considered recent meta analysis and cohort study. We mentioned when literature was weak.
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Affiliation(s)
- L Jacquesson
- Centre de médecine de la reproduction, 17 rue de la Pompe, 75116 Paris, France.
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Current world literature. Curr Opin Obstet Gynecol 2010; 22:354-9. [PMID: 20611001 DOI: 10.1097/gco.0b013e32833d582e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Hanevik HI, Hilmarsen HT, Skjelbred CF, Tanbo T, Kahn JA. Single nucleotide polymorphisms in the anti-Müllerian hormone signalling pathway do not determine high or low response to ovarian stimulation. Reprod Biomed Online 2010; 21:616-23. [PMID: 20864412 DOI: 10.1016/j.rbmo.2010.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 05/20/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
There is substantial variability in ovarian response to exogenous gonadotrophins in women undergoing ovarian stimulation for IVF. Genetic variation in signalling pathways of the ovary could influence ovarian stimulation outcome. Studies have shown a correlation between the serum concentration of anti-Müllerian hormone (AMH) and ovarian stimulation outcome. This paper present a retrospective case-controlled genetic association study designed to test the association between single nucleotide polymorphisms (SNP) in the AMH signalling pathway and two clinically important outcomes of ovarian stimulation: low and high response. Blood samples from 53 high responders, 38 low responders and 100 controls were analysed for eight SNP of interest. Odds ratios and 95% confidence intervals were estimated by a binary logistic regression model adjusting for age and body mass index. As far as is known, this is the first report on the influence of these SNP, present in approximately 19% of women, on ovarian stimulation outcome. No statistically significant association was found between any of the SNP studied and high or low response to ovarian stimulation. It seems unnecessary to detect these SNP when applying the serum concentration of AMH as a predictor of ovarian response to stimulation. Many infertile couples are treated by IVF. Part of this treatment is to pharmacologically stimulate the ovaries to develop many oocytes simultaneously. This process is called ovarian stimulation. Some women respond either too little (low responders) or too much (high responders) to ovarian stimulation. Both these situations are unfavourable to the woman. This study evaluates whether these chances of having one of these two outcomes of ovarian stimulationare influenced by variation in the gene for anti-Müllerian hormone (AMH) or its receptor. This is done by taking blood samples from three groups of patients: low responders, high responders and controls with a normal response. These blood samples were analysed to see if the variation in the genes for AMH or its receptor were different in the three groups. They were not, and so we conclude that the genetic variation that exists in the AMH and receptor signalling pathway is not a major determinant of ovarian stimulation outcome.
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Curiel Balsera E, Prieto Palomino MÁ, Muñoz Bono J, Banderas Bravo E. [Severe ovarian hyperstimulation syndrome]. Med Clin (Barc) 2010; 137:184-5. [PMID: 20338599 DOI: 10.1016/j.medcli.2010.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 02/02/2010] [Accepted: 02/04/2010] [Indexed: 11/27/2022]
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Mottershead DG, Watson AJ. Oocyte peptides as paracrine tools for ovarian stimulation and oocyte maturation. Mol Hum Reprod 2009; 15:789-94. [PMID: 19846464 DOI: 10.1093/molehr/gap085] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recent studies report the production and isolation of a stable bioactive recombinant human bone morphogenetic protein 15 (rhBMP15) that is appropriately processed in HEK-293 cells and activates the SMAD 1/5/8 pathway in mouse granulosa cell cultures. Further, the purified rhBMP15 induces the expression of genes associated with cumulus expansion. Thanks to recent research, we have a greater understanding of the importance of the dialogue that occurs between the oocyte and the granulosa cell layer with regard to regulating folliculogenesis and the acquisition of oocyte developmental competence and maturation. BMP15 is one of the critical components of these intra-follicular communication pathways. The production of recombinant human BMP15 is important for understanding the biochemistry of this specific pathway and for also fully understanding its functional contributions to mediating oocyte development. The production of a stable recombinant human BMP15 is also important for use in experiments aimed at optimizing ovarian stimulation protocols and in vitro oocyte maturation methods. This is required to improve oocyte and embryonic developmental competence and increase our ability to effectively use in vitro methods for animal production and the treatment of human infertility.
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Affiliation(s)
- David G Mottershead
- Robinson Institute, School of Paediatrics and Reproductive Health, Medical School, The University of Adelaide, Adelaide 5005, Australia
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