1
|
Effects of Intraovarian Injection of Autologous Platelet-Rich Plasma on Ovarian Rejuvenation in Poor Responders and Women with Primary Ovarian Insufficiency. Reprod Sci 2021; 28:2050-2059. [PMID: 33683669 DOI: 10.1007/s43032-021-00483-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/31/2021] [Indexed: 12/25/2022]
Abstract
Injection of intraovarian platelet-rich plasma (PRP) was recently presented in terms of improvement ovarian function in women with a poor ovarian response (POR) or primary ovarian insufficiency (POI). In a before and after study, 17 poor responder women and 9 women with the diagnosis of POI were recruited. The multifocal intramedullary infusion of 1.5 ml activated PRP was performed into each ovary. The majority of women in both groups received the second PRP injection with the twofold increase in the dosage to 3ml, 3 months after the first injection. Evaluation of serum anti-mullerian hormone ( AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) was performed. In addition, all women were followed with regard to pregnancy outcome up to delivery. In the POI group, menstrual restoration was monitored. The significant difference was not detected regarding the hormonal profile between the three time points in both groups. With regard to pregnancy outcome, 8/17 (47%) of PORs had spontaneous pregnancy in response to PRP injection. Of those, three women (37.55%) had abortions, whereas 4 pregnancies (50%) led to healthy live births, and one woman (12.5%) was in the 24th week of her pregnancy. Menstruation recovery occurred among 22.2% of women with POI after the second PRP injection, but no one became pregnant. Intraovarian injection of autologous PRP might be considered an alternative treatment in poor responders. As for women with POI, it is questionable whether PRP could induce menstrual recovery.
Collapse
|
2
|
Sunkara SK, Ramaraju GA, Kamath MS. Management Strategies for POSEIDON Group 2. Front Endocrinol (Lausanne) 2020; 11:105. [PMID: 32174892 PMCID: PMC7056824 DOI: 10.3389/fendo.2020.00105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/18/2020] [Indexed: 02/05/2023] Open
Abstract
Although individualization of ovarian stimulation aims at maximal efficacy and safety in assisted reproductive treatments, in its current form it is far from ideal in achieving the desired success in women with a low prognosis. This could be due a failure to identify such women who are likely to have a low prognosis with currently used prognostic characteristics. Introduction of the patient-oriented strategies encompassing individualized oocyte number (POSEIDON) concept reinforces recognizing such low prognosis groups and stratifying in accordance with important prognostic factors. The POSEIDON concept provides a practical approach to the management of these women and is a useful tool for both counseling and clinical management. In this commentary, we focus on likely management strategies for POSEIDON group 2 criteria.
Collapse
Affiliation(s)
- Sesh Kamal Sunkara
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- *Correspondence: Sesh Kamal Sunkara ;
| | - G. A. Ramaraju
- Center for Assisted Reproduction, Krishna IVF Clinic, Visakhapatnam, India
| | | |
Collapse
|
3
|
Li XL, Wang L, Lv F, Huang XM, Wang LP, Pan Y, Zhang XM. The influence of different growth hormone addition protocols to poor ovarian responders on clinical outcomes in controlled ovary stimulation cycles: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6443. [PMID: 28328856 PMCID: PMC5371493 DOI: 10.1097/md.0000000000006443] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Growth hormone (GH) is used as an adjuvant therapy in in vitro fertilization and embryo transfer (IVF-ET) for poor ovarian responders, but findings for its effects on outcomes of IVF have been conflicting. The aim of the study was to compare IVF-ET outcomes among women with poor ovarian responders, and find which subgroup can benefit from the GH addition. METHODS We searched the databases, using the terms "growth hormone," "GH," "IVF," "in vitro fertilization." Randomized controlled trials (RCT) were included if they assessed pregnancy rate, live birth rate, collected oocytes, fertilization rate, and implantation rate. Extracted the data from the corresponding articles, Mantel-Haenszel random-effects model, or fixed-effects model was used. Eleven studies were included. RESULTS Clinical pregnancy rate (RR 1.65, 95% CI 1.23-2.22), live birth rate (RR1.73, 1.25-2.40), collected oocytes number (SMD 1.09, 95% CI 0.54-1.64), MII oocytes number (SMD 1.48, 0.84-2.13), and E2 on human chorionic gonadotropin (HCG) day (SMD 1.03, 0.18-1.89) were significantly increased in the GH group. The cancelled cycles rate (RR 0.65, 0.45-0.94) and the dose of gonadotropin (Gn) (SMD -0.83, -1.47, -0.19) were significantly lower in patients who received GH. Subgroup analysis indicated that the GH addition with Gn significantly increased the clinical pregnancy rate (RR 1.76, 1.25-2.48) and the live birth rate (RR 1.91, 1.29-2.83). CONCLUSION The GH addition can significantly improve the clinical pregnancy rate and live birth rate. Furthermore, the GH addition time and collocation of medications may affect the pregnancy outcome.
Collapse
Affiliation(s)
- Xue-Li Li
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Li Wang
- Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Holcombe Boulevard, TX
| | - Fang Lv
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Xia-Man Huang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Li-Ping Wang
- Department of Biobank, Clinical Medical School of Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Yu Pan
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| | - Xiao-Mei Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China
| |
Collapse
|
4
|
Mak SMJ, Wong WY, Chung HS, Chung PW, Kong GWS, Li TC, Cheung LP. Effect of mid-follicular phase recombinant LH versus urinary HCG supplementation in poor ovarian responders undergoing IVF - a prospective double-blinded randomized study. Reprod Biomed Online 2016; 34:258-266. [PMID: 28063801 DOI: 10.1016/j.rbmo.2016.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/20/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
Luteinizing hormone (LH) is crucial for the development of follicular growth and oocyte maturation, especially in the management of poor ovarian responders (PORs). This study presents the results of a prospective double-blinded randomized study to compare the effect of mid-follicular phase recombinant LH (rLH) supplementation with urinary human chorionic gonadotrophin (uHCG) supplementation when using a fixed gonadotrophin-releasing hormone (GnRH) antagonist protocol in IVF cycles. A total of 49 women with poor ovarian response (POR) according to the Bologna criteria were recruited. This study showed no statistically significant difference in cycle cancellation rates, numbers of oocytes retrieved per cycle initiated, fertilization rates, the numbers of embryos obtained per cycle initiated, implantation, clinical pregnancy and live birth rates, although the live birth rate per cycle initiated in the uHCG group (29.2%) was 3.6 times that of the rLH group (8.0%). Further studies are required to verify if uHCG supplementation produces better clinical outcomes compared with rLH in women with POR.
Collapse
Affiliation(s)
- Sze Man Jennifer Mak
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wai Yee Wong
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Hoi Sze Chung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Pui Wah Chung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Grace Wing Shan Kong
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Tin Chiu Li
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai Ping Cheung
- Assisted Reproduction Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
5
|
Londra L, Moreau C, Strobino D, Bhasin A, Zhao Y. Is the type of gonadotropin-releasing hormone suppression protocol for ovarian hyperstimulation associated with ectopic pregnancy in fresh autologous cycles for in vitro fertilization? Fertil Steril 2016; 106:666-72. [DOI: 10.1016/j.fertnstert.2016.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 01/24/2023]
|
6
|
Papathanasiou A, Searle BJ, King NMA, Bhattacharya S. Trends in 'poor responder' research: lessons learned from RCTs in assisted conception. Hum Reprod Update 2016; 22:306-19. [PMID: 26843539 DOI: 10.1093/humupd/dmw001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/11/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A substantial minority of women undergoing IVF will under-respond to controlled ovarian hyperstimulation. These women-so-called 'poor responders'-suffer persistently reduced success rates after IVF. Currently, no single intervention is unanimously accepted as beneficial in overcoming poor ovarian response (POR). This has been supported by the available research on POR, which consists mainly of randomized controlled trials (RCTs ) with an inherent high-risk of bias. The aim of this review was to critically appraise the available experimental trials on POR and provide guidance towards more useful-less wasteful-future research. METHODS A comprehensive review was undertaken of RCTs on 'poor responders' published in the last 15 years. Data on various methodological traits as well as important clinical characteristics were extracted from the included studies and summarized, with a view to identifying deficiencies from which lessons can be learned. Based on this analysis, recommendations were provided for further research in this field of assisted conception. RESULTS We selected and analysed 75 RCTs. A valid, 'low-risk' randomization method was reported in three out of four RCTs. An improving trend in reporting concealment of patient allocation was also evident over the 15-year period. In contrast, <1 in 10 RCTs 'blinded' patients and <1 in 5 RCTs 'blinded' staff to the proposed intervention. Only 1 in 10 RCTs 'blinded' ultrasound practitioners to patient allocation, when assessing the outcome of early pregnancy. The majority of trials reported an intention-to-treat analysis for at least one of their outcomes, with an improving trend in the recent years. Substantial variation was noted in the definitions used for 'poor responders', the most popular being 'low ovarian response at previous stimulation'. The preferred cut-off value for defining previous low response has been 'less or equal to three retrieved oocytes'. The most popular tests used for diagnosing diminished ovarian reserve have been antral follicle count and FSH. Although the Bologna criteria for POR were only recently introduced, they are expected to become a popular definition in future 'poor responder' trials. Numerous interventions have been studied on 'poor responders'. Most of these have been applied before/during controlled ovarian hyperstimulation. The antagonist protocol, the microdose flare protocol and the long down-regulation protocol have been among the most popular interventions. The analysis of outcomes revealed a clear improving trend in reporting live birth. In contrast, only 10% of RCTs reported significant improvement in reproductive outcomes among tested interventions. Twelve 'significant' interventions were reported, each supported by a single 'positive' RCT. Finally, trials of higher methodological quality were more likely to have been published in a high-impact journal. CONCLUSIONS Overall, the majority of published trials on POR suffer from methodological flaws and are, thus, regarded as being high-risk for bias. The same trials have used a variety of definitions for their poor responders and a variety of interventions for their head-to-head comparisons. Not surprisingly, discrepancies are also evident in the findings of trials comparing similar interventions. Based on the identified deficiencies, this novel type of 'methodology and clinical' review has introduced custom recommendations on how to improve future experimental research in the 'poor responder' population.
Collapse
|
7
|
Management of poor responders in IVF: is there anything new? BIOMED RESEARCH INTERNATIONAL 2014; 2014:352098. [PMID: 25136579 PMCID: PMC4127291 DOI: 10.1155/2014/352098] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/26/2014] [Indexed: 12/22/2022]
Abstract
Despite the fact that in the last two decades an enormous number of papers on the topic of poor ovarian response have been published in the literature, so far it has been impossible to identify any efficient treatment to improve the ovarian response and the clinical outcome of this group of patients. The incidence of poor ovarian responders among infertile women has been estimated at 9–24% but according to recent reviews, it seems to have slightly increased. The limitation in quantifying the incidence of these patients among the infertile population is due to the difficulty of a clear definition in literature. A recent paper by the Bologna ESHRE working group on poor ovarian response has been the first real attempt to find a common definition. Current literature proposes new risk factors which could be the cause of a reduction in ovarian reserve, which also includes genetic factors. This represents the first necessary step towards finding applicable solutions for these patients. To date, there is a substantial lack of literature that identifies an ideal protocol for these patients. The use of the “Bologna criteria” and the introduction of long acting gonadotropin in clinical practice have given rise to new promising stimulation protocols for this group of patients.
Collapse
|
8
|
Trolice MP. Live birth from a 46-year-old using fresh autologous oocytes through in vitro fertilization. Fertil Steril 2014; 102:96-8. [PMID: 24796763 DOI: 10.1016/j.fertnstert.2014.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To report a live birth with IVF from a 46-year-old woman using autologous oocytes. DESIGN Case report. SETTING Reproductive endocrinology and infertility private practice and ambulatory IVF center. PATIENT(S) One 46-year-old nulligravid woman. INTERVENTION(S) IVF with fresh ET. MAIN OUTCOME MEASURE(S) Live birth after IVF. RESULT(S) A 46-year-old with antimullerian hormone (AMH) level less than 0.16 conceived through IVF using autologous oocytes. A total of seven oocytes were retrieved, from which four embryos were transferred at the cleavage stage, resulting in a pregnancy and delivery of a healthy male infant weighing 1,580 g at 31 and 3/7 weeks' estimated gestational age. CONCLUSION(S) The prognosis for a live birth from IVF in a patient with very advanced reproductive age, particularly with an undetectable AMH level using autologous oocytes, remains extremely poor. This case should be interpreted with caution so as to not provide false hope to women aged 45 and above.
Collapse
Affiliation(s)
- Mark P Trolice
- Fertility Center of Assisted Reproduction and Endocrinology, Winter Park, Florida.
| |
Collapse
|
9
|
Polyzos NP, Camus M, Llacer J, Pantos K, Tournaye H. Corifollitropin α followed by menotropin for poor ovarian responders' trial (COMPORT): a protocol of a multicentre randomised trial. BMJ Open 2013; 3:bmjopen-2013-002938. [PMID: 23794545 PMCID: PMC3669711 DOI: 10.1136/bmjopen-2013-002938] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Poor response to ovarian stimulation affects a significant proportion of infertile couples undergoing in vitro fertilisation (IVF) treatment. Recently, the European Society of Human Reproduction and Embryology developed new criteria to define poor ovarian response, the so-called Bologna criteria. Although preliminary studies in these patients demonstrated very low pregnancy rates, a recent pilot study has shown promising results in women <40 years old fulfilling the criteria, after treatment with corifollitropin α followed by highly purified menotropin (hpHMG) in a gonadotropin-releasing hormone (GnRH) antagonist setting. Corifollitropin α followed by menotropin for poor ovarian responders' trial (COMPORT) is a randomised trial aiming to investigate whether this novel protocol is superior to treatment with recombinant follicle-stimulating hormone (FSH) in an antagonist setting for young poor responders. METHODS/DESIGN COMPORT is a multicentre, open label, phase III randomised trial using a parallel two-arm design. 150 patients <40 years old fulfilling the 'Bologna criteria' will be randomised to corifollitropin α followed by hpHMG (group A) or recombinant FSH (group B) in a GnRH antagonist protocol for IVF/intracytoplasmic sperm injection (ICSI). The primary outcome is the ongoing pregnancy rate (defined as the presence of intrauterine gestational sac with an embryonic pole demonstrating cardiac activity at 9-10 weeks of gestation). Secondary outcomes are clinical and biochemical pregnancy rates and number of oocytes retrieved. Central randomisation will be performed using a computer-generated list and allocation concealment will be secured with the use of sealed-opaque envelopes. A sample size of 150 women is essential to detect a difference of 19.5% in ongoing pregnancy rates between group A (28%) and group B (8.5%) with a power of 85% and a level of significance at 0.05 using a two-sided Fisher's exact test.
Collapse
Affiliation(s)
- Nikolaos P Polyzos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Michel Camus
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
10
|
Copperman AB, Benadiva C. Optimal usage of the GnRH antagonists: a review of the literature. Reprod Biol Endocrinol 2013; 11:20. [PMID: 23496864 PMCID: PMC3618003 DOI: 10.1186/1477-7827-11-20] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/27/2013] [Indexed: 11/25/2022] Open
Abstract
Gonadotropin-releasing hormone (GnRH) antagonists, which became commercially available from 1999, have been used for the prevention of premature luteinizing hormone (LH) surges in controlled ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection. This review focuses on the recent literature on the use of GnRH antagonists and provides guidelines for optimal use in light of increasing evidence showing that GnRH antagonists are safe and effective, allowing flexibility of treatment in a wide range of patient populations. This includes patients undergoing first-line controlled ovarian stimulation, poor responders, and women diagnosed with polycystic ovary syndrome. The GnRH antagonist offers a viable alternative to the long agonists, providing a shorter duration of treatment with fewer injections and with no adverse effects on assisted reproductive technology outcome. This results in a significantly lower amount of gonadotropins required, which is likely to lead to improved patient compliance.
Collapse
Affiliation(s)
- Alan B Copperman
- Mount Sinai Medical Center, New York, NY, USA
- Reproductive Medicine Associates of New York, New York, NY, USA
| | - Claudio Benadiva
- The Center for Advanced Reproductive Services, Department of Ob/Gyn, University of Connecticut, Farmington, CT, USA
| |
Collapse
|
11
|
Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BWJ, Broekmans FJ, Broer S, van Disseldorp J, Broeze K, Dolleman M, Opmeer B, Anderson R, Ashrafi M, Bancsi L, Caroppo LE, Copperman A, Ebner T, Eldar Geva M, Erdem M, Greenblatt E, Jayaprakasan K, Fenning R, Klinkert E, Kwee J, Lambalk C, La Marca A, McIlveen M, Merce L, Muttukrishna S, Nelson S, Ng H, Popovic-Todorovic B, Smeenk J, Tomás C, Van der Linden P, van Rooij I, Vladimirov I, Bossuyt P, Eijkemans M, Mol B, Frank B. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update 2013. [DOI: 10.1093/humupd/dms041] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simone L. Broer
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Jeroen van Disseldorp
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Kimiko A. Broeze
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Madeleine Dolleman
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Brent C. Opmeer
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Patrick Bossuyt
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Marinus J.C. Eijkemans
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Ben-Willem J. Mol
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Frank J.M. Broekmans
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Chatillon-Boissier K, Genod A, Denis-Belicard E, Felloni B, Chene G, Seffert P, Chauleur C. [Prospective randomised study of long versus short agonist protocol with poor responder patients during in vitro fertilization]. ACTA ACUST UNITED AC 2012; 40:652-7. [PMID: 22342506 DOI: 10.1016/j.gyobfe.2011.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 12/21/2010] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Different ovarian stimulation protocols are used for in vitro fertilization (IVF) in "poor responder" patients. Our work aims at comparing two ovarian stimulation protocols (long agonist half-dose protocol versus short agonist protocol without pretreatment) in this population of women. PATIENTS AND METHODS This prospective, randomized study was realized at the University Hospital of Saint-Étienne and concerns "poor responder" patients (age between 38 and 42 years and FSH at day 3 more than 9.5 IU/L; and/or antral follicles count less or equal to 6; and/or failure of previous stimulation). The primary endpoint is based on the number of oocytes retrieved at the end of an IVF cycle. RESULTS Out of the 44 patients randomized, 39 cycles were taken into account (20 in the long protocol, 19 in the short one). At the end of the stimulation (FSH-r 300 to 450 UI/d), the number of follicles recruited appears higher in the long protocol but the difference is not significant (diameter between 14 and 18 mm: 3.0±2.31 vs. 1.88±1.89 and diameter greater than 18 mm: 3.9±2 85 vs. 3.06±2.77). The same tendency is observed for all the following criteria: the number of retrieved oocytes (6.74±2.73 vs. 6.38±4.26), the total number of embryos (3.16±2.03 vs. 2.25±2.11), the pregnancy rate per retrieval (21% vs. 19%) and per cycle (20% vs. 16%), and the number of children born alive. DISCUSSION AND CONCLUSION The study did not reveal any difference between the two protocols but the long half-dose seems to be better.
Collapse
Affiliation(s)
- K Chatillon-Boissier
- Service de gynécologie-obstétrique, université Jean-Monnet, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | | | | | | | | | | | | |
Collapse
|
13
|
Sunkara SK, Coomarasamy A, Arlt W, Bhattacharya S. Should androgen supplementation be used for poor ovarian response in IVF? Hum Reprod 2012; 27:637-40. [PMID: 22252080 DOI: 10.1093/humrep/der464] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Poor ovarian response is reported in 9-24% of IVF cycles. Several interventions have been proposed to improve the outcome, although evidence to support these has been scant. There has been interest in the use of adjuvant androgens in this context and a recent worldwide survey showed that nearly a quarter of IVF clinicians used dehydroepiandrosterone (DHEA) in poor responders. We examine the rationale for the use of adjuvant androgens and suggest that the current clinical uncertainty should be addressed by a randomized controlled trial of DHEA in poor responders.
Collapse
Affiliation(s)
- Sesh Kamal Sunkara
- Assisted Conception Unit, Guy's and St Thomas' Foundation Trust, King's College London, 11th Floor, Tower Wing, St Thomas' Street, London SE1 9RT, UK.
| | | | | | | |
Collapse
|
14
|
Sunkara SK, Pundir J, Khalaf Y. Effect of androgen supplementation or modulation on ovarian stimulation outcome in poor responders: a meta-analysis. Reprod Biomed Online 2011; 22:545-55. [PMID: 21493151 DOI: 10.1016/j.rbmo.2011.01.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/24/2011] [Accepted: 01/26/2011] [Indexed: 11/15/2022]
Abstract
Many trials have evaluated the use of androgen supplements and androgen-modulating agents to improve outcome of poor responders undergoing IVF treatment. This study conducted a systematic review and meta-analysis of controlled trials of androgen adjuvants (testosterone, dehydroepiandrostereone) and the androgen-modulating agent (letrozole) in poor responders undergoing IVF treatment. Searches were conducted on MEDLINE, EMBASE, Cochrane Library, ISRCTN Register and ISI proceedings. All randomized and non-randomized controlled trials were included. Study selection, quality appraisal and data extraction were performed independently and in duplicate. The main outcome measure was clinical pregnancy rate. The secondary outcome measures were dose and duration of gonadotrophin use, cycles cancelled before oocyte retrieval, oocytes retrieved and ongoing pregnancy rates. A total of 2481 cycles in women considered as poor responders undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment were included in nine controlled trials. Meta-analyses of these studies did not show any significant difference in the number of oocytes retrieved and ongoing pregnancy/live-birth rates with androgen supplementation or modulation compared with the control groups. There is currently insufficient evidence from the few randomized controlled trials to support the use of androgen supplementation or modulation to improve live birth outcome in poor responders undergoing IVF/ICSI treatment.
Collapse
Affiliation(s)
- Sesh Kamal Sunkara
- Assisted Conception Unit, Guy's Hospital, St. Thomas Street, London, UK.
| | | | | |
Collapse
|
15
|
Gonadotropin-releasing hormone agonists versus antagonists for controlled ovarian hyperstimulation in oocyte donors: a systematic review and meta-analysis. Fertil Steril 2011; 95:164-9. [DOI: 10.1016/j.fertnstert.2010.06.068] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/24/2010] [Accepted: 06/21/2010] [Indexed: 11/23/2022]
|
16
|
Datta AK, Vitthala S, Tozer A, Zosmer A, Sabatini L, Davis C, Al-Shawaf T. Controlled ovarian hyperstimulation for low responders in in vitro fertilization/intracytoplasmic sperm injection: a low-dose flare protocol. Fertil Steril 2010; 95:1809-12. [PMID: 21168131 DOI: 10.1016/j.fertnstert.2010.11.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 10/25/2010] [Accepted: 11/17/2010] [Indexed: 11/16/2022]
Abstract
In this retrospective study of 652 anticipated low response women, the overall clinical outcomes (live birth rate and clinical pregnancy rate [PR]) of low-dose flare (LDF) protocol appeared lower than those of conventional down-regulation (DR) (LDF: 15.1% vs. DR: 20.6% and LDF: 10.3% vs. DR: 17.4%, respectively). The findings that LDF protocol improved the clinical outcome in older women, or when LDF followed an unsuccessful IVF/intracytoplasmic sperm injection (ICSI) cycle with DR (LDF: 19.4% vs. DR: 9.76% and LDF: 13.9% vs. DR: 4.2% respectively), need further evaluation through randomized trials.
Collapse
Affiliation(s)
- Adrija Kumar Datta
- Centre for Reproductive Medicine, St Bartholomew's Hospital, London, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
17
|
Cavagna M, Maldonado LGL, de Souza Bonetti TC, de Almeida Ferreira Braga DP, Iaconelli Jr. A, Borges Jr. E. Supplementation with a recombinant human chorionic gonadotropin microdose leads to similar outcomes in ovarian stimulation with recombinant follicle-stimulating hormone using either a gonadotropin-releasing hormone agonist or antagonist for pituitary suppression. Fertil Steril 2010; 94:167-72. [DOI: 10.1016/j.fertnstert.2009.02.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 02/16/2009] [Accepted: 02/25/2009] [Indexed: 10/21/2022]
|
18
|
Are gonadotropin-releasing hormone agonists losing popularity? Current trends at a large fertility center. Fertil Steril 2010; 93:101-8. [DOI: 10.1016/j.fertnstert.2008.09.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 09/09/2008] [Accepted: 09/11/2008] [Indexed: 11/23/2022]
|
19
|
Gonadotropin-releasing hormone antagonist use is associated with increased pregnancy rates in ovulation induction-intrauterine insemination to in vitro fertilization conversions, independent of age and estradiol level on the day of human chorionic gonadotropin administration. Fertil Steril 2009; 93:605-8. [PMID: 19324340 DOI: 10.1016/j.fertnstert.2009.01.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 01/17/2009] [Accepted: 01/19/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether the use of GnRH antagonist in cycles converted from ovulation induction-IUI to IVF affects cycle outcome and pregnancy rates. DESIGN Retrospective cohort study. SETTING Academic research institution. PATIENT(S) One hundred eighty-two consecutive patients with ovulation induction-IUI to IVF conversions undergoing oocyte retrieval conducted at our institution from 2004 to 2006. INTERVENTION(S) The relation between observation of fetal heartbeat and GnRH antagonist exposure was evaluated with use of multivariable logistic regression. The difference in intermediate cycle outcomes by antagonist exposure was estimated with use of linear regression. MAIN OUTCOME MEASURE(S) Fetal cardiac activity on early ultrasound, intermediate cycle parameters. RESULT(S) For patients given treatment with a GnRH antagonist, the odds ratio for achieving pregnancy was 2.13 (95% confidence interval = 1.03-4.39) compared with untreated patients, independent of age and E(2) levels on day of hCG. Patients given antagonist had 1.6 more follicles and 2.1 more oocytes retrieved, 1.9 more mature oocytes, and 2.3 more fertilized oocytes, and the fertilization rate was 9.7% higher. CONCLUSION(S) Gonadotropin-releasing hormone antagonist use in ovulation induction-IUI to IVF conversions was associated with increased pregnancy rates and improved intermediate cycle parameters, controlled for age and E(2) levels on day of hCG. Addition of a GnRH antagonist should be considered in ovulation induction-IUI to IVF conversions.
Collapse
|
20
|
Ata B, Yakin K, Balaban B, Urman B. Embryo implantation rates in natural and stimulated assisted reproduction treatment cycles in poor responders. Reprod Biomed Online 2008; 17:207-12. [PMID: 18681994 DOI: 10.1016/s1472-6483(10)60196-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Controlled ovarian stimulation with exogenous gonadotrophins and gonadotrophin-releasing hormone (GnRH) analogues enables the collection of multiple oocytes and subsequent development of multiple embryos. However, interfering with the natural hormonal milieu may decrease the probability of successful embryo implantation due to effects on oocytes and/or endometrium. In order to provide a fair comparison of embryo implantation rates between natural cycles and stimulated cycles, bias caused by the presence of multiple embryos available for transfer in stimulated cycles should be avoided. This retrospective study analysed embryo implantation rates in cycles in which only a single embryo was available for transfer in 304 women who had poorly responded to ovarian stimulation in the previous cycle. Embryo implantation rates with different stimulation protocols were as follows: natural cycle, 20% (6/30); gonadotrophin only, 5.6% (3/54); long GnRH protocol, 3.8% (2/52); co-flare protocol, 1.9% (1/52); microdose flare-up, 15.4% (4/26); GnRH antagonists, 14.4% (13/90). Although the difference was not statistically significant there was a trend towards higher implantation rates with natural cycles in this group of women. Natural cycle IVF may be a reasonable and patient-friendly treatment choice yielding an acceptable outcome for women who are known or anticipated poor responders to ovarian stimulation.
Collapse
Affiliation(s)
- Baris Ata
- Assisted Reproduction Unit, American Hospital of Istanbul, Turkey.
| | | | | | | |
Collapse
|
21
|
|
22
|
Randomized controlled pilot trial of luteal phase recombinant FSH stimulation in poor responders. Reprod Biomed Online 2008; 17:745-50. [DOI: 10.1016/s1472-6483(10)60400-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|