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Ban M, Sun Y, Chen X, Zhou X, Zhang Y, Cui L. Association between maternal polycystic ovarian syndrome undergoing assisted reproductive technology and pregnancy complications and neonatal outcomes: a systematic review and meta-analysis. J Ovarian Res 2024; 17:6. [PMID: 38184624 PMCID: PMC10770902 DOI: 10.1186/s13048-023-01331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is recognized as the most prevalent endocrine disorder among women of reproductive age. While the utilization of assisted reproductive technology (ART) has resulted in favorable outcomes for infertility treatment in PCOS patients, the inherent pathophysiological features of the condition give rise to complications and consequences during pregnancy and delivery for both the mother and offspring. This study was to assess the correlation between maternal PCOS and various pregnancy complications and neonatal outcomes undergone ART. METHODS A systematic search was conducted on PubMed, EmBase, and the Cochrane Library to identify observational studies that investigated the association between PCOS and the risk of various pregnancy complications and neonatal outcomes, including gestational diabetes mellitus (GDM), hypertension in pregnancy (PIH), preeclampsia (PE), preterm birth, abortion, congenital malformations (CA), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia, neonatal intensive care unit (NICU) admission and birth weight. Eligible studies were selected based on predetermined inclusion and exclusion criteria. The meta-analysis was conducted using Review Manager and Stata software, with odds ratios (ORs) or mean difference (MD), confidence intervals (CIs), and heterogeneity (I2) being calculated. The search was conducted up to March 2023. RESULTS A total of 33 studies with a combined sample size of 92,810 participants were identified. The findings indicate that PCOS is significantly associated with an increased risk of GDM (OR 1.51, 95% CI:1.17-1.94), PIH (OR 1.72, 95% CI:1.25-2.39), PE (OR 2.12, 95% CI:1.49-3.02), preterm birth (OR 1.29, 95% CI:1.21-1.39), and LBW (OR 1.29, 95% CI:1.14-1.47). In subgroup analyses, the risks of GDM (OR 1.80, 95% CI:1.23-2.62) and abortion (OR 1.41, 95% CI:1.08-1.84) were elevated in fresh embryo transferred (ET) subgroup, whereas elevated risk of PE (OR 1.82, 95% CI:1.17-2.83) and preterm birth (OR 1.31, 95% CI:1.21-1.42) was identified in frozen ET subgroup. Whatever with or without hyperandrogenism, patients with PCOS had a higher risk in preterm birth (OR 1.69, 95% CI: 1.31-2.18; OR 1.24, 95% CI:1.02-1.50) and abortion (OR 1.38, 95% CI:1.12-1.71; OR 1.23, 95% CI:1.06-1.43). CONCLUSION Our findings suggest that individuals with PCOS undergone ART are at a notably elevated risk for experiencing pregnancy complications and unfavorable neonatal outcomes. Nevertheless, to establish a definitive association between PCOS and pregnancy-related outcomes, it is necessary to conduct extensive prospective, blinded cohort studies and effectively control for confounding variables.
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Affiliation(s)
- Miaomiao Ban
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, No.2021RU001), Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Yifei Sun
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, No.2021RU001), Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Xiaojing Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, No.2021RU001), Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Xiaoqian Zhou
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, No.2021RU001), Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Yiyuan Zhang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, No.2021RU001), Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Linlin Cui
- Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, No.2021RU001), Jinan, 250012, Shandong, China.
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250012, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
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Xia Q, Wang W, Liu Z, Xiao J, Qiao C, Zhao Y, Li B, Liu Y, Peng Y, Yang X, Shi J, Gao X, Wang D. New insights into mechanisms of berberine in alleviating reproductive disorders of polycystic ovary syndrome: Anti-inflammatory properties. Eur J Pharmacol 2023; 939:175433. [PMID: 36535493 DOI: 10.1016/j.ejphar.2022.175433] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a complex reproductive disorder that seriously harms female reproductive health and decreases quality of life. Although spontaneous or assisted ovulation occurs, women with PCOS suffer from poor-quality oocytes and embryos and lower fertilization and final pregnancy rates. Therefore, it is urgent to identify new pathological mechanisms and discover the underlying therapeutic targets for reproductive disorders associated with PCOS. Berberine, one of the famous traditional Chinese medicines, has been shown to improve ovulation and live birth rates in women with PCOS. The effects of berberine on insulin resistance and abnormal glucose and lipid metabolism for restoring the reproductive health of women with PCOS are well recognized and have been widely studied, but much less attention has been given to its anti-inflammatory properties. Chronic low-grade inflammation is the unifying feature of PCOS and may contribute to reproductive disorders in PCOS. Berberine can modulate the inflammatory state of the ovaries and uterus in PCOS. The anti-inflammatory properties of berberine may provide new insight into the mechanisms by which berberine alleviates reproductive disorders associated with PCOS. Here, we summarized the most recent insights into the anti-inflammatory properties of berberine in PCOS reproductive disorders to inspire researchers to pursue new study directions involving berberine.
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Affiliation(s)
- Qing Xia
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Wenjing Wang
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Zijie Liu
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Jiaying Xiao
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Cong Qiao
- Department of Pathology, Harbin Medical University, Harbin, China
| | - Yu Zhao
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Bowen Li
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Yuanli Liu
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China; Basic Medical Institute, Heilongjiang Medical Science Academy, Harbin, China; Translational Medicine Center of Northern China, Harbin, China; Key Laboratory of Heilongjiang Province for Genetically Modified Animals, Harbin Medical University, Harbin, China
| | - Yahui Peng
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China; Basic Medical Institute, Heilongjiang Medical Science Academy, Harbin, China; Translational Medicine Center of Northern China, Harbin, China; Key Laboratory of Heilongjiang Province for Genetically Modified Animals, Harbin Medical University, Harbin, China
| | - Xinyu Yang
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Jiabin Shi
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
| | - Xu Gao
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China; Basic Medical Institute, Heilongjiang Medical Science Academy, Harbin, China; Translational Medicine Center of Northern China, Harbin, China; Key Laboratory of Heilongjiang Province for Genetically Modified Animals, Harbin Medical University, Harbin, China.
| | - Dayong Wang
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China; Basic Medical Institute, Heilongjiang Medical Science Academy, Harbin, China; Translational Medicine Center of Northern China, Harbin, China; Key Laboratory of Heilongjiang Province for Genetically Modified Animals, Harbin Medical University, Harbin, China.
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Bahadur G, Homburg R, Jayaprakasan K, Raperport CJ, Huirne JAF, Acharya S, Racich P, Ahmed A, Gudi A, Govind A, Jauniaux E. Correlation of IVF outcomes and number of oocytes retrieved: a UK retrospective longitudinal observational study of 172 341 non-donor cycles. BMJ Open 2023; 13:e064711. [PMID: 36592998 PMCID: PMC9809223 DOI: 10.1136/bmjopen-2022-064711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE How do numbers of oocytes retrieved per In vitro fertilisation (IVF) cycle impact on the live birth rate (LBR) and multiple gestation pregnancy (MGP) rates? DESIGN Retrospective observational longitudinal study. SETTING UK IVF clinics. POPULATION Non-donor IVF patients. MAIN OUTCOME MEASURES LBR per IVF cycle and MGP levels against number of oocytes retrieved into subgroups: 0, 1-5, 6-15, 16-25, 26-49 oocytes and 50+ oocytes. Relative risk (RR) and 95% CIs were calculated for each group against the intermediate responder with '6-15 oocytes collected'. RESULTS From 172 341 attempted fresh oocyte retrieval cycles, the oocyte retrieved was: 0 in 10 148 (5.9%) cycles from 9439 patients; 1-5 oocytes in 42 574 cycles (24.7%); 6-15 oocytes in 91 797 cycles (53.3%); 16-25 oocytes in 23 794 cycles (13.8%); 26-49 oocytes in 3970 cycles (2.3%); ≥50 oocytes in 58 cycles (0.033%). The LBRs for the 1-5, 6-15, 16-25 and 26-49 subgroups of oocytes retrieved were 17.2%, 32.4%, 35.3% and 18.7%, respectively. The RR (95% CI) of live birth in comparison to the intermediate group (6-15) for 1-5, 16-25 and 26-49 groups was 0.53 (0.52 to 0.54), 1.09 (1.07 to 1.11) and 0.58 (0.54 to 0.62), respectively. The corresponding MGP rates and RR were 9.2%, 11.0%, 11.4% and 11.3%, respectively and 0.83 (0.77 to 0.90), 1.04 (0.97 to 1.11) and 1.03 (0.84 to 1.26), respectively. CONCLUSION There was only limited benefit in LBR beyond the 6-15 oocyte group going to the 16-25 oocytes group, after which there was significant decline in LBR. The MGP risk was lower in 1-5 group.
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Affiliation(s)
- Gulam Bahadur
- Reproductive Medicine Unit, North Middlesex University Hospital, London N18 1QX, London, UK
- Homerton Fertility Unit, Homerton University Hospital, London E9 6SR, London, UK
| | - Roy Homburg
- Homerton Fertility Unit, Homerton University Hospital, London E9 6SR, London, UK
| | - Kanna Jayaprakasan
- University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | | | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, University medical centers Amsterdam- location VUmc and AMC-,Research institute Reproduction and development-, Amsterdam, The Netherlands
| | - Santanu Acharya
- University Hospital Crosshouse, Ayrshire Fertility Unit, Kilmarnock- KA2 0BE, Scotland, UK
| | - Paul Racich
- Linacre College, Oxford University, Oxford OX13JA, England, UK
| | - Ali Ahmed
- Reproductive Medicine Unit, North Middlesex University Hospital, London N18 1QX, London, UK
- The Brooklyn Hospital Center/The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201, USA
| | - Anil Gudi
- Homerton Fertility Unit, Homerton University Hospital, London E9 6SR, London, UK
| | - Abha Govind
- Reproductive Medicine Unit, North Middlesex University Hospital, London N18 1QX, London, UK
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population HealthScience, University College London, London, WC1E 6HX, London, UK
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Liu A, Li J, Shen H, Zhang L, Li Q, Zhang X. Progestin-primed ovarian stimulation protocol with or without clomiphene citrate for poor ovarian responders: a retrospective cohort study. BMC Womens Health 2022; 22:527. [PMID: 36528555 PMCID: PMC9759868 DOI: 10.1186/s12905-022-02126-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To explore the efficacy of progestin-primed ovarian stimulation (PPOS) combined with clomiphene citrate (CC) versus PPOS protocol used alone on cycle characteristics and pregnancy outcomes for women with the poor ovarian response (POR). METHODS We performed a retrospective cohort study and a total of 578 POR patients who underwent IVF/ICSI cycles were collected and divided into Group A (HMG 300 IU/d + MPA 10 mg/d) and Group B (HMG 300 IU/d + MPA 10 mg/d + CC 50 mg/d). The primary outcome measure was the number of oocytes retrieved, other outcome measures were cycle characteristics and clinical pregnancy rate. RESULTS The baseline information between the two groups were not statistically significant (P > 0.05). Compared with Group A, Group B had a lower total dose of human menopausal gonadotrophin (HMG) (2998.63 ± 1051.09 vs. 3399.18 ± 820.75, P < 0.001) and the duration of stimulation (10.21 ± 3.56 vs. 11.27 ± 2.56, P < 0.001). Serum luteinizing hormone level was higher in Group B on human chorionic gonadotrophin injection day (P < 0.001). The number of oocyte for retrieval, maturation, and fertilization were significantly lower in Group B than that in Group A (P < 0.001). However, the oocyte retrieval rate, maturation rate, fertilization rate, and viable embryo rate showed no statistical difference in the two groups (P > 0.05). After adjusting for confounders, the clinical pregnancy rate (OR 1.286; 95% CI 0.671-2.470) and live birth rate (OR 1.390; 95% CI 0.478-3.990) were comparable between the two groups. CONCLUSIONS PPOS protocol combined with CC reduces the total dose of HMG and the duration of stimulation, and can also achieve similar oocyte yields and clinical pregnancy rate compared with the PPOS protocol used alone in poor ovarian responders.
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Affiliation(s)
- Ahui Liu
- grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, Gansu China
| | - Jie Li
- grid.415954.80000 0004 1771 3349The China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City, 130033 Jilin Province China
| | - Haofei Shen
- grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, Gansu China
| | - Lili Zhang
- grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, Gansu China
| | - Qiuyuan Li
- grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, Gansu China
| | - Xuehong Zhang
- grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, Gansu China ,Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, No. 1, Donggangxi Rd, Chengguan District, Lanzhou City, 730000 Gansu Province China
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Bellemare V, Rotshenker-Olshinka K, Nicholls L, Digby A, Pooni A, Kadour-Peero E, Son WY, Dahan MH. Among high responders, is oocyte development potential different in Rotterdam consensus PCOS vs non-PCOS patients undergoing IVF? J Assist Reprod Genet 2022; 39:2311-2316. [PMID: 36029372 PMCID: PMC9596635 DOI: 10.1007/s10815-022-02598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE To evaluate the oocyte potential to develop to blastocyst in Rotterdam consensus PCOS in women with hyper-responses requiring freeze-all embryos. METHODS Retrospective, single-academic center, cohort study of 205 patients who underwent freeze-all antagonist IVF cycles for OHSS risk between 2013 and 2019. Women in the PCOS group (n = 88) were diagnosed per the 2003 Rotterdam criteria. Control patients (n = 122) had no evidence of hyperandrogenism or menstrual disturbance. Data was compared by t-tests, chi-squared tests, or multivariate logistic regression (SPSS). Frozen blastocysts were Gardner's grade BB or better. RESULTS There was no difference in terms of number of oocytes collected (PCOS vs non-PCOS 27.7 ± 9.4 vs 25.9 ± 8.2, p = 0.157), number of MII (20.7 ± 8.0 vs 19.1 ± 6.6, p = 0.130), number of 2PN fertilized (15.6 ± 7.4 vs 14.4 ± 5.9, p = 0.220), and number of frozen blastocysts (7.8 ± 4.9 vs 7.1 ± 3.8, p = 0.272). In addition, fertilization rates (74 ± 17% vs 75 ± 17%, p = 0.730), blastulation rates per 2PN (51 ± 25% vs 51 ± 25%, p = 0.869), and blastulation rates per mature oocytes (37 ± 18% vs 37 ± 15%, p = 0.984) were all comparable between PCOS and controls, respectively. Moreover, there was no difference when comparing PCOS and controls in pregnancy rates (45/81 vs 77/122, p = 0.28) and clinical pregnancy rates (34/81 vs 54/122, p = 0.75), respectively. Multivariate logistic regression controlling for confounders failed to alter these results. CONCLUSION PCOS subjects do not seem to have altered oocyte potential as measured by number of MII oocytes collected, fertilization, and blastulation rates when compared to high-responder controls, with similar magnitude of stimulation.
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Affiliation(s)
| | | | - Laura Nicholls
- Fertility Clinic, McGill University Health Center, Montreal, QC, Canada
| | - Alyson Digby
- Fertility Clinic, McGill University Health Center, Montreal, QC, Canada
| | - Amrita Pooni
- Fertility Clinic, McGill University Health Center, Montreal, QC, Canada
| | | | - Weon-Young Son
- Fertility Clinic, McGill University Health Center, Montreal, QC, Canada
| | - Michael H Dahan
- Fertility Clinic, McGill University Health Center, Montreal, QC, Canada
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6
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Jannatifar R, Piroozmanesh H, Sahraei SS, Asa E. Combination of alpha lipoic acid and metformin supplement improve assisted reproductive technologies outcomes in polycystic ovary syndrome patients. Anat Cell Biol 2022; 55:239-246. [PMID: 35501295 PMCID: PMC9256491 DOI: 10.5115/acb.21.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022] Open
Abstract
We aimed to investigating the effects of metformin (MET) in combination with alpha lipoic acid (ALA) on hormonal and biochemical parameters, in polycystic ovary syndrome (PCOS) women undergoing intracytoplasmic sperm injection (ICSI). This experimental pilot study with a randomized design was carried out on 40 PCOS women in two groups: (1) MET group, administered 1,500 mg/day MET, and (2) MET (1,500 mg/day)+ALA (1,800 mg/day) group. Drugs were administered from the third day of the previous cycle until the day of oocyte aspiration (six weeks of treatment in total). MET+ALA significantly increased the number of maturated oocytes and the rate of fertilization when compared to the MET group. Combination MET+ALA could increase significantly the number of oocytes retrieval and the number of good-quality embryos. Also, the malondialdehyde (MDA) level decreased significantly in the MET+ALA group and the total antioxidant capacity (TAC) level increased significantly in the MET+ALA group compared to the MET group. Also, fasting blood sugar (FBS), insulin, luteinizing hormone (LH), and LH/follicle stimulating hormone (FSH) levels were significantly lower in the MET+ALA group. The pregnancy outcomes showed no significant difference in the rates of biochemical pregnancy, clinical pregnancy, miscarriage, and live births between the control and study groups. The combination of MET+ALA treatment could moderate the complications of PCOS and subsequently improve oocyte and embryo quality.
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Affiliation(s)
- Rahil Jannatifar
- Department of Reproductive Biology, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran.,Infertility Treatment Center, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran
| | - Hamid Piroozmanesh
- Department of Reproductive Biology, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran.,Infertility Treatment Center, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran
| | - Seyedeh Saeideh Sahraei
- Department of Reproductive Biology, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran.,Infertility Treatment Center, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran
| | - Elham Asa
- Department of Reproductive Biology, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran.,Infertility Treatment Center, Academic Center for Education, Culture, and Research (ACECR), Qom Branch, Qom, Iran
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7
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Amini P, Ramezanali F, Parchehbaf-Kashani M, Maroufizadeh S, Omani-Samani R, Ghaheri A. Factors Associated with In Vitro Fertilization Live Birth Outcome: A Comparison of Different Classification Methods. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2021; 15:128-134. [PMID: 33687166 PMCID: PMC8052806 DOI: 10.22074/ijfs.2020.134582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/04/2020] [Indexed: 11/04/2022]
Abstract
Background In vitro fertilization (IVF) is a useful assisted reproductive technology to achieve pregnancy in infertile couples. However, it is very important to optimize the success rate after IVF by controlling for its influencing factors. This study aims to classify successful deliveries after IVF according to couples' characteristics and available data on oocytes, sperm, and embryos using several classification methods. Materials and Methods This historical cohort study was conducted in a referral infertility centre located in Tehran, Iran. The patients' demographic and clinical variables for 6071 cycles during March 21, 2011 to March 20, 2014 were collected. We used six different machine learning approaches including support vector machine (SVM), extreme gradient boosting (XGBoost), logistic regression (LR), random forest (RF), naïve Bayes (NB), and linear discriminant analysis (LDA) to predict successful delivery. The results of the performed methods were compared using accuracy tools. Results The rate of successful delivery was 81.2% among 4930 cycles. The total accuracy of the results exposed RF had the best performance among the six approaches (ACC=0.81). Regarding the importance of variables, total number of embryos, number of injected oocytes, cause of infertility, female age, and polycystic ovary syndrome (PCOS) were the most important factors predicting successful delivery. Conclusion A successful delivery following IVF in infertile individuals is considerably affected by the number of embryos, number of injected oocytes, cause of infertility, female age, and PCOS.
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Affiliation(s)
- Payam Amini
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fariba Ramezanali
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Omani-Samani
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Azadeh Ghaheri
- Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
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8
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Daneshjou D, Zadeh Modarres S, Soleimani Mehranjani M, Shariat Zadeh SMA. Comparing the effect of sitagliptin and metformin on the oocyte and embryo quality in classic PCOS patients undergoing ICSI. Ir J Med Sci 2020; 190:685-692. [PMID: 32720198 DOI: 10.1007/s11845-020-02320-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Insulin resistance plays a major role in the pathogenesis of polycystic ovary syndrome (PCOS). Therefore, there is a growing interest in the use of insulin sensitizer drugs in the treatment of PCOS. Research in recent years has shown that sitagliptin has been reported to improve ovarian cycles and ovulation in PCOS patients. AIMS We aimed to compare the effects of metformin and sitagliptin on PCOS individuals undergoing ICSI. METHODS Sixty PCOS patients were divided into 3 groups: metformin, sitagliptin, and placebo group. Treatment was carried out 2 months before the start of the ovulation cycle and continued until the day of oocyte aspiration. The serum levels of total testosterone, estradiol, and fasting insulin along with the total number of retrieved, normal and abnormal MII, and fertilized oocytes, the number of transferred embryos (grades I, II and III), and biochemical and clinical pregnancy rates as well as the ovarian hyperstimulation syndrome (OHSS) were evaluated. RESULTS There was a significant reduction in the serum levels of Insulin and total testosterone in the treated groups compared with the placebo. The number of mature and normal MII oocytes increased significantly in the treated groups compared with the placebo. Moreover, the number of immature oocytes decreased significantly and the number of grade I embryos increases significantly in the sitagliptin group compared with the placebo group. CONCLUSION We conclude that sitagliptin can improve the maturation of oocytes and embryos' quality more effectively than metformin, in PCOS patients undergoing ICSI. TRIAL REGISTRATION Trial registration is NCT04268563 ( https://clinicaltrials.gov ).
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Affiliation(s)
- Delbar Daneshjou
- Department of Biologyt, Faculty of Science, Arak University, Arak, Iran
| | - Shahrzad Zadeh Modarres
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chehin MB, Fraietta R, Lorenzon AR, Bonetti TCS, Motta ELA. The insulin signaling pathway is dysregulated in cumulus cells from obese, infertile women with polycystic ovarian syndrome with an absence of clinical insulin resistance. Ther Adv Reprod Health 2020; 14:2633494120906866. [PMID: 32596667 PMCID: PMC7303777 DOI: 10.1177/2633494120906866] [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: 05/03/2019] [Accepted: 01/20/2020] [Indexed: 01/12/2023] Open
Abstract
Methods: This is a cohort study, conducted at a university-based reproductive medicine
center and private reproductive medicine center that aimed to evaluate
granulosa cumulus cell gene expression in the insulin signaling pathway in
Polycystic Ovary Syndrome (PCOS) patients undergoing in vitro fertilization
(IVF) treatment and to compare the cumulus gene expression between normal
weight and obese women without clinical insulin resistance. Fifteen PCOS
patients, nine normal weight patients and six obese patients presenting
normal HOMA IR (Homeostasis Model Assessment–Insulin Resistance),
participated. Patients underwent oocyte retrieval for IVF and after the
procedure, granulosa cumulus cells were removed from the oocytes for RNA
extraction. Quantitative polymerase chain reaction (PCR) array analysis of
84 genes from insulin signaling pathway was conducted. The results were
expressed as fold up- or fold down-expression in obese patients compared
with normal weight patients. Any fold change ⩾3 or ⩽3 and any
p ⩽ 0.05 were considered statistically significant. Results: There were 10 genes that were overexpressed in obese compared with normal
weight women, BCL2L1, BRAF, CBL, DOK1, FBP1, FRS2, MTOR, PCK2, RPS6KA1, and
SORBS1, that had a fold change ⩾3 and p ⩽ 0.05. Discussion: In the obese group, the overexpressed genes are mainly responsible for the
proliferation and differentiation of cumulus cells during oocyte maturation,
insulin resistance, apoptosis regulation, and glucose metabolism during
early embryogenesis, suggesting that in the follicular environment, insulin
resistance is present even in the absence of clinical signs. Conclusion: Together, our findings and the related literature suggest that those
alterations may be associated with the worse prognosis of follicular
development and oocyte maturation observed in PCOS obese women.
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Affiliation(s)
- Mauricio B Chehin
- Huntington Medicina Reprodutiva, Medical Coordinator Vila Mariana, Rua Sena Madureira, 100, São Paulo, SP 04021-000, Brazil
| | - Renato Fraietta
- Human Reproduction Section, Surgery Discipline, Urology Department Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, Brazil
| | | | - Tatiana C S Bonetti
- Gynecology Endocrinology Discipline, Gynecology Department, Escola Paulista de Medicina da Universidade Federal de Sao Paulo (UNIFESP-EPM), São Paulo, Brazil
| | - Eduardo L A Motta
- Gynecology Endocrinology Discipline, Gynecology Department, Escola Paulista de Medicina da Universidade Federal de Sao Paulo (UNIFESP-EPM), São Paulo, Brazil
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Sha T, Wang X, Cheng W, Yan Y. A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF. Reprod Biomed Online 2019; 39:281-293. [PMID: 31255606 DOI: 10.1016/j.rbmo.2019.03.203] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/13/2019] [Accepted: 03/08/2019] [Indexed: 12/24/2022]
Abstract
This meta-analysis aimed to study whether pregnancy-related outcomes and complications differed between patients with polycystic ovary syndrome (PCOS) and those with other causes of infertility who had undergone IVF. A systematic search of PubMed, Embase, the Cochrane Library and Chinese databases was carried out to identify relevant studies published before July 2018. Outcomes were expressed as odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses and sensitivity analyses were also conducted. Twenty-nine studies were identified for inclusion. Women with PCOS had higher risks of miscarriage (OR 1.41, 95% CI 1.04-1.91), ovarian hyperstimulation syndrome (OR 4.96, 95% CI 3.73-6.60), gestational diabetes mellitus (OR 2.67, 95% CI 1.43-4.98), pregnancy-induced hypertension (OR 2.06, 95% CI 1.45-2.91), preterm birth (OR 1.60, 95% CI 1.25-2.04) and large-for-gestational-age babies (OR 2.10, 95% CI 1.01-4.37). Women with PCOS showed similar rates of clinical pregnancy, multiple pregnancy, ectopic pregnancy, small for gestational age and congenital malformations, and a higher live birth rate, compared with women without PCOS. This study provides an update on and comprehensive evidence to support the observation that despite the fact that PCOS patients achieve a better live birth rate, physicians should continue to consider them to be at high risk of adverse pregnancy-related outcomes.
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Affiliation(s)
- Tingting Sha
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
| | - Xiaojuan Wang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha Hunan, China
| | - Wenwei Cheng
- Third Xiangya Hospital of Central South University, Changsha Hunan, China
| | - Yan Yan
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China.
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Kalhori Z, Soleimani Mehranjani M, Azadbakht M, Shariaatzadeh MA. Ovary stereological features and serum biochemical factors following induction of polycystic ovary syndrome with testosterone enanthate in mice: An experimental study. Int J Reprod Biomed 2018. [DOI: 10.29252/ijrm.16.4.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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12
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Salehi E, Aflatoonian R, Moeini A, Yamini N, Asadi E, Khosravizadeh Z, Tarzjani MD, Harat ZN, Abolhassani F. Apoptotic biomarkers in cumulus cells in relation to embryo quality in polycystic ovary syndrome. Arch Gynecol Obstet 2017; 296:1219-1227. [PMID: 28988321 DOI: 10.1007/s00404-017-4523-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate associations between gene expression pattern of apoptotic biomarkers in cumulus cells of polycystic ovary syndrome (PCOS) patients and the quality of oocytes and embryos. METHODS 40 intracytoplasmic sperm injection patients, of whom 20 were PCOS and 20 were healthy women, were included in this study. Serum hormone levels were measured using Radioimmunoassay for each patient. The expression of survivin, caspase-3, and caspase-7 in 200 cumulus complexes surrounding mature oocytes (100 in PCOS versus 100 in control groups) collected individually at pick up was examined by real-time polymerase chain reaction (real-time PCR). RESULTS The expression levels of survivin were significantly lower in PCOS patients than those of normal women while caspase-3 and caspase-7 expression levels were higher in PCOS patients (p < 0.05). There was a statistically significant correlation between the levels of these genes and embryo quality. CONCLUSIONS This study reveals that the measurement of survivin, caspase-3, caspase-7 levels in cumulus cells of PCOS patients could be used as genetic biomarkers for oocyte and embryo selection under an ART program. However, further prospective studies are required to elucidate this issue.
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Affiliation(s)
- Ensieh Salehi
- Department of Anatomy, School of Medicine, Tehran University of Medical Science, 16 Azar Avenue, Poor Sina Street, Tehran, Iran
| | - Reza Aflatoonian
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Bani Hashem Street, Resalat Highway, Tehran, Iran
| | - Ashraf Moeini
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Number 12, East Hafez Avenue, Bani Hashem Street, Resalat Highway, Tehran, Iran.,Department of Gynecology and Obstetrics, School of Medicine, Tehran University of Medical Science, 16 Azar Avenue, Poor Sina Street, Tehran, Iran.,Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Yamini
- Department of ART, Embryology Laboratory, Arash Women's Hospital, Tehran University of Medical Science, Resalat Highway, Tehran, Iran
| | - Ebrahim Asadi
- Department of Anatomy, School of Medicine, Tehran University of Medical Science, 16 Azar Avenue, Poor Sina Street, Tehran, Iran
| | - Zahra Khosravizadeh
- Department of Anatomy, School of Medicine, Tehran University of Medical Science, 16 Azar Avenue, Poor Sina Street, Tehran, Iran
| | - Masoumeh Dehghan Tarzjani
- Department of Anatomy, School of Medicine, Tehran University of Medical Science, 16 Azar Avenue, Poor Sina Street, Tehran, Iran
| | - Zhila Naghibi Harat
- Department of ART, Embryology Laboratory, Southern California Center, New Port Beach, CA, USA
| | - Farid Abolhassani
- Department of Anatomy, School of Medicine, Tehran University of Medical Science, 16 Azar Avenue, Poor Sina Street, Tehran, Iran.
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Jiang S, Kuang Y. Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization. Medicine (Baltimore) 2017; 96:e7540. [PMID: 28796038 PMCID: PMC5556204 DOI: 10.1097/md.0000000000007540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/03/2017] [Accepted: 06/26/2017] [Indexed: 01/19/2023] Open
Abstract
The aim of this study was to explore the effect of clomiphene citrate (CC) on the cycle characteristics and outcomes of obese women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation for in vitro fertilization (IVF).This is a retrospective cohort study, and it was conducted at the tertiary-care academic medical center.This study included 174 obese PCOS patients undergoing IVF.In the study group (n = 90), CC and human menopausal gonadotropin (HMG) were administered simultaneously beginning on cycle day 3, while in control group (n = 84) HMG was used only. Both of the 2 groups used medroxyprogesterone acetate (MPA) for preventing premature luteinizing hormone (LH) surges. Ovulation was cotriggered by a GnRH agonist and hCG when dominant follicles matured.The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the number of top-quality embryos, maturation rate, fertilization rate, cleavage rate, incidence of premature LH surge, and OHSS.The study group received obviously lower total HMG dose [1650 (975-4800) vs 2025 (1350-3300) IU, P = 2.038E-4] but similar HMG duration. While the antral follicle count (AFC) is higher in study group, the number of oocytes retrieved and top-quality embryos are remarkably less [5 (0-30) vs 13 (0-42), P = 6.333E-5; 2 (0-14) vs 3.5 (0-15), P = .003; respectively]. The mature oocyte rate is higher in study group (P = .036). No significant differences were detected in fertilization rate and cleavage rate between 2 groups.CC has a positive influence on cycle characteristics, but might be correlated with the impaired IVF outcomes (less oocytes retrieved and top quality embryos, lower oocyte retrieval rate) in obese PCOS patients undergoing IVF, when HMG and MPA are used simultaneously.
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Altered FoxO3 expression and apoptosis in granulosa cells of women with polycystic ovary syndrome. Arch Gynecol Obstet 2016; 294:185-92. [PMID: 26993517 DOI: 10.1007/s00404-016-4068-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the level of apoptosis, and alteration of FoxO3 (forkhead box O3 transcription factor) expression and phosphorylation in human granulosa cells amongst polycystic ovary syndrome (PCOS) patients and control group. METHODS We recruited infertile women with PCOS (n = 14) and compared them with infertile women due to tubal blockage or male factor infertility (n = 14, controls). GnRH agonist and gonadotropins were used for ovarian stimulation. Follicular fluids from large follicles (>16 mm) were pooled and granulosa cells (GCs) were isolated using cell strainer methodology. Apoptosis of purified GCs was measured by flow cytometry using Annexin V and propidium iodide. Quantitative real-time PCR and western blotting were performed to assess alteration of FoxO3 expression and phosphorylation in GCs. RESULTS There were higher percentages of early and late apoptosis in GCs of PCOS patients than in the control group. FoxO3 mRNA level and total FoxO3 protein were significantly higher in PCOS group than in the control group. The ratio of p-FoxO3/total FoxO3 decreased significantly in PCOS than in the control group. It was inferred that unphosphorylated (active form) FoxO3 was higher in GCs of PCOS patients. Apoptosis was significantly and positively correlated with the total FoxO3 and negatively correlated with the p-FoxO3 protein levels in PCOS patients. CONCLUSIONS Activation and overexpression of FoxO3 in granulosa cells of PCOS women correlated with higher apoptosis levels in these cells suggesting that FoxO3 may be a candidate for the higher apoptosis in granulosa cells from women with PCOS.
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15
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Aghadavod E, Zarghami N, Farzadi L, Zare M, Barzegari A, Movassaghpour AA, Nouri M. Evaluation of relationship between serum levels of anti-müllerian hormone, androgen, and insulin resistant with retrieval oocytes in overweight patients with polycystic ovary syndrome. Adv Biomed Res 2015; 4:76. [PMID: 25879001 PMCID: PMC4386207 DOI: 10.4103/2277-9175.153903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/01/2013] [Indexed: 12/03/2022] Open
Abstract
Background: This study aimed to find a correlation between increased body mass index (BMI), insulin resistance (IR), hyperandrogenism, and anti-mullerian hormone (AMH) serum levels with the number of follicles retrieved in polycystic ovary syndrome (PCOS) patients. Materials and Methods: The descriptive study was taken on 80 women with average ages of 20-35 years at Alzahra Hospital of Tabriz-Iran who referred for in vitro fertilization. Patients were divided into four groups and serum levels of AMH, testosterone and IR were evaluated at the puncture time. Results: The mean number of follicle retrieved was higher in PCOS (P < 0.05) group than non-PCOS patients. There was a negative significant correlation of follicle number with BMI (r = −0.26, P < 0.05). The ratio of follicle numbers in PCOS/overweight group decreased in comparison to PCOS/normal weight group (−30%, P < 0.05) while the follicle numbers in non-PCOS/overweight patients decreased in comparison with non-PCOS/normal weight (−26%, P > 0.05). There was a significant negative association between BMI with AMH (r = −0.59, P < 0.05), BMI with the follicle numbers (r = −0.2, P < 0.05) and a positive association BMI with -IR (r = 0.3, P < 0.05), but there wasn’t a significant correlation between BMI with testosterone (r = 0.1, P < 0.5). Conclusion: Our finding provides that increasing BMI with direct effect on AMH levels and IR can affect the number of follicles, which are retrieved in these patients.
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Affiliation(s)
- Esmat Aghadavod
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ; Research Center for Biochemistry and Nutrition In Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Nosratollah Zarghami
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Laya Farzadi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Zare
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran ; Student's Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolfazl Barzegari
- Research Center for Pharmaceutical Nanotechnology, Research and Development Complex, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Akbar Movassaghpour
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Nouri
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ; Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Ryan A, Wang S, Alvero R, Polotsky AJ. Prolonged gonadotropin stimulation for assisted reproductive technology cycles is associated with decreased pregnancy rates for all women except for women with polycystic ovary syndrome. J Assist Reprod Genet 2014; 31:837-42. [PMID: 24865669 DOI: 10.1007/s10815-014-0253-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/08/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine if etiology of infertility modifies the relationship between the duration of ovarian stimulation and success during assisted reproductive technology (ART) cycles. METHODS A prospectively collected database was analyzed in an academic infertility practice. Eight hundred and twelve infertile women undergoing their initial fresh embryo, non-donor in vitro fertilization (IVF) or Intracytoplasmic Sperm Injection ICSI) cycle between January 1999 and December 2010 were evaluated. Clinical pregnancy was the main outcome measured. RESULTS Out of 663 cycles resulting in oocyte retrieval, 299 produced a clinical pregnancy (45.1%). Women who achieved a clinical pregnancy had a significantly shorter stimulation length (11.9 vs. 12.1 days, p = 0.047). Polycystic ovary syndrome (PCOS) was the only etiology of infertility that was significantly associated with a higher chance for clinical pregnancy and was a significant confounder for the association of duration and success of treatment. Women with 13 days or longer of stimulation had a 34 % lower chance of clinical pregnancy as compared to those who had a shorter cycle (OR 0.66, 95% CI:0.46-0.95) after adjustment for age, ovarian reserve, number of oocytes retrieved, embryos transferred and PCOS diagnosis. CONCLUSION Prolonged duration of stimulation is associated with decreased ART success for all couples, except for women with PCOS.
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Affiliation(s)
- Amanda Ryan
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 12631 East 17th Avenue, Mail Stop B198-3, Aurora, CO, 80045, USA
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Sermondade N, Dupont C, Massart P, Cédrin-Durnerin I, Lévy R, Sifer C. [Impact of polycystic ovary syndrome on oocyte and embryo quality]. ACTA ACUST UNITED AC 2012; 41:27-30. [PMID: 23286960 DOI: 10.1016/j.gyobfe.2012.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
This review analyzes the literature concerning oocyte and embryo quality, in case of in vitro fertilization (IVF) for women with polycystic ovary syndrome (PCOS). Alterations in oocyte quality, and consequently in embryo quality, may be due to endocrine and intra-ovarian paracrine changes. However, most of publications find similar biological and clinical results after IVF, with or without microinjection, for women with PCOS compared to those obtained in control populations. Subgroups of more pejorative outcome probably exist within PCOS population. Finally, obesity, which is frequent in PCOS, is clearly deleterious, and multidisciplinary care, including lifestyle modifications, is then needed.
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Affiliation(s)
- N Sermondade
- Service d'histologie-embryologie-cytogénétique-CECOS, hôpital Jean-Verdier, AP-HP, avenue du 14-Juillet, Bondy, France.
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Qiao J, Feng HL. Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence. Hum Reprod Update 2011; 17:17-33. [PMID: 20639519 PMCID: PMC3001338 DOI: 10.1093/humupd/dmq032] [Citation(s) in RCA: 305] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 06/10/2010] [Accepted: 06/18/2010] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common metabolic dysfunction and heterogeneous endocrine disorder in women of reproductive age. Although patients with PCOS are typically characterized by increased numbers of oocytes retrieved during IVF, they are often of poor quality, leading to lower fertilization, cleavage and implantation rates, and a higher miscarriage rate. METHODS For this review, we searched the database MEDLINE (1950 to January 2010) and Google for all full texts and/or abstract articles published in English with content related to oocyte maturation and embryo developmental competence. RESULTS The search showed that alteration of many factors may directly or indirectly impair the competence of maturating oocytes through endocrine and local paracrine/autocrine actions, resulting in a lower pregnancy rate in patients with PCOS. The extra-ovarian factors identified included gonadotrophins, hyperandrogenemia and hyperinsulinemia, although intra-ovarian factors included members of the epidermal, fibroblast, insulin-like and neurotrophin families of growth factors, as well as the cytokines. CONCLUSIONS Any abnormality in the extra- and/or intra-ovarian factors may negatively affect the granulosa cell-oocyte interaction, oocyte maturation and potential embryonic developmental competence, contributing to unsuccessful outcomes for patients with PCOS who are undergoing assisted reproduction.
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Affiliation(s)
- Jie Qiao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100083, People's Republic of China
| | - Huai L. Feng
- Department of Obstetrics and Gynecology, North Shore University Hospital, NYU School of Medicine, Manhasset, NY 11030, USA
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Gleicher N, Weghofer A, Lee IH, Barad DH. FMR1 genotype with autoimmunity-associated polycystic ovary-like phenotype and decreased pregnancy chance. PLoS One 2010; 5:e15303. [PMID: 21179569 PMCID: PMC3002956 DOI: 10.1371/journal.pone.0015303] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 11/10/2010] [Indexed: 11/18/2022] Open
Abstract
The FMR1 gene partially appears to control ovarian reserve, with a specific ovarian sub-genotype statistically associated with a polycystic ovary (PCO)- like phenotype. Some forms of PCO have been associated with autoimmunity. We, therefore, investigated in multiple regression analyses associations of ovary-specific FMR1 genotypes with autoimmunity and pregnancy chances (with in vitro fertilization, IVF) in 339 consecutive infertile women (455 IVF cycles), 75 with PCO-like phenotype, adjusted for age, race/ethnicity, medication dosage and number of oocytes retrieved. Patients included 183 (54.0%) with normal (norm) and 156 (46%) with heterozygous (het) FMR1 genotypes; 133 (39.2%) demonstrated laboratory evidence of autoimmunity: 51.1% of het-norm/low, 38.3% of norm and 24.2% het-norm/high genotype and sub-genotypes demonstrated autoimmunity (p = 0.003). Prevalence of autoimmunity increased further in PCO-like phenotype patients with het-norm/low genotype (83.3%), remained unchanged with norm (34.0%) and decreased in het-norm/high women (10.0%; P<0.0001). Pregnancy rates were significantly higher with norm (38.6%) than het-norm/low (22.2%, p = 0.001). FMR1 sub-genotype het-norm/low is strongly associated with autoimmunity and decreased pregnancy chances in IVF, reaffirming the importance of the distal long arm of the X chromosome (FMR1 maps at Xq27.3) for autoimmunity, ovarian function and, likely, pregnancy chance with IVF.
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Affiliation(s)
- Norbert Gleicher
- Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, New York, United States of America
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail: (NG); (DHB)
| | - Andrea Weghofer
- Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, New York, United States of America
- Department of Obstetrics and Gynecology, Vienna University School of Medicine, Vienna, Austria
| | - Irene H. Lee
- Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, New York, United States of America
| | - David H. Barad
- Center for Human Reproduction (CHR) and Foundation for Reproductive Medicine, New York, New York, United States of America
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, New York City, New York, United States of America
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, New York City, New York, United States of America
- * E-mail: (NG); (DHB)
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Amar-Hoffet A, Hédon B, Belaisch-Allart J. [Assisted reproductive technologies place]. J Gynecol Obstet Hum Reprod 2010; 39:S88-S99. [PMID: 21185490 DOI: 10.1016/s0368-2315(10)70034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There are three kinds of infertility treatment: medical treatment, surgical treatment and assisted reproductive technology (ART). ART includes intra uterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). ART technologies made a lot of progress last years and their field of applications extended. Through literature reviews, IUI is recommended for unexplained infertility and discussed for male or cervical infertility. IVF is recommended for tubal and unexplained infertility. Limits between IVF and ICSI in case of male infertility remains unclear. In non mal infertility ICSI is not recommended.
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Affiliation(s)
- A Amar-Hoffet
- Hôpital Saint Joseph, Unité de médecine de la reproduction, 26 bd de Louvain, 13008 Marseille, France
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Síndrome de ovario poliquístico e infertilidad. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Qualité ovocytaire et embryonnaire et issue des cycles d’ICSI chez les patientes porteuses d’un syndrome des ovaires polykystiques (SOPK) versus normo-ovulantes. ACTA ACUST UNITED AC 2009; 38:133-43. [DOI: 10.1016/j.jgyn.2008.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 11/25/2008] [Accepted: 12/03/2008] [Indexed: 11/19/2022]
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Vrtacnik-Bokal E, Virant Klun I, Verdenik I. Follicular oestradiol and VEGF after GnRH antagonists or GnRH agonists in women with PCOS. Reprod Biomed Online 2009; 18:21-8. [PMID: 19146765 DOI: 10.1016/s1472-6483(10)60420-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to determine whether follicular oestradiol and vascular endothelial growth factor (VEGF) concentrations in women with polycystic ovarian syndrome (PCOS) differ according to the use of gonadotrophin-releasing hormone (GnRH) antagonists or GnRH agonists. Furthermore, the effect of follicular oestradiol and VEGF concentrations on oocyte and embryo quality was investigated. In this prospective clinical study, 20 women with PCOS undergoing intracytoplasmic sperm injection for male factor infertility were included using a GnRH antagonist or a GnRH agonist protocol. In each follicle, oestradiol and VEGF concentrations were determined. In the GnRH antagonist group 254 follicles and in the GnRH agonist group 245 follicles, were aspirated. Fewer metaphase II (MII) and more immature and degenerative oocytes were registered in the GnRH antagonist group. Follicular oestradiol and VEGF were lower in the GnRH antagonist group (P = 0.014 and P < 0.001, respectively). Moreover, higher oestradiol concentrations were related to embryos of higher quality (P = 0.037). It is concluded that GnRH antagonists decrease follicular oestradiol and VEGF concentrations and the number of retrieved MII oocytes in women with PCOS.
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Affiliation(s)
- Eda Vrtacnik-Bokal
- Department of Obstetrics and Gynecology, Reproductive Unit, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Bibliography. Current world literature. Fertility. Curr Opin Obstet Gynecol 2006; 18:344-53. [PMID: 16735837 DOI: 10.1097/01.gco.0000193023.28556.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Affiliation(s)
- Shrita M Patel
- Division of Endocrinology, Diabetes, and Metabolism, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Esinler I, Bayar U, Bozdag G, Yarali H. Outcome of intracytoplasmic sperm injection in patients with polycystic ovary syndrome or isolated polycystic ovaries. Fertil Steril 2006; 84:932-7. [PMID: 16213846 DOI: 10.1016/j.fertnstert.2005.04.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2004] [Revised: 04/07/2005] [Accepted: 04/07/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) performance of patients with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian (PCO) morphology. DESIGN Case-control study. SETTING IVF Center, Hacettepe University Faculty of Medicine. PATIENT(S) Ninety-nine consecutive infertile women (n = 109 cycles) with PCOS and 58 patients (n = 58 cycles) with isolated PCO morphology were recruited. The control group consisted of 210 patients (n = 232 cycles) with isolated male factor infertility necessitating ICSI. All three groups were matched for female age and body mass index. INTERVENTION(S) Controlled ovarian hyperstimulation and ICSI. MAIN OUTCOME MEASURE(S) Oocyte number, fertilization rate, embryo quality, clinical pregnancy rate, implantation rate, and ovarian hyperstimulation syndrome (OHSS). RESULT(S) Six (5.5%) cycles in the PCOS group, 6 (10.3%) cycles in the PCO-only group, and 10 cycles (4.3%) in the control group were canceled. Despite a significantly lower total FSH dose used, a significantly higher serum E2 level was attained in both the PCOS and the PCO-only groups compared to the control group. The PCOS and PCO-only groups had significantly higher numbers of retrieved oocyte-cumulus complexes and metaphase II oocytes compared to the control group. The fertilization rates did not differ among the three groups. The mean number of embryos transferred was comparable among the three groups; however, the mean number of grade 1 embryos was significantly higher in the PCOS and PCO-only groups compared to the controls. The clinical pregnancy rates per ET of both the PCOS (66%) and the PCO-only (60%) groups were significantly higher than that of the control group (44%). However, the implantation rates were comparable among the three groups. Four cycles (3.7%) in the PCOS group had OHSS necessitating hospitalization. The respective figures in the PCO-only and the control groups were 1 (1.7%) and 3 (1.3%). CONCLUSION(S) Patients with the full-blown picture of PCOS or isolated PCO-only morphology behave exactly in the same manner during all stages of assisted reproduction. Owing to the availability of more fertilized oocytes and grade 1 embryos, patients with PCOS or PCO-only morphology are associated with higher clinical pregnancy rates per ET compared to patients with isolated male factor infertility.
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Affiliation(s)
- Ibrahim Esinler
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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27
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Abstract
Assessment of oocyte morphology is a difficult task, since underlying mechanisms that change the appearance of the oocyte are multifactorial and complex. Significant morphological variations are known to exist among oocytes that may affect the developmental competence and implantation potential of the derived embryo. Morphological variations of the oocyte may result from intrinsic factors such as age and genetic defects or extrinsic factors such as stimulation protocols, culture conditions, and nutrition. The effect of these morphological variations of the oocyte on embryo development and implantation, however, is not conclusively defined because of methodological flaws inherent to most of the studies in the literature. This review will mainly discuss morphological markers of oocyte quality/viability in relation to the oocyte morphology and attempt to clarify whether morphological evaluation of the oocyte can be utilized for predicting the implantation potential of the derived embryo.
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Affiliation(s)
- Basak Balaban
- Assisted Reproduction Unit, American Hospital of Istanbul, Guzelbahce sok no. 20, 34365 Nisantasi, Turkey.
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Onalan G, Pabuçcu R, Goktolga U, Ceyhan T, Bagis T, Cincik M. Metformin treatment in patients with polycystic ovary syndrome undergoing in vitro fertilization: a prospective randomized trial. Fertil Steril 2005; 84:798-801. [PMID: 16169430 DOI: 10.1016/j.fertnstert.2005.03.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 03/02/2005] [Accepted: 03/02/2005] [Indexed: 10/25/2022]
Abstract
In the present study, we investigated the impact of metformin therapy on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in patients with polycystic ovary syndrome (PCOS). Metformin does not lead to any improvement in IVF/ICSI outcomes among patients with PCOS.
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Heijnen EMEW, Eijkemans MJC, Hughes EG, Laven JSE, Macklon NS, Fauser BCJM. A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome. Hum Reprod Update 2005; 12:13-21. [PMID: 16123051 DOI: 10.1093/humupd/dmi036] [Citation(s) in RCA: 233] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This meta-analysis was conducted to compare outcomes of conventional IVF in women presenting with polycystic ovary syndrome (PCOS) and non-PCOS patients. Studies in which PCOS patients undergoing IVF were compared with a matched--no male factor--control group were considered for this review. A definition consistent with the Rotterdam consensus criteria of PCOS was required, and all patients within a given study had to be treated with the same ovarian stimulation protocol. Information regarding patient characteristics and pregnancy outcome was also required. Nine out of 290 identified studies reporting data on 458 PCOS patients (793 cycles) and 694 matched controls (1116 cycles) fulfilled these inclusion criteria. PCOS patients demonstrated a significantly reduced chance of oocyte retrieval per started cycle, odds ratio (OR) = 0.5 [95% confidence interval (CI) = 0.2-1.0]. However, no difference was observed in chance of embryo transfer per oocyte retrieval between the groups (OR = 0.7, 95% CI = 0.4-1.3). Significantly more oocytes per retrieval were obtained in PCOS patients compared with controls [random effects estimate 3.4 [95% (CI) = 1.7-5.1)]. The number of oocytes fertilized did not differ significantly between PCOS patients and controls, weighted mean difference (WMD) 0.1 oocytes (95% CI = 21.4-1.6). No significant difference was observed in the clinical pregnancy rates per started cycle, OR = 1.0 (95% CI = 0.8-1.3). The incidence of ovarian hyperstimulation syndrome (OHSS) after oocyte retrieval was rarely reported. This meta-analysis demonstrates an increased cancellation rate, but more oocytes retrieved per retrieval and a lower fertilization rate in PCOS undergoing IVF. Overall, PCOS and control patients achieved similar pregnancy and live birth rates per cycle.
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Affiliation(s)
- E M E W Heijnen
- Department of Reproductive Medicine, University Medical Center, Utrecht, The Netherlands.
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Urman B, Yakin K, Balaban B. Recurrent implantation failure in assisted reproduction: how to counsel and manage. A. General considerations and treatment options that may benefit the couple. Reprod Biomed Online 2005; 11:371-81. [PMID: 16176681 DOI: 10.1016/s1472-6483(10)60846-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recurrent implantation failure is a distressing phenomenon, both for the infertile couple and for the physician responsible for their treatment. Aetiology is often not clear and treatment options are vague. Particularly when transferred embryos are of good quality, recurrent implantation failure may be attributed to less than optimal embryo transfer technique, pathological lesions of the uterine cavity, the presence of hydrosalpinges, fibroids and endometriosis. Poor embryo quality, especially when repetitive, is a major impediment to successful implantation and cannot be corrected at the present time. Molecular abnormalities at the endometrial level and abnormal embryo-endometrium dialogue may be responsible for some cases of recurrent implantation failure. Furthermore, there may be over- or under-expressed genes that may be related to successful implantation. At the present time, the physician confronted with a couple presenting with recurrent implantation failure should discuss openly the potential causes of this phenomenon, with special emphasis on correctable causes, and offer remedies that are evidence based.
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Affiliation(s)
- Bulent Urman
- Assisted Reproduction Unit, American Hospital of Istanbul, Turkey.
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Moreno L, Diaz I, Pacheco A, Zúñiga A, Requena A, Garcia-Velasco JA. Extended coasting duration exerts a negative impact on IVF cycle outcome due to premature luteinization. Reprod Biomed Online 2004; 9:500-4. [PMID: 15588466 DOI: 10.1016/s1472-6483(10)61633-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coasting, or withholding gonadotrophin administration while maintaining gonadotrophin-releasing hormone analogue until oestradiol drops to a safe concentration, is an alternative approach to prevent ovarian hyperstimulation syndrome (OHSS) in high responder patients. However, the length of this procedure has not been precisely studied. This paper is a retrospective study of 132 patients who showed a high response (oestradiol > 4500 pg/ml and/or more than 20 follicles > 17 mm) to ovarian stimulation and were coasted due to their high risk of developing OHSS, and evaluated the impact of the duration of coasting on IVF cycle outcome. Additionally, serum LH and progesterone concentrations were studied to investigate whether premature luteinization was present in these cycles and whether it might be related to coasting duration. A significant decrease in implantation rate was found when coasting was required for more than 4 days, together with a trend towards a higher cancellation rate. Premature luteinization was significantly elevated in women undergoing coasting compared with control women (34 versus 15.6%, P < 0.05). In the majority of patients who showed premature luteinization, coasting lasted >/=3 days. To conclude, prolonged coasting may affect the endometrium, anticipating the implantation window. These data may explain why some women undergoing extended coasting show a lower implantation rate compared with controls.
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Affiliation(s)
- L Moreno
- IVI-Madrid, Rey Juan Carlos University, Madrid, Spain
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