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Wen W, Zhang D, Liu X, Shi J, Cai H. Embryo development and live birth in women with one previously failed full IVF/ICSI cycle. J Assist Reprod Genet 2024; 41:1517-1525. [PMID: 38739214 PMCID: PMC11224215 DOI: 10.1007/s10815-024-03107-8] [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: 09/27/2023] [Accepted: 03/25/2024] [Indexed: 05/14/2024] Open
Abstract
PURPOSE To evaluate the embryological and pregnancy outcomes of women who failed in their first IVF treatment if they attempted a second cycle. METHODS For evaluating the embryological outcomes, the study cohort included 1,227 women who failed to obtain a live birth after the initial IVF cycle from September 2018 to August 2021 and returned for a second attempt. To evaluate reproductive outcomes including live birth rates (LBRs), 1227 women who returned for a second attempt were compared with 13,195 women undergoing their first oocyte retrieval with blastocyst culture attempted during the same study period. RESULTS In women who had a second cycle, the median number of oocyte retrieved (11 vs 9), fertilized oocytes (7 vs 5), usable embryos (6 vs 4) and blastocysts (3 vs 1) was higher in the second cycle compared to the first cycle (All p < 0.001). Blastocyst formation rates were significantly increased from 33% in the first cycle to 50% in the second cycle across the age group (p < 0.001). However, the primary transfer LBRs were significantly lower in the second cycle than that in the initial cycle (40.82% versus 51.79%, aOR: 0.74 [0.65, 0.84]). LBRs in the second cycle were 42.26%, 42.68%, 25.49% and 16.22% in women aged < 35, 35-37, 38-40, and > 40 years. CONCLUSION There was a notable enhancement in laboratory outcomes following the second attempt in women whose initial IVF cycles were unsuccessful. However, the uncertainty inherent in the successful implantation and the consequent progression to live birth remains a significant challenge.
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Affiliation(s)
- Wen Wen
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Houzaimen North Street, Xi'an, 73#, China
| | - Dian Zhang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Houzaimen North Street, Xi'an, 73#, China
- Graduate Department, Xi'an Medical University, Xi'an, China
| | - Xiaohua Liu
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Houzaimen North Street, Xi'an, 73#, China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Houzaimen North Street, Xi'an, 73#, China
| | - He Cai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Houzaimen North Street, Xi'an, 73#, China.
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Yarkiner Z, Boynukalın FK, Coban Ö. Assessment of Repetitive Controlled Ovarian Stimulation (COS) Cycles on Oocyte Donors: Impact on Oocyte Quality and Viable Embryo Yield. Reprod Sci 2024:10.1007/s43032-024-01584-x. [PMID: 38767768 DOI: 10.1007/s43032-024-01584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
The utilization of donor eggs has broadened the options for Assisted Reproductive Technology (ART) among women facing challenges with egg quantity or quality. Given that donors are typically selected from young and fertile individuals, In Vitro Fertilization with egg donation (IVF-ED) tends to exhibit higher rates of implantation, pregnancy, and live births compared to IVF with the woman's own eggs, especially for females over 35 years old. This has led to a projected increase in the demand for IVF-ED, surpassing the number of available donors. Consequently, many centers opt to use oocyte donors for multiple cycles. However, the correlation between repeated Controlled Ovarian Stimulation (COS) cycles and the performance of donors in terms of viable blastocyst stage embryo (VEC) or blastocyst embryo rate is not definitively established and remains of interest. This study aims to explore the preimplantation characteristics of embryo development and oocyte maturation status based on the number of donor COS cycles, employing a Generalized Linear Mixed Model (GLMM) framework. The study encompasses 1965 embryo transfer (ET) cycles involving 399 donors who underwent a minimum of two and a maximum of nine controlled ovarian hyperstimulation (COS) cycles. The findings indicate that, with the patient undergoing six or more cycles of ovarian stimulation, despite a 3.9% increase in both maturation and fertilization rates, there is a corresponding decrease of 4.5% in VEC rate and 4.7% in blastulation rates. In essence, an escalating number of donor COS cycles appears to be associated with a disadvantageous reduction in embryo quality.
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Affiliation(s)
- Zalihe Yarkiner
- Department of Basic Sciences and Humanities, Faculty of Arts and Sciences, Cyprus International University, Nicosia, Cyprus.
| | - Fazilet Kübra Boynukalın
- Infertility Department, Turkey, Obstetrics and Gynaecology, Istanbul, Bahçeci Fulya IVF Center, Üsküdar University, Istanbul, Turkey
| | - Önder Coban
- British Cyprus IVF Hospital, Embryology, Nicosia, Cyprus
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Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus 2023; 15:e47956. [PMID: 38034211 PMCID: PMC10685323 DOI: 10.7759/cureus.47956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
This narrative review article comprehensively explores the multifaceted landscape of social egg freezing, delving into its medical, ethical, societal, psychological, legal, and cultural dimensions. Oocyte cryopreservation, a developing procedure, gives women the chance to match their life goals with fertility goals. Informed decision-making, morally sound guidance, and open communication are all stressed by ethical considerations. Family planning practices, workplace cultures, and gender equality all have an impact on societal dynamics. The process's emotional toll and associated coping mechanisms are highlighted by psychological elements. Legal and policy frameworks need constant ethical reflection and understanding of the regulatory environment. Religious and cultural views highlight the variety of perspectives that influence attitudes toward this practice. For responsible practice to ensure individual liberty while navigating the evolving landscape of reproductive options, it is essential to comprehend how these aspects interact.
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Affiliation(s)
- Udit Lahoti
- Obstretics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejas Shegekar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anup Juganavar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Metzemaekers J, Lust E, Rhemrev J, Van Geloven N, Twijnstra A, Van Der Westerlaken L, Jansen FW. Prognosis in fertilisation rate and outcome in IVF cycles in patients with and without endometriosis: a population-based comparative cohort study with controls. Facts Views Vis Obgyn 2021; 13:27-34. [PMID: 33889858 PMCID: PMC8051192 DOI: 10.52054/fvvo.13.1.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Subfertility occurs in 30-40% of endometriosis patients. Regarding the fertilisation rate with in vitro fertilisation (IVF) and endometriosis, conflicting data has been published. This study aimed to compare endometriosis patients to non-endometriosis cycles assessing fertilisation rates in IVF. Methods: A population-based cohort study was conducted at the Leiden University Medical Center. IVF cycles of endometriosis patients and controls (unexplained infertility and tubal pathology) were analysed. The main outcome measurement was fertilisation rate. Results: 503 IVF cycles in total, 191 in the endometriosis group and 312 in the control. The mean fertilisation rate after IVF did not differ between both groups, 64.1%±25.5 versus 63.9%±24.8 (p=0.95) respectively, independent of age and r-ASRM classification. The median number of retrieved oocytes was lower in the endometriosis group (7.0 versus 8.0 respectively, p=0.19) and showed a significant difference when corrected for age (p=0.02). When divided into age groups, the statistical effect was only seen in the group of ≤ 35 years (p=0.04). In the age group ≤35, the endometriosis group also showed significantly more surgery on the internal reproductive organs compared to the control group (p<0.001). All other outcomes did not show significant differences. Conclusion: Similar fertilisation rates were found in endometriosis IVF cycles compared to controls. The oocyte retrieval was lower in the endometriosis group, however this effect was only significant in the age group ≤ 35 years. All other secondary outcomes did not show significant differences. In general, endometriosis patients with an IVF indication can be counselled positively regarding the chances of becoming pregnant, and do not need a different IVF approach.
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Affiliation(s)
- J Metzemaekers
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eer Lust
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jpt Rhemrev
- Department of Gynaecology, Haaglanden Medisch Centrum-Bronovo, Den Haag, the Netherlands
| | - N Van Geloven
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Arh Twijnstra
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - L Van Der Westerlaken
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - F W Jansen
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
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Riganelli L, Merlino L, Aragona C, Capri O, Franceschetti S, Linari A, Mariani M, Micara G, Pietrangeli D, Porpora MG, Piccioni MG. Could art cycles have a detrimental effect on ovarian reserve? A retrospective case control study. MINERVA GINECOLOGICA 2020; 72:75-81. [PMID: 32403907 DOI: 10.23736/s0026-4784.20.04542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Even if it is supposed damage of repeated ART (assisted reproductive technology) cycles on oocyte pool, there is still no evidence in literature. Aim of the study is to investigate whether infertile women who undergo to several ART cycles can show a lower ovarian reserve measured by AMH (Anti-Mullerian hormone) levels. METHODS The study includes 282 infertile women, between 18 and 42 years, and allocated into two groups: 159 women previously submitted to two or more ART cycles (group A) and 123 women never submitted naïve to-ART cycles (group B). We tested whether AMH, FSH, LH and E2 levels were significantly different between the two groups, stratifying according to age. RESULTS Regardless to the age ranges bands, the AMH in group A was statistically significant lower than in group B with a statistical significance (P=0.047). In particular women aged over 35 previously submitted to one or more ART cycles showed lower AMH levels, than those paired with age, which had never been treated with ART. CONCLUSIONS Despite the limitations of the study, our data demonstrate a reduced AMH levels in women aged over 35 previously submitted to two or more repeated ART-cycles compared to patients never treated before. The strength of this study is the actuality of the topic that has not been discussed before in detail.
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Affiliation(s)
- Lucia Riganelli
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Lucia Merlino
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy -
| | - Cesare Aragona
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Oriana Capri
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Silvia Franceschetti
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Antonella Linari
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Marianna Mariani
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Giulietta Micara
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Daniela Pietrangeli
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Maria G Porpora
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Maria G Piccioni
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
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Barad DH, Kushnir VA, Lee HJ, Lazzaroni E, Gleicher N. Effect of inter-cycle interval on oocyte production in humans in the presence of the weak androgen DHEA and follicle stimulating hormone: a case-control study. Reprod Biol Endocrinol 2014; 12:68. [PMID: 25048047 PMCID: PMC4123494 DOI: 10.1186/1477-7827-12-68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/27/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In various animal models androgens have been demonstrated to enhance follicle stimulating hormone (FSH) activity on granulosa cells during small growing follicle stages. To assess whether similar synergism may also exist in humans we investigated women on androgen (dehydroepiandrosterone, DHEA) supplementation with varying concomitant FSH exposure. METHODS In a case controlled cohort study we determine if time interval between IVF cycles of IVF treatment with FSH had an effect on ovarian response to ovulation induction in women supplemented with DHEA. Among 85 women with known low functional ovarian reserve (LFOR), supplemented with DHEA, and undergoing at least 3 consecutive IVF cycles, 68 demonstrated short (<120 days) intervals between repeated cycles (Group 1) and were, therefore, considered to have consistent FSH exposure. In contrast 17 women (Group 2) demonstrated long (>=120 days) intervals between repeated cycles and, therefore, were considered to demonstrate inconsistent FSH exposure. Trends in oocyte yields were compared between these groups, utilizing mixed model repeated measures ANOVA, adjusted for initial age and FSH dose. RESULTS Only women in Group I demonstrated a linear increase in oocyte yields across their three cycles of treatments (F=7.92; df 1, 68.6; p=0.017). Moreover, the analysis revealed a significant interaction between the two patient groups and cycle number for retrieved oocytes (F=6.32, df=2, 85.9, p=0.003). CONCLUSIONS This study offers preliminary confirmatory evidence that repeated short interval exposure to androgens in combination with FSH improves human FOR. A higher level of evidence will require prospectively randomized studies.
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Affiliation(s)
- David H Barad
- The Center for Human Reproduction, 21 East 69th St, New York, New York, USA
- Foundation for Reproductive Medicine, New York, New York, USA
| | - Vitaly A Kushnir
- The Center for Human Reproduction, 21 East 69th St, New York, New York, USA
| | - Ho-Joon Lee
- The Center for Human Reproduction, 21 East 69th St, New York, New York, USA
| | - Emanuela Lazzaroni
- The Center for Human Reproduction, 21 East 69th St, New York, New York, USA
| | - Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th St, New York, New York, USA
- Foundation for Reproductive Medicine, New York, New York, USA
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Cavagna M, Paes de Almeida Ferreira Braga D, Biaggioni Lopes F, de Cássia Savio Figueira R, Iaconelli A, Borges E. The effect of GnRH analogues for pituitary suppression on ovarian response in repeated ovarian stimulation cycles. Arch Med Sci 2011; 7:470-5. [PMID: 22295031 PMCID: PMC3258761 DOI: 10.5114/aoms.2011.23414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 04/10/2010] [Accepted: 05/20/2010] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ovarian stimulation is employed in assisted reproduction techniques in order to obtain as many oocytes as possible. The early rise in oestradiol levels may lead to the premature end of the respective cycle. In order to avoid such an effect, pituitary suppression has been employed. The aim of this study was to evaluate whether maintenance or replacement of the type of GnRH analogue (i.e., agonist or antagonist) employed for pituitary suppression in the consecutive intracytoplasmic sperm injection (ICSI) cycle would negatively influence oocyte quality and ICSI outcome. MATERIAL AND METHODS A retrospective observational study was conducted including 181 women with primary infertility. Patients were divided into four different groups according to the GnRH analogue used for pituitary suppression in the first and consecutive cycle. RESULTS When a GnRH agonist was employed for pituitary suppression in the first cycle, the consecutive cycle showed comparable outcomes when performed with either a GnRH agonist or a GnRH antagonist. When the first cycle was performed with a GnRH antagonist, the use of the GnRH agonist in the successive cycle led to an increased number of oocytes retrieved (7.5% vs. 10.3%, p = 0.032) and the production of a higher number of embryos (4.5% vs. 6.3%, p = 0.036). CONCLUSIONS When the first cycle is carried out with a GnRH antagonist, the use of a GnRH agonist in the successive cycle would lead to increased numbers of oocytes collected and embryos produced.
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Affiliation(s)
- Mario Cavagna
- Women’s Health Reference Center, Hospital Perola Byington, São Paulo, Brazil
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility-Assisted Fertilization Center, São Paulo, Brazil
- Sapientiae Institute – Educational and Research Center in Assisted Reproduction, São Paulo, Brazil
| | | | | | | | - Edson Borges
- Fertility-Assisted Fertilization Center, São Paulo, Brazil
- Sapientiae Institute – Educational and Research Center in Assisted Reproduction, São Paulo, Brazil
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9
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Nyachieo A, Spiessens C, Mwenda JM, Debrock S, D’Hooghe TM. Improving ovarian stimulation protocols for IVF in baboons: Lessons from humans and rhesus monkeys. Anim Reprod Sci 2009; 110:187-206. [DOI: 10.1016/j.anireprosci.2008.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 08/18/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
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Serna J, García-Velasco JA. Effect of repeated assisted reproduction techniques on the ovarian response. Curr Opin Obstet Gynecol 2005; 17:233-6. [PMID: 15870555 DOI: 10.1097/01.gco.0000169098.90966.50] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite the increasing success of assisted reproduction techniques, most couples need more than one cycle of controlled ovarian hyperstimulation to achieve a pregnancy. The effect of several cycles on the ovarian response in subsequent cycles is a concern for gynaecologists and patients. In addition, egg donors have the possible risk of an ovarian reserve decrease. In this review, we present published evidence on the effects of repeated assisted reproduction techniques on the ovarian response. RECENT FINDINGS Recent available data indicate that ovarian response persists with subsequent cycles of controlled ovarian hyperstimulation in terms of oocytes being retrieved, although it is not clear whether an increased level of gonadotropins is required to achieve this response. There is a decrease in the number of oocytes retrieved in subsequent cycles due to increased female age as more cycles are needed. The oocytes retrieved in one cycle seem to come from the antral pool that otherwise would be atretic due to dominant follicle selection. SUMMARY The mechanisms involved in the recruitment from atresia of more than one follicle are discussed and it is shown that repetitive ovarian stimulation does not appear to affect the ovarian reserve. Published evidence shows that gonadotropins alter the physiologic selection of one single dominant follicle but do not accelerate the recruitment of follicles from further cycles, confirming that there is no detrimental effect on ovarian function after repetitive controlled ovarian hyperstimulation.
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Affiliation(s)
- José Serna
- Valenciano Institute of Infertility, Rey Juan Carlos University, Madrid, Spain
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Abstract
Ovarian stimulation is an integral part of assisted reproduction treatments. Ovarian response to gonadotrophin treatment, besides other factors, determines the outcome of treatment, as the number and quality of oocytes retrieved are related to the chance of achieving a pregnancy. A number of factors have been identified that might predict ovarian response, such as age of the patient and antral follicle count. In addition, it has been shown that genetic factors such as the patient's FSH-receptor genotype also determine individual response to FSH treatment. Besides patient-related factors, the choice of drugs for ovarian stimulation plays a significant role. Until recently, biopotency of gonadotrophin preparations was tested by an in-vivo bioassay with an intrinsic variability up to 20%. Due to a superior manufacturing technique, follitropin alpha can now be filled by mass. This allows assessment of FSH with a precise SE-HPLC assay and variability of the FSH content between production lots has now been estimated at 1.6%. Results of recent studies indicate that treatment with follitropin alpha filled by mass results in consistent ovarian response, fewer treatment days and fewer cancelled cycles. This is an important step towards further minimizing drug-related variability of ovarian response to FSH treatment.
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