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Arvis P, Rongières C, Pirrello O, Lehert P. Predicting the ovarian response: towards a determinant model and implications for practice. J Assist Reprod Genet 2024; 41:213-222. [PMID: 37921971 PMCID: PMC10789711 DOI: 10.1007/s10815-023-02975-w] [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: 03/30/2023] [Accepted: 10/16/2023] [Indexed: 11/05/2023] Open
Abstract
OBJECTIVE To improve the reliability of prediction models for ovarian response to stimulation in ART. DESIGN A multicenter retrospective cohort study. SETTING Twelve reproductive centers. PATIENTS A total of 25,854 controlled ovarian stimulations between 2005 and 2016, including cycles cancelled for inadequate response, were included. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Precision of the prediction of the number of oocytes at ovarian pickup and of cancellation rate for poor ovarian response. RESULTS Both AMH and antral follicle count exhibit a non-linear effect on the oocyte yield, with a linear relationship after log-transformation. After adjustment for age, BMI, and center, ovarian response observed in a previous stimulation was found to be the best predictor, followed by AMH and AFC. The zero-inflated binomial negative model showed that predictors of cycle cancellation and number of oocytes at retrieval were different, and assimilating cancellation to zero oocyte greatly reduces the determination of the model. Our model was characterized by the best ever reached determination (R2=0.505 for non-naïve women, 0.313 for all the women) and provided evidence of a very strong difference among centers. The results can be easily converted in the prediction of response levels (poor-medium-good-high). Finally, in case of partial report of the above predictors, we show that the univariate prediction based on the best predictor provides a good approximation. CONCLUSION(S) A substantial improvement of the ovarian response prediction is possible in modelling the possible cancellation decision, followed by the oocyte retrieval itself, according to an appropriate model based on previous stimulation and non-linear effects of AMH and AFC.
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Affiliation(s)
- Philippe Arvis
- Department of Obstetrics and Gynecology, Clinique La Sagesse, Rennes, France.
| | - Catherine Rongières
- Department de Medecine de La Reproduction, Centre Medico-Chirurgical Et Obstetrical (CMCO), 19 rue Louis Pasteur, 67300 Schiltigheim, Strasbourg, France
| | - Olivier Pirrello
- Department de Medecine de La Reproduction, Centre Medico-Chirurgical Et Obstetrical (CMCO), 19 rue Louis Pasteur, 67300 Schiltigheim, Strasbourg, France
| | - Philippe Lehert
- Faculty of Economics (P.L.), UCL Mons, Louvain, Belgium
- Faculty of Medicine (P.L.), The University of Melbourne, Melbourne, Australia
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Chen Z, Li W, Ma S, Li Y, Lv L, Huang K, Gong A. Evaluative effectiveness of follicular output rate, ovarian sensitivity index, and ovarian response prediction index for the ovarian reserve and response of low-prognosis patients according to the POSEIDON criteria: a retrospective study. ZYGOTE 2023; 31:557-569. [PMID: 37737063 DOI: 10.1017/s0967199423000382] [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] [Indexed: 09/23/2023]
Abstract
The aim was to explore the implications of follicular output rate (FORT), ovarian sensitivity index (OSI), ovarian response prediction index (ORPI), and follicle-to-oocyte index (FOI) in low-prognosis patients defined by POSEIDON criteria. In total, 4030 fresh in vitro fertilization (IVF) cycles from January 2013 to October 2021 were included in this retrospective cohort analysis and were categorized into four groups based on the POSEIDON criteria. The FORT between Groups 1 and 2 (0.61 ± 0.34 vs. 0.65 ± 0.35, P = 0.081) and Groups 3 and 4 (1.08 ± 0.82 vs. 1.09 ± 0.94, P = 0.899) were similar. The OSI in the order from the highest to the lowest were 3.01 ± 1.46 in Group 1, 2.28 ± 1.09 in Group 2, 1.54 ± 1.04 in Group 3, and 1.34 ± 0.96 in Group 4 (P < 0.001). The trend in the ORPI values was consistent with that in the OSI. FORT, OSI, ORPI, and FOI complemented each other and offered excellent effectiveness in reflecting ovarian reserve and response, but they were not good predictors of clinical pregnancy rate (CPR) from IVF.
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Affiliation(s)
- Zhilan Chen
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Wei Li
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Shufang Ma
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Yanmin Li
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Liqun Lv
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Kecheng Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Aidong Gong
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
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Ferrand T, Boulant J, He C, Chambost J, Jacques C, Pena CA, Hickman C, Reignier A, Fréour T. Predicting the number of oocytes retrieved from controlled ovarian hyperstimulation with machine learning. Hum Reprod 2023; 38:1918-1926. [PMID: 37581894 PMCID: PMC10546073 DOI: 10.1093/humrep/dead163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/05/2023] [Indexed: 08/16/2023] Open
Abstract
STUDY QUESTION Can machine learning predict the number of oocytes retrieved from controlled ovarian hyperstimulation (COH)? SUMMARY ANSWER Three machine-learning models were successfully trained to predict the number of oocytes retrieved from COH. WHAT IS KNOWN ALREADY A number of previous studies have identified and built predictive models on factors that influence the number of oocytes retrieved during COH. Many of these studies are, however, limited in the fact that they only consider a small number of variables in isolation. STUDY DESIGN, SIZE, DURATION This study was a retrospective analysis of a dataset of 11,286 cycles performed at a single centre in France between 2009 and 2020 with the aim of building a predictive model for the number of oocytes retrieved from ovarian stimulation. The analysis was carried out by a data analysis team external to the centre using the Substra framework. The Substra framework enabled the data analysis team to send computer code to run securely on the centre's on-premises server. In this way, a high level of data security was achieved as the data analysis team did not have direct access to the data, nor did the data leave the centre at any point during the study. PARTICIPANTS/MATERIALS, SETTING, METHODS The Light Gradient Boosting Machine algorithm was used to produce three predictive models: one that directly predicted the number of oocytes retrieved and two that predicted which of a set of bins provided by two clinicians the number of oocytes retrieved fell into. The resulting models were evaluated on a held-out test set and compared to linear and logistic regression baselines. In addition, the models themselves were analysed to identify the parameters that had the biggest impact on their predictions. MAIN RESULTS AND THE ROLE OF CHANCE On average, the model that directly predicted the number of oocytes retrieved deviated from the ground truth by 4.21 oocytes. The model that predicted the first clinician's bins deviated by 0.73 bins whereas the model for the second clinician deviated by 0.62 bins. For all models, performance was best within the first and third quartiles of the target variable, with the model underpredicting extreme values of the target variable (no oocytes and large numbers of oocytes retrieved). Nevertheless, the erroneous predictions made for these extreme cases were still within the vicinity of the true value. Overall, all three models agreed on the importance of each feature which was estimated using Shapley Additive Explanation (SHAP) values. The feature with the highest mean absolute SHAP value (and thus the highest importance) was the antral follicle count, followed by basal AMH and FSH. Of the other hormonal features, basal TSH, LH, and testosterone levels were similarly important and baseline LH was the least important. The treatment characteristic with the highest SHAP value was the initial dose of gonadotropins. LIMITATIONS, REASONS FOR CAUTION The models produced in this study were trained on a cohort from a single centre. They should thus not be used in clinical practice until trained and evaluated on a larger cohort more representative of the general population. WIDER IMPLICATIONS OF FINDINGS These predictive models for the number of oocytes retrieved from COH may be useful in clinical practice, assisting clinicians in optimizing COH protocols for individual patients. Our work also demonstrates the promise of using the Substra framework for allowing external researchers to provide clinically relevant insights on sensitive fertility data in a fully secure, trustworthy manner and opens a number of exciting avenues for accelerating future research. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the French Public Bank of Investment as part of the Healthchain Consortium. T.Fe., C.He., J.C., C.J., C.-A.P., and C.Hi. are employed by Apricity. C.Hi. has received consulting fees and honoraria from Vitrolife, Merck Serono, Ferring, Cooper Surgical, Dibimed, Apricity, and Fairtility and travel support from Fairtility and Vitrolife, participates on an advisory board for Merck Serono, was the founder and organizer of the AI Fertility conference, has stock in Aria Fertility, TMRW, Fairtility, Apricity, and IVF Professionals, and received free equipment from Planar in exchange for first user feedback. C.J. has received a grant from BPI. J.C. has also received a grant from BPI, is a member of the Merck AI advisory board, and is a board member of Labelia Labs. C.He has a contract for medical writing of this manuscript by CHU Nantes and has received travel support from Apricity. A.R. haș received honoraria from Ferring and Organon. T.Fe. has received a grant from BPI. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | | | - Chloe He
- AI Team, Apricity, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Computer Science, University College London, London, UK
| | | | | | | | - Cristina Hickman
- AI Team, Apricity, London, UK
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | | | - Thomas Fréour
- Centre Hospitalier Universitaire de Nantes, Nantes, France
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
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Salman MM, Zaki AM, El-Gamal HH, Gomaa MF, Osman AA, Farid LA. Effect of intrauterine infusion of autologous platelet-rich plasma in patients with refractory thin endometrium undergoing in vitro fertilization. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2023; 22:77-82. [PMID: 37674922 PMCID: PMC10477767 DOI: 10.5114/pm.2023.128814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/16/2023] [Indexed: 09/08/2023]
Abstract
Introduction Treatment of refractory thin endometrium during IVF is a relatively challenging problem, considering that optimal endometrium thickness is one of the critical factors for successful implantation and pregnancy. Autologous intrauterine platelet-rich plasma (PRP) infusion is an adjuvant therapeutic alternative for enhancing the endometrial thickness (EMT) and echo pattern. It was shown that PRP could expand EMT and improve pregnancy outcomes with its high content of growth factors and cytokines, and its role in the regulation of the immunological interaction between the embryo and the endometrium. The aim of the study is to evaluate the effect of autologous PRP in improving the ongoing pregnancy rate in patients with refractory thin endometrium undergoing IVF. Material and methods A prospective study in Ain Shams University Hospital including 66 infertile women with a refractory thin endometrium below 7 mm by ultrasound on the day of human chorionic gonadotropin injection in fresh embryo transfer (ET) cycle, who did not respond to standard medical therapies after more than 2 cycles of previous medical therapy, and who were candidates for IVF cycle were given intrauterine PRP. Results A significant increase in EMT was noted and enhancement of endometrial pattern after intrauterine PRP infusion in the days of ovum pick-up and ET. There was also a significant increase in ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, while the miscarriage rate decreased after PRP infusion. Conclusions Intrauterine PRP infusion improved ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, in addition to EMT and pattern on the days of ovum pick-up and ET, while the miscarriage rate significantly decreased.
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Affiliation(s)
- Mohamed M. Salman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
| | - Aya M. Zaki
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
| | - Hatem H. El-Gamal
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
| | - Mostafa F. Gomaa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
| | - Amany A. Osman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
| | - Laila A. Farid
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
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He Y, Tang Y, Chen S, Liu J, Liu H. Effect of GnRH agonist alone or combined with different low-dose hCG on cumulative live birth rate for high responders in GnRH antagonist cycles: a retrospective study. BMC Pregnancy Childbirth 2022; 22:172. [PMID: 35236312 PMCID: PMC8892730 DOI: 10.1186/s12884-022-04499-0] [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: 10/03/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background There is insufficient evidence regarding the impact of dual trigger on oocyte maturity and reproductive outcomes in high responders. Thus, we aimed to explore the effect of gonadotropin-releasing hormone agonist (GnRHa) trigger alone or combined with different low-dose human chorionic gonadotropin (hCG) regimens on rates of oocyte maturation and cumulative live birth in high responders who underwent a freeze-all strategy in GnRH antagonist cycles. Methods A total of 1343 cycles were divided into three groups according to different trigger protocols: group A received GnRHa 0.2 mg (n = 577), group B received GnRHa 0.2 mg and hCG 1000 IU (n = 403), and group C received GnRHa 0.2 mg and hCG 2000 IU (n = 363). Results There were no significant differences in age, body mass index, and rates of oocyte maturation, fertilization, available embryo, and top-quality embryo among the groups. However, the incidence of moderate to severe ovarian hyperstimulation syndrome (OHSS) was significantly different among the three groups (0% in group A, 1.49% in group B, and 1.38% in group C). For the first frozen embryo transfer (FET) cycle, there were no significant differences in the number of transferred embryos and rates of implantation, clinical pregnancy, live birth, and early miscarriage among the three groups. Additionally, the cumulative ongoing pregnancy rate and cumulative live birth rate were not significantly different among the three groups. Similarly, there were no significant differences in gestational age, birth weight, birth height, and the proportion of low birth weight among subgroups stratified by singleton or twin. Conclusions GnRHa trigger combined with low-dose hCG (1000 IU or 2000 IU) did not improve oocyte maturity and embryo quality and was still associated with an increased risk of moderate to severe OHSS. Therefore, for high responders treated with the freeze-all strategy, the single GnRHa trigger is recommended for final oocyte maturation, which can prevent the occurrence of moderate to severe OHSS and obtain satisfactory pregnancy and neonatal outcomes in subsequent FET cycles.
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Affiliation(s)
- Yuxia He
- Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan Tang
- Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Zhongshan City People's Hospital, Zhongshan, China
| | - Shiping Chen
- Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianqiao Liu
- Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haiying Liu
- Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong, China.
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Laqqan M, Yassin M. Anti–Müllerian hormone and antral follicle count predict ovarian response in women less than 45 years following GnRH antagonist multiple–dose protocol. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2022. [DOI: 10.4103/2305-0500.356839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sun TC, Chen X, Shi C, Tian L, Zhou SJ. The Predictive Levels of Serum Anti-Müllerian Hormone and the Combined Index of the Number of Retrieved Oocytes and Good-Quality Embryos in Advanced-Age Infertile Women. Int J Endocrinol 2022; 2022:4224417. [PMID: 35479662 PMCID: PMC9038402 DOI: 10.1155/2022/4224417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
The primary objective of the study was to assess the values of serum anti-Müllerian hormone (AMH) levels and the combined index for the prediction of number of oocytes retrieved (NOR) and number of good-quality embryos (GQE) in infertile women undergoing IVF/ICSI treatment. A group of 521 infertile women aged 21-46 years were recruited as subject in this study. Serum AMH, hormones, and antral follicle count (AFC) were measured. The infertile women were categorized into three groups: 21-34 years (reproductive age), 35-39 years (reproductive age), and 40-46 years (advanced-age infertile). The predictive accuracy of variables was analyzed by the receiver operating characteristic (ROC) curve. AFC, AFC/age ratio, AMH/age ratio, and ovarian response prediction index (ORPI) decreased gradually, while AMH decreased significantly with increase in age. Moreover, NOR and GQE were positively correlated with AFC, AMH, AFC/age ratio, AMH/age ratio, and ORPI (P < 0.001). A statistical significance was observed in predicted oocyte retrieval including AMH, AMH/age ratio, and ORPI between 21-34 years and 35-46 years; especially in the 35-46 years group, these variables reached a "high" grade in the diagnostic accuracy because area under curve (AUC) ranged from 0.982 to 0.988 significantly. No statistical significance was observed for FSH, AMH, AFC, and related combined index predicting GQE. The predictive value of AFC and AFC/age ratio was limited regarding oocyte retrieval; however, AMH, AMH/age ratio, and ORPI concurrently had an excellent value for predicting NOR in reproductive-age women, especially in advanced-age infertile women.
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Affiliation(s)
- Tie-Cheng Sun
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing 102206, China
| | - Xi Chen
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Cheng Shi
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Li Tian
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Shan-Jie Zhou
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing 102206, China
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Ejenobo D, Ameh N, M. Otubu J, Ola B, Wada I, Onuh A. Prediction of poor ovarian response during In vitro fertilization in Nigerian women: A comparison of basal antral follicle count and follicle-stimulating hormone. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_18_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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Vagnini LD, Renzi A, Petersen CG, Dieamant F, Oliveira JBA, Canas MDCT, Franco Junior JG, Oliani AH. Correlation of TP53 (rs1625895), TP73 (rs3765730), MMP9 (rs17576), and MTHFR (rs868014) polymorphisms with low ovarian reserve. Eur J Obstet Gynecol Reprod Biol 2021; 269:132-137. [PMID: 34953598 DOI: 10.1016/j.ejogrb.2021.08.034] [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: 09/22/2020] [Revised: 06/18/2021] [Accepted: 08/26/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the influence of the Single Nucleotide Polymorphisms (SNPs) TP53 rs1625895, TP73 rs3765730, MMP9 rs17576, and MTHFR rs868014 on ovarian reserve (OR) in infertile patients. STUDY DESIGN A prospective cross-sectional study was carried out in 145 infertile women. The patients were divided into two groups according to ovarian reserve, characterized by association between AMH levels and AFC:After patient distribution, both groups were compared (LOR X NOR) regarding the genotypes of the SNPs TP53 T/C rs1625895, TP73 G/A rs3765730, MMP9 Gln/Arg rs17576, and MTHFR A/G rs868014. RESULT(S) The frequency of the TP53-T/T genotype was greater in the LOR and the TP53-C/C genotype was more frequent in patients with NOR. This association was confirmed by the frequency of alleles, where the presence of the T allele was significantly higher in patients who exhibited LOR (P = 0.0003). The frequency of the TP73-G/G genotype and of the G allele was higher in the LOR group (P = 0.01). Considering the MMP9 gene, the frequency of the Gln/Gln genotype was higher in the LOR group. However, the Gln/Arg genotype and the Arg allele prevailed in the NOR group (P = 0.006). The frequency of the MTHFR-A/A genotype was higher in the LOR group, whereas that of the MTHFR-GG genotype was higher in the NOR group. The presence of allele A was significantly higher in the LOR group (P = 0.002). The regression analysis shows that patients who present the TP53-T/T, TP73-G/G, MMP9-Gln/Gln, and MTHFR-A/A genotypes are 3.6X, 3.1X, 3.2X, and 3.7X more likely of having LOR, respectively. In addition, the association of the TP53/TT + TP73/GG genotypes increased the chance of women being included in the LOR group in 5.7-fold. CONCLUSION(S) The genotypes TP53-T/T, TP73-G/G, MMP9-Gln/Gln, and MTHFR-A/A increase the chance of women to exhibit LOR. These polymorphisms could be useful as genetic markers of low ovarian reserve in infertile patients.
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Affiliation(s)
- Laura D Vagnini
- Paulista Centre for Diagnosis Research and Training, CPDP, Ribeirao Preto, Brazil.
| | - Adriana Renzi
- Paulista Centre for Diagnosis Research and Training, CPDP, Ribeirao Preto, Brazil
| | - Cláudia G Petersen
- Paulista Centre for Diagnosis Research and Training, CPDP, Ribeirao Preto, Brazil; Centre for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
| | - Felipe Dieamant
- Centre for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
| | - João Batista A Oliveira
- Paulista Centre for Diagnosis Research and Training, CPDP, Ribeirao Preto, Brazil; Centre for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
| | | | - José G Franco Junior
- Paulista Centre for Diagnosis Research and Training, CPDP, Ribeirao Preto, Brazil; Centre for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
| | - Antônio H Oliani
- São José do Rio Preto School of Medicine FAMERP, Sao Jose do Rio Preto, Brazil
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Ebid AHIM, Motaleb SMA, Mostafa MI, Soliman MMA. Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: A modeling approach. Clin Exp Reprod Med 2021; 48:163-173. [PMID: 34024083 PMCID: PMC8176155 DOI: 10.5653/cerm.2020.03909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. METHODS This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. RESULTS The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women's age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. CONCLUSION Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.
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Zhou SJ, Sun TC, Song LL, Yang M, Sun XP, Tian L. The status and comparison of ovarian reserve between fertile and infertile healthy Chinese women of reproductive age. Medicine (Baltimore) 2021; 100:e25361. [PMID: 33907092 PMCID: PMC8084010 DOI: 10.1097/md.0000000000025361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022] Open
Abstract
ABSTRACT We aimed to investigate ovarian reserve status, and explore differences in ovarian reserve between fertile and infertile healthy Chinese women of reproductive age.We recruited 442 fertile women aged 23 to 49 years (mean: 35.22 ± 4.91 years) as subjects, and 196 infertile women aged 23 to 46 years (mean: 32.34 ± 4.34 years) as controls. For all participants, a number of parameters were tested on days 2 to 4 of a spontaneous cycle, including basal serum follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), total testosterone, anti-Müllerian hormone (AMH), ovarian response prediction index (ORPI), and antral follicle count (AFC).There were significant differences in terms of AFC, serum AMH levels, and ORPI among subject subgroups (10.58 ± 5.80; 2.533 ± 2.146 ng/mL; 1.28 ± 1.87; respectively), and among control subgroups (12.44 ± 5.69; 3.189 ± 2.551 ng/mL; 1.88 ± 2.68; respectively) (P < .01 for all). For both subjects and controls, AFC, AMH levels, and ORPI decreased gradually with increasing age, and presented with similar age-related trends; there were positive correlations between AMH and AFC (P < .001), and negative correlations between age and AFC, AMH, ORPI (P < .05 for all). There was a significant difference in age (P < .001), serum E2 (P < .01), and AMH (P < .01) levels between subjects and controls; however, when controlling for confounding factors (age, body mass index, total testosterone, and LH), we found no differences between the 2 groups with regards to the serum levels of AMH, FSH, E2, and AFC (P > .05 for all). Moreover, receiver operating characteristic curve analysis indicated that the significant variables of subjects and controls for evaluating ovarian reserve included age, AMH and ORPI, and ORPI was more valuable than other variables.A diminished ovarian reserve was one of the manifestations caused by female aging. When confounding factors were controlled for, we found no differences in ovarian reserve when compared between fertile and infertile women, and no correlation with infertility.
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Affiliation(s)
- Shan-Jie Zhou
- Reproductive Medicine Center, Department of Gynecology and Obstetrics
| | - Tie-Cheng Sun
- Reproductive Medicine Center, Department of Gynecology and Obstetrics
| | - Ling-Li Song
- Reproductive Medicine Center, Department of Gynecology and Obstetrics
| | - Ming Yang
- Department of Clinical Laboratory, Peking University International Hospital, Beijing, China
| | - Xin-Ping Sun
- Department of Clinical Laboratory, Peking University International Hospital, Beijing, China
| | - Li Tian
- Reproductive Medicine Center, Department of Gynecology and Obstetrics
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Peluso C, Oliveira RD, Laporta GZ, Christofolini DM, Fonseca FLA, Laganà AS, Barbosa CP, Bianco B. Are ovarian reserve tests reliable in predicting ovarian response? Results from a prospective, cross-sectional, single-center analysis. Gynecol Endocrinol 2021; 37:358-366. [PMID: 32613875 DOI: 10.1080/09513590.2020.1786509] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJETIVE Several biomarkers of ovarian reserve have been proposed as possible predictors of the response to controlled ovarian stimulation (COS). We aimed to evaluate age, FSH, AMH, antral follicle count (AFC), and ovarian response prediction index (ORPI), as potential predictors of response to COS. METHODS Cross-sectional study enrolling of 188 infertile women who underwent the first cycle of IVF/ICSI. AFC was evaluated; serum FSH and AMH levels were measured by ELISA. ORPI was calculated as AMH x AFC/patient´s age. RESULTS As expected, hypo-responder group had less retrieved oocytes, MII, and embryos compared to the good responders. The hyper-response patients were younger, with lower FSH, increased AMH, AFC, and ORPI values. Regarding the assessment of the predictive capacity of ovarian reserve tests, none of them individually or combined showed a good predictive capacity for hypo-response. With respect to the hyper-responder group, individually AMH was the best predictor, while in the multivariable model, ORPI demonstrated the best predictive capacity. Furthermore, patients with serum AMH < 2.09 ng/mL (p25) had fewer AFC than patients with higher AMH values. CONCLUSIONS Our findings suggest that none of the ovarian reserve tests showed a good predictive capacity for hypo-response, while the ORPI was the strongest predictor of hyper-response in normovulatory infertile women.
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Affiliation(s)
- Carla Peluso
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | - Renato de Oliveira
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | - Gabriel Zorello Laporta
- Program of Postgraduate, Research and Innovation, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | - Denise Maria Christofolini
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | | | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Caio Parente Barbosa
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | - Bianca Bianco
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
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Eisele BS, Silva GCV, Bessow C, Donato R, Genro VK, Cunha-Filho JS. An in silico model using prognostic genetic factors for ovarian response in controlled ovarian stimulation: A systematic review. J Assist Reprod Genet 2021; 38:2007-2020. [PMID: 33788133 DOI: 10.1007/s10815-021-02141-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/02/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To study the use of in silica model to better understand and propose new markers of ovarian response to controlled ovarian stimulation before IVF. METHODS A systematic review and in silica model using bioinformatics. After the selection of 103 papers from a systematic review process, we performed a GRADE qualification of all included papers for evidence-based quality evaluation. We included 57 genes in the silica model using a functional protein network interaction. Moreover, the construction of protein-protein interaction network was done importing these results to Cytoscape. Therefore, a cluster analysis using MCODE was done, which was exported to a plugin BINGO to determine Gene Ontology. A p value of < 0.05 was considered significant, using a Bonferroni correction test. RESULTS In silica model was robust, presenting an ovulation-related gene network with 87 nodes (genes) and 348 edges (interactions between the genes). Related to the network centralities, the network has a betweenness mean value = 102.54; closeness mean = 0.007; and degree mean = 8.0. Moreover, the gene with a higher betweenness was PTPN1. Genes with the higher closeness were SRD5A1 and HSD17B3, and the gene with the lowest closeness was GDF9. Finally, the gene with a higher degree value was UBB; this gene participates in the regulation of TP53 activity pathway. CONCLUSIONS This systematic review demonstrated that we cannot use any genetic marker before controlled ovarian stimulation for IVF. Moreover, in silica model is a useful tool for understanding and finding new markers for an IVF individualization. PROSPERO CRD42020197185.
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Affiliation(s)
- B S Eisele
- Obstetrics/Gynecology Post-Graduate Program, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350-11 andar, Porto Alegre, Rio Grande do Sul, CEP 91003-001, Brazil
| | - G C Villalba Silva
- Graduate Program in Genetics and Molecular Biology, Gene Therapy Center and Bioinformatics Core, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - C Bessow
- Obstetrics/Gynecology Post-Graduate Program, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350-11 andar, Porto Alegre, Rio Grande do Sul, CEP 91003-001, Brazil
| | - R Donato
- Obstetrics/Gynecology Post-Graduate Program, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350-11 andar, Porto Alegre, Rio Grande do Sul, CEP 91003-001, Brazil
| | - V K Genro
- Hospital de Clínicas de Porto Alegre, Ob/Gyn Service, Porto Alegre, Rio Grande do Sul, Brazil
| | - J S Cunha-Filho
- Obstetrics/Gynecology Post-Graduate Program, Medical School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2350-11 andar, Porto Alegre, Rio Grande do Sul, CEP 91003-001, Brazil.
- Hospital de Clínicas de Porto Alegre, Ob/Gyn Service, Porto Alegre, Rio Grande do Sul, Brazil.
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Zhou SJ, Zhao MJ, Li C, Su X. The comparison of evaluative effectiveness between antral follicle count/age ratio and ovarian response prediction index for the ovarian reserve and response functions in infertile women. Medicine (Baltimore) 2020; 99:e21979. [PMID: 32899038 PMCID: PMC7478524 DOI: 10.1097/md.0000000000021979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim of the present study was to explore the evaluative effectiveness of age, ovarian volume (OV), antral follicle count (AFC), serum follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), AFC/Age ratio, AMH/Age ratio, FSH/luteinizing hormone (LH) ratio, and ovarian response prediction index (ORPI) to determine which could more advantageously assess ovarian reserve and response.This research enrolled 319 consecutive infertile women who had undergone in vitro fertilization-ET/intracytoplasmic sperm injection (IVF-ET/ICSI) treatments. Abovementioned variables were measured and calculated. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive accuracy of variables and to calculate cut-off values and corresponding sensitivity and specificity.Our study revealed that the significant variables for evaluating a decline in ovarian reserve include age, OV, FSH, AFC/Age ratio, AMH/Age ratio, and ORPI. Moreover, the area under the curve (AUC) of AFC/Age ratio was higher than other 5 variables (AUC = 1.000), and the cut-off value of AFC/Age ratio was 0.111 (sensitivity 100.00%, specificity 100.00%). The significant variables forecasting excessive ovarian response were age, AFC, AMH, FSH, AFC/Age ratio, AMH/Age ratio, FSH/LH ratio, and ORPI, and the significant variables forecasting poor ovarian response were AMH, LH, OV, AFC/Age ratio, AMH/Age ratio, and FSH/LH ratio. When ORPI was used to predict excessive response, the cut-off value of ORPI was 0.880 (sensitivity 84.72%, specificity 67.32%) and ORPI presented better effectiveness. When used to predict poor response, the evaluative effectiveness of 6 variables was almost similar, although the AUC of AFC/Age ratio presented the largest value.Regarding the infertile women, AFC/Age ratio performed better than did the other variables in evaluating ovarian reserve, and it offered excellent effectiveness in predicting poor ovarian response, however, ORPI presented better effectiveness in predicting excessive ovarian response.
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Affiliation(s)
- Shan-Jie Zhou
- Reproductive Medicine Center, Department of Gynecology and Obstetrics, Peking University International Hospital, Beijing
| | - Ming-Jia Zhao
- Department of Reproduction and Genetics, Tangshan Maternity and Child Healthcare Hospital, Tangshan, China
| | - Cui Li
- Department of Reproduction and Genetics, Tangshan Maternity and Child Healthcare Hospital, Tangshan, China
| | - Xing Su
- Department of Reproduction and Genetics, Tangshan Maternity and Child Healthcare Hospital, Tangshan, China
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15
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Ng DYT, Ko JKY, Li HWR, Lau EYL, Yeung WSB, Ho PC, Ng EHY. Performance of ovarian response prediction index (ORPI) in predicting ovarian response and livebirth in the in-vitro fertilisation cycle using a standard stimulation with corifollitropin alpha in a GnRH antagonist protocol. HUM FERTIL 2020; 25:1-7. [PMID: 32787471 DOI: 10.1080/14647273.2020.1805517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/10/2020] [Indexed: 01/22/2023]
Abstract
The objective of this study was to evaluate the performance of ovarian response prediction index (ORPI) in predicting ovarian response and livebirth of women undergoing their first in-vitro fertilisation (IVF) cycle. This is a retrospective analysis of 285 women from 2013 to 2016. The outcome measures were area (AUC) under the receiver-operator characteristic (ROC) curves for prediction of excessive and poor response, livebirth in the fresh cycle and cumulative livebirth. The ORPI was significantly correlated with the oocyte number. For prediction of excessive response, AUC for ORPI was comparable to AMH and significantly higher than AFC and female age. At a cut-off of 0.42, ORPI has a sensitivity and specificity of 84% and 77% respectively for prediction of excessive response. For prediction of poor response, AUC for ORPI was significantly higher than AFC, AMH and female age. At a cut-off of 0.12, ORPI has a sensitivity of 69% and specificity of 89% respectively for prediction of poor response. For prediction of livebirth, AUCs of ORPI were not significantly different from AFC and female age. Therefore, ORPI is not a good predictor of livebirth. Its prediction of excessive and poor ovarian response is comparable to that of serum AMH.
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Affiliation(s)
- Dorothy Yuet Tao Ng
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Jennifer Ka Yee Ko
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Estella Yee Lan Lau
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - William Shu Biu Yeung
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
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Li HWR, Nelson SM. Clinical Application of AMH Measurement in Assisted Reproduction. Front Endocrinol (Lausanne) 2020; 11:606744. [PMID: 33362720 PMCID: PMC7757755 DOI: 10.3389/fendo.2020.606744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/30/2020] [Indexed: 12/27/2022] Open
Abstract
Anti-Müllerian hormone reflects the continuum of the functional ovarian reserve, and as such can predict ovarian response to gonadotropin stimulation and be used to individualize treatment pathways to improve efficacy and safety. However, consistent with other biomarkers and age-based prediction models it has limited ability to predict live birth and should not be used to refuse treatment, but rather to inform counselling and shared decision making. The use of absolute clinical thresholds to stratify patient phenotypes, assess discordance and individualize treatment protocols in non-validated algorithms combined with the lack of standardization of assays may result in inappropriate classification and sub-optimal clinical decision making. We propose that holistic baseline phenotyping, incorporating antral follicle count and other patient characteristics is critical. Treatment decisions driven by validated algorithms that use ovarian reserve biomarkers as continuous measures, reducing the risk of misclassification, are likely to improve overall outcomes for our patients.
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Affiliation(s)
- Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
- *Correspondence: Hang Wun Raymond Li,
| | - Scott M. Nelson
- School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
- The Fertility Partnership, Oxford, United Kingdom
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Dieamant F, Vagnini LD, Petersen CG, Mauri AL, Renzi A, Petersen B, Mattila MC, Nicoletti A, Oliveira JBA, Baruffi R, Franco Jr. JG. New therapeutic protocol for improvement of endometrial receptivity (PRIMER) for patients with recurrent implantation failure (RIF) - A pilot study. JBRA Assist Reprod 2019; 23:250-254. [PMID: 31091064 PMCID: PMC6724389 DOI: 10.5935/1518-0557.20190035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/04/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate whether or not one should use a new Protocol for Endometrial Receptivity Improvement (PRIMER) based on platelet-rich plasma (PRP) and granulocyte colony-stimulation factor (G-CSF) to enhance ongoing pregnancy rates in patients with recurrent implantation failure (RIF). METHODS Women undergoing IVF/ICSI were prospectively divided into two groups: - PRIMER/RIF group (n:33): patients with RIF (defined as ≥2embryo transfers (ETs) and at least 5 morphologically good embryos transferred) in which intrauterine PRP injection and subcutaneous G-CSF-injection were performed. - Control group (n:33): patients in their first IVF/ICSI attempt/cycle (without PRP or G-CSF injection). The PRP was prepared using autologous fresh-whole blood processed to increase platelet-concentration in 2 to 4 fold. All patients undergoing the PRP-treatment received 0.7ml of it through intrauterine-injection 48 hours before the ET. G-CSF (300mg/0.5ml) started simultaneously to PRP and was administered subcutaneously every week. RESULTS Regarding implantation, clinical pregnancy and miscarriage rates, we found no statistically significant difference (18.2% versus 17.6%, p=0.90; 36.4% versus 30.3%, p=0.61 and 25.0% versus 9.0%, p=0.43, respectively). The use of PRIMER enabled RIF patients (previous ET µ: 4.0±1.5) to reach similar ongoing pregnancy and live birth rates like those patients who had their first IVF/ICSI cycle attempt (27.3% versus 27.3%, p=0.99). CONCLUSIONS Our results showed, for the first time, evidence that this therapeutic protocol (PRIMER) could be used as a feasible treatment based on biological rationale for patients with RIF, considering its promising outcomes, it is a simple procedure and not associated with patient complications.
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Affiliation(s)
- Felipe Dieamant
- Center for Human Reproduction Prof Franco Jr. Ribeirão
Preto, Brazil
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | - Laura D. Vagnini
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | - Claudia G. Petersen
- Center for Human Reproduction Prof Franco Jr. Ribeirão
Preto, Brazil
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | - Ana L. Mauri
- Center for Human Reproduction Prof Franco Jr. Ribeirão
Preto, Brazil
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | - Adriana Renzi
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | - Bruna Petersen
- Center for Human Reproduction Prof Franco Jr. Ribeirão
Preto, Brazil
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | | | - Andreia Nicoletti
- Center for Human Reproduction Prof Franco Jr. Ribeirão
Preto, Brazil
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | - Joao Batista A. Oliveira
- Center for Human Reproduction Prof Franco Jr. Ribeirão
Preto, Brazil
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | - Ricardo Baruffi
- Center for Human Reproduction Prof Franco Jr. Ribeirão
Preto, Brazil
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
| | - Jose G. Franco Jr.
- Center for Human Reproduction Prof Franco Jr. Ribeirão
Preto, Brazil
- Paulista Center for Diagnosis Research and Training.
Ribeirão Preto, Brazil
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Selcuk S, Bilgic BE, Kilicci C, Kucukbas M, Cam C, Kutlu HT, Karateke A. Comparison of ovarian responsiveness tests with outcome of assisted reproductive technology - a retrospective analysis. Arch Med Sci 2018; 14:851-859. [PMID: 30002704 PMCID: PMC6040134 DOI: 10.5114/aoms.2016.62447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study aims to compare the association between the most commonly used ovarian responsiveness markers - age, anti-Müllerian hormone levels (AMH), antral follicle count (AFC), ovarian sensitivity index (OSI), and ovarian response prediction index (ORPI) - and ovarian responsiveness to gonadotropin stimulation in assisted reproductive technology (ART) cycles. MATERIAL AND METHODS Patients who underwent intracytoplasmic sperm injection treatment using either a gonadotropin releasing hormone (GnRH) antagonist or agonist protocol were enrolled in the study. Data of the patients were abstracted from the hospital's database. Tests were compared for total number of retrieved oocytes, metaphase II (MII) oocytes, embryos, good quality embryos on day 1 and day 3, and ongoing pregnancies per cycle. RESULTS The OSI was the ovarian response test that had the strongest relationship with the ART outcomes. The level of association between the ovarian response tests and poor ovarian response data was (in descending order): OSI, ORPI, AFC, AMH, and age (AUCOSI = 0.976, AUCORPI = 0.905, AUCAFC = 0.899, AUCAMH = 0.864, AUCage = 0.617). The overall association between OSI and poor ovarian response was significantly higher than the other parameters (p1 = 0.0023, p2 = 0.0014, p3 = 0.0001, p4 ≤ 0.0001). In patients with high ovarian response data, OSI had the highest association, followed by AFC and ORPI age (AUCOSI = 0.984, AUCAFC = 0.907, AUCORPI = 0.887). There was no statistically significant difference among the tests for the data of patients with ongoing pregnancies. CONCLUSIONS In this study, which is the first study comparing the five most frequently used ovarian responsiveness markers and the second study signifying the role of OSI in an antagonist protocol, OSI was found to be more convenient to calculate, and it could be superior to other ovarian responsiveness markers for poor and high ovarian responses on cycles with agonist or antagonist protocols.
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Affiliation(s)
- Selcuk Selcuk
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Bulent Emre Bilgic
- Department of IVF, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Cetin Kilicci
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Kucukbas
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Cetin Cam
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Huseyin Tayfun Kutlu
- Department of IVF, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Ates Karateke
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
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Ashrafi M, Hemat M, Arabipoor A, Salman Yazdi R, Bahman-Abadi A, Cheraghi R. Predictive values of anti-müllerian hormone, antral follicle count and ovarian response prediction index (ORPI) for assisted reproductive technology outcomes. J OBSTET GYNAECOL 2016; 37:82-88. [DOI: 10.1080/01443615.2016.1225025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Mandana Hemat
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Salman Yazdi
- Department of Andrology, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Akram Bahman-Abadi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Rezvaneh Cheraghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Oliveira JBA, Franco JG. The ovarian response prediction index (ORPI) as a clinical internal quality control to prevent ovarian hyperstimualtion syndrome. JBRA Assist Reprod 2016; 20:91-2. [PMID: 27584597 PMCID: PMC5264369 DOI: 10.5935/1518-0557.20160021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moro F, Tropea A, Scarinci E, Leoncini E, Boccia S, Federico A, Alesiani O, Lanzone A, Apa R. Anti-Müllerian hormone concentrations and antral follicle counts for the prediction of pregnancy outcomes after intrauterine insemination. Int J Gynaecol Obstet 2015; 133:64-8. [PMID: 26873125 DOI: 10.1016/j.ijgo.2015.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/03/2015] [Accepted: 12/08/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate anti-Müllerian hormone (AMH) concentrations and antral follicle counts (AFCs) in the prediction of pregnancy outcomes after controlled ovarian stimulation among women undergoing intrauterine insemination. METHODS A retrospective study included women with unexplained infertility aged 41years or younger who attended a fertility clinic in Italy between December 2009 and May 2014. Ovarian stimulation was achieved with recombinant follicle-stimulating hormone or highly purified human menopausal gonadotropin. Receiver operating characteristic curves were generated to predict ongoing pregnancy. The primary outcome was the association between AMH/AFC and ongoing pregnancy, and was assessed by logistic regression. RESULTS Overall, 276 women were included, of whom 43 (15.6%) achieved ongoing pregnancy. Multivariate analysis showed that women with a serum day-3 concentration of AMH higher than 2.3ng/mL were more likely to have ongoing pregnancy than were those with a concentration lower than 2.3ng/mL (odds ratio 5.84, 95% confidence interval 2.38-14.31; P<0.001). No associations were recorded for AFCs. CONCLUSION AMH should be used to predict the pregnancy outcome of intrauterine insemination.
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Affiliation(s)
- Francesca Moro
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Anna Tropea
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Scarinci
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Leoncini
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alex Federico
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ornella Alesiani
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosanna Apa
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Oliveira JBA, Vagnini LD, Petersen CG, Renzi A, Oliveira-Pelegrin GR, Mauri AL, Ricci J, Massaro FC, Dieamant F, Cavagna M, Baruffi RLR, Franco JG. Association between leukaemia inhibitory factor gene polymorphism and pregnancy outcomes after assisted reproduction techniques. Reprod Biomed Online 2015; 32:66-78. [PMID: 26615902 DOI: 10.1016/j.rbmo.2015.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
Certain gene polymorphisms are associated with implantation failure and pregnancy loss. Studies of leukaemia inhibitory factor (LIF) gene polymorphisms are scarce. The LIF single nucleotide polymorphism (SNP) thymine (T)/guanine (G) (rs929271) was studied in women to determine whether an association existed with pregnancy outcomes after intracytoplasmic sperm injection (ICSI); 411 women who underwent ICSI were recruited. DNA was extracted from the peripheral blood, and the LIF gene SNP T/G (rs929271) was genotyped using real-time polymerase chain reaction. Participants were divided into three groups according to their LIF genotype: T/T (n = 168), T/G (n = 202) and G/G (n = 41). All IVF and ICSI procedures were carried out under the same clinical and laboratory conditions. The ICSI cumulative results (from fresh plus frozen cycles) of each genotype group were analysed. The G/G genotype in women was associated with a higher implantation rate (T/T: 15.9%, T/G: 16.2%, G/G: 27.0%; P < 0.05), ongoing pregnancy rate/patient (T/T: 31.5%, T/G: 36.1%, G/G: 53.7%; P < 0.05) and ongoing pregnancy rate/transfer (T/T: 18.5%, T/G: 20.2%, G/G: 36.7%; P < 0.05). LIF SNP T/G (rs929271) seems to be a susceptibility biomarker capable of predicting implantation efficiency and pregnancy outcomes.
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Affiliation(s)
- Joao Batista A Oliveira
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil; Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil
| | - Laura D Vagnini
- Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil
| | - Claudia G Petersen
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil; Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil
| | - Adriana Renzi
- Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil
| | | | - Ana L Mauri
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil; Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil
| | - Juliana Ricci
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil
| | - Fabiana C Massaro
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil
| | - Felipe Dieamant
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil; Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil
| | - Mario Cavagna
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil; Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil; Women's Health Reference Center, Perola Byington Hospital, Sao Paulo, SP, Brazil
| | - Ricardo L R Baruffi
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil; Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil
| | - Jose G Franco
- Center for Human Reproduction Prof Franco Jr., Ribeirao Preto, SP, Brazil; Paulista Center for Diagnosis Research and Training, Ribeirao Preto, SP, Brazil.
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23
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Vagnini LD, Renzi A, Oliveira-Pelegrin GR, Canas MDCT, Petersen CG, Mauri AL, Oliveira JBA, Baruffi RLR, Cavagna M, Franco Junior JG. The TP73 gene polymorphism (rs4648551, A>G) is associated with diminished ovarian reserve. PLoS One 2015; 10:e0120048. [PMID: 25794170 PMCID: PMC4368621 DOI: 10.1371/journal.pone.0120048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/03/2015] [Indexed: 11/29/2022] Open
Abstract
It’s known that the members of the TP53 family are involved in the regulation of female reproduction. Studies in mice showed that the TP73 gene (member of this family) plays a role in the size of follicular pool, ovulation rate and maintenance of genomic stability. In the present study we analyzed data from 605 patients with ≤ 37 years attending their first intracytoplasmic sperm injection (ICSI). The association between the TP73 polymorphism (rs4648551, A>G) and the following parameters related to ovarian reserve, like age, antral follicular count (AFC), anti-Mullerian hormone levels (AMH) and ovarian response prediction index (ORPI) was evaluated. Our results showed an association of the AA genotype with diminished ovarian reserve (AMH <1, AFC ≤9). Women presenting the AA genotype had a 2.0-fold increased risk for having AMH <1 and AFC ≤9 (OR 2.0, 95% CI 1.23-3.31, P = 0.005). Patients presenting AA genotype had the lowest levels of AMH (P = 0.02), the lowest number of antral follicles (P = 0.01) and the lowest ORPI (P = 0.007). Analyzing the alleles, we can see an enrichment of the A allele in the group of diminished ovarian reserve (OR 1.4, 95%CI 1.02-1.83, P = 0.04). To the best of our knowledge, the present study is the first to analyze this polymorphism in humans for assessing the numbers of ovarian follicles and AMH levels and, therefore, the ovarian reserve. Our findings can contribute to the use of this polymorphism as a potential marker of diminished ovarian reserve.
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Affiliation(s)
- Laura Diniz Vagnini
- Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, São Paulo, Brazil
| | - Adriana Renzi
- Paulista Center for Diagnosis, Research and Training, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Ana Lucia Mauri
- Center for Human Reproduction Prof. Franco Jr, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Mario Cavagna
- Center for Human Reproduction Prof. Franco Jr, Ribeirão Preto, São Paulo, Brazil
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24
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Comparative genomic hybridization selection of blastocysts for repeated implantation failure treatment: a pilot study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:457913. [PMID: 24779011 PMCID: PMC3980987 DOI: 10.1155/2014/457913] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 02/10/2014] [Indexed: 12/11/2022]
Abstract
The aim of this study is to determine if the use of preimplantation genetic screening (PGS) by array comparative genomic hybridization (array CGH) and transfer of a single euploid blastocyst in patients with repeated implantation failure (RIF) can improve clinical results. Three patient groups are compared: 43 couples with RIF for whom embryos were selected by array CGH (group RIF-PGS), 33 couples with the same history for whom array CGH was not performed (group RIF NO PGS), and 45 good prognosis infertile couples with array CGH selected embryos (group NO RIF PGS). A single euploid blastocyst was transferred in groups RIF-PGS and NO RIF PGS. Array CGH was not performed in group RIF NO PGS in which 1-2 blastocysts were transferred. One monoembryonic sac with heartbeat was found in 28 patients of group RIF PGS and 31 patients of group NO RIF PGS showing similar clinical pregnancy and implantation rates (68.3% and 70.5%, resp.). In contrast, an embryonic sac with heartbeat was only detected in 7 (21.2%) patients of group RIF NO PGS. In conclusion, PGS by array CGH with single euploid blastocyst transfer appears to be a successful strategy for patients with multiple failed IVF attempts.
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