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Iakovidou MC, Kolibianakis E, Zepiridis L, Venetis C. The role of endometrial scratching prior to in vitro fertilization: an updated systematic review and meta-analysis. Reprod Biol Endocrinol 2023; 21:89. [PMID: 37784097 PMCID: PMC10544419 DOI: 10.1186/s12958-023-01141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023] Open
Abstract
RESEARCH QUESTION To evaluate the role of endometrial scratching performed prior to an embryo transfer cycle on the probability of pregnancy compared to placebo/sham or no intervention. DESIGN A computerized literature (using a specific search strategy) search was performed across the databases MEDLINE, EMBASE, COCHRANE CENTRAL, SCOPUS and WEB OF SCIENCE up to June 2023 in order to identify randomized controlled trials (RCTs) evaluating the effect of endometrial scratching prior to an embryo transfer cycle on the probability of pregnancy, expressed either as live birth, ongoing pregnancy or clinical pregnancy (in order of significance) compared to placebo/sham or no intervention. Data were pooled using random-effects or fixed-effects model, depending on the presence or not of heterogeneity. Heterogeneity was assessed using the I2 statistic. Subgroup analyses were performed based on the population studied in each RCT, as well as on the timing and method of endometrial biopsy. Certainty of evidence was assessed using the GRADEPro tool. RESULTS The probability of live birth was significantly higher in embryo transfer cycles after endometrial scratching as compared to placebo/sham or no intervention (relative risk-RR: 1.12, 95% CI: 1.05-1.20; heterogeneity: I2=46.30%, p<0.001, 28 studies; low certainty). The probability of ongoing pregnancy was not significantly difference between the two groups (RR: 1.07, 95% CI: 0.98-1.18; heterogeneity: I2=27.44%, p=0.15, 11 studies; low certainty). The probability of clinical pregnancy was significantly higher in embryo transfer cycles after endometrial scratching as compared to placebo/sham or no intervention (RR: 1.12, 95% CI: 1.06-1.18; heterogeneity: I2=47.48%, p<0.001, 37 studies; low certainty). A subgroup analysis was performed based on the time that endometrial scratching was carried out. When endometrial scratching was performed during the menstrual cycle prior to the embryo transfer cycle a significantly higher probability of live birth was present (RR: 1.18, 95% CI:1.09-1.27; heterogeneity: I2=39.72%, p<0.001, 21 studies; moderate certainty). On the contrary, no effect on the probability of live birth was present when endometrial injury was performed during the embryo transfer cycle (RR: 0.87, 95% CI: 0.67-1.15; heterogeneity: I2=65.18%, p=0.33, 5 studies; low certainty). In addition, a higher probability of live birth was only present in women with previous IVF failures (RR: 1.35, 95% CI: 1.20-1.53; heterogeneity: I2=0%, p<0.001, 13 studies; moderate certainty) with evidence suggesting that the more IVF failures the more likely endometrial scratching to be beneficial (p=0.004). The number of times endometrial scratching was performed, as well as the type of instrument used did not appear to affect the probability of live birth. CONCLUSIONS Endometrial scratching during the menstrual cycle prior to an embryo transfer cycle can lead to a higher probability of live birth in patients with previous IVF failures. PROSPERO REGISTRATION PROSPERO CRD42023433538 (18 Jun 2023).
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Affiliation(s)
- Maria Chrysoula Iakovidou
- Unit for Human Reproduction, Medical School, 1st Department of Obstetrics & Gynecology, Papageorgiou General Hospital, Peripheral Road, Nea Efkarpia, 56430, Thessaloniki, Greece
| | - Efstratios Kolibianakis
- Unit for Human Reproduction, Medical School, 1st Department of Obstetrics & Gynecology, Papageorgiou General Hospital, Peripheral Road, Nea Efkarpia, 56430, Thessaloniki, Greece
| | - Leonidas Zepiridis
- Unit for Human Reproduction, Medical School, 1st Department of Obstetrics & Gynecology, Papageorgiou General Hospital, Peripheral Road, Nea Efkarpia, 56430, Thessaloniki, Greece
| | - Christos Venetis
- Unit for Human Reproduction, Medical School, 1st Department of Obstetrics & Gynecology, Papageorgiou General Hospital, Peripheral Road, Nea Efkarpia, 56430, Thessaloniki, Greece.
- Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia.
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Yung Y, Aizer A, Tieb S, Maydan SA, Maman E, Haham LM, Haas J, Orvieto R. The in-vitro effect of gonadotropins' type and combination on Granulosa cells gene expressions. Reprod Biol Endocrinol 2022; 20:144. [PMID: 36153536 PMCID: PMC9508785 DOI: 10.1186/s12958-022-01017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Nowadays, different modes and timing of GnRH-agonist combined with hCG trigger, for final follicular maturation, have been described. While LH + FSH are the naturally occurring final follicular maturation trigger, hCG is commonly use during stimulated cycle, and recently the introduction of the Dual/Double trigger combines LH + FSH + hCG. In the present study we aim to investigate the messenger RNA (mRNA) expression of reproduction-related genes in human granulosa cells (GCs) exposed to the aforementioned different types and combinations of gonadotropins. MATERIAL AND METHODS Mural GCs were obtained from follicular fluid aspirated during IVF protocol. GCs were seeded in culture for 4 days with daily medium exchange followed by administration of either hCG (1 U/ml); FSH (1 U/ml) and LH (8 U/ml); or hCG (1 U/ml) and FSH (1 U/ml) and LH (8 U/ml) for 16 h. mRNA was purified from harvested GCs and gene expression was quantitative by qPCR. MAIN OUTCOME MEASURES The expression of genes related to steroidogenesis (StAR/ CYP19) and oocyte maturation (COX2/Amphiregulin) in cultured GCs. RESULTS The Dual/Double trigger (LH + FSH + hCG) showed higher activation of steroidogenesis (StAR/CYP19) and maturation (COX2/Amphiregulin) as compared to the naturally occurring trigger (LH + FSH) and the hCG triggers. Moreover, while the naturally occurring trigger (LH + FSH) activated maturation significantly and more intensely than the hCG trigger, no in between group differences were observed with regards to steroidogenic related genes. CONCLUSIONS Our findings are in agreement with clinical experience, demonstrating the superiority of the double/dual (LH + FSH + hCG) trigger over the naturally occurring and the hCG triggers.
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Affiliation(s)
- Yuval Yung
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Adva Aizer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Sarah Tieb
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Avhar Maydan
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ettie Maman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Lilach Marom Haham
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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Tulek F, Kahraman A, Demirel LC. Dual trigger with gonadotropin releasing hormone agonist and human chorionic gonadotropin improves live birth rates in POSEIDON group 3 and 4 expected poor responders. Gynecol Endocrinol 2022; 38:731-735. [PMID: 35856433 DOI: 10.1080/09513590.2022.2101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Aim of this study was to evaluate the effects of dual triggering with gonadotropin releasing hormone agonist and human chorionic gonadotropin (hCG) on outcomes of fresh embryo transfers following gonadotropin antagonist cycles in POSEIDON group 3 and group 4 low prognosis women and to compare the outcomes with hCG-only triggering. METHODS This study was conducted by retrospective analysis of patients with expected poor ovarian response (POSEIDON group 3 and 4) that underwent fresh embryo transfers following in-vitro fertilization/intracytoplasmic sperm injection cycles with either dual triggering or hCG-only triggering between January 2010 and April 2020. A total of 1068 women that underwent dual triggering and 1931 that underwent hCG-only triggering were included in the study. RESULTS Number of retrieved oocytes, M2 oocytes, oocyte maturation rate, fertilization rate, obtained 2PN embryos, implantation rate, clinical pregnancy rate and live birth delivery rates were found significantly higher in dual-triggering group in comparison to hCG-only group (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.02, p < 0.001 respectively). CONCLUSION Dual trigger with concomitant injections of GnRH agonist and hCG in GnRH antagonist cycles appears to improve IVF outcomes, increase quality of embryos, reduce miscarriage rates and consequently increase live birth delivery rates in POSEIDON groups 3/4 poor responders.
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Affiliation(s)
- Firat Tulek
- Faculty of Health Sciences, Department of Midwifery, Uskudar University, Istanbul, Turkey
- Department of Obstetrics and Gynecology, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Alper Kahraman
- Department of Obstetrics and Gynecology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Lutfi Cem Demirel
- Department of Obstetrics and Gynecology, Memorial Atasehir Hospital, Istanbul, Turkey
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Pretreatment: Does it improve quantity or quality? Fertil Steril 2022; 117:657-663. [DOI: 10.1016/j.fertnstert.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
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Avraham S, Kedem A, Zur H, Youngster M, Yaakov O, Yerushalmi GM, Gat I, Gidoni Y, Hochberg A, Baum M, Hourvitz A, Maman E. COVID-19 Vaccination and Infertility Treatment Outcomes. Fertil Steril 2022; 117:1291-1299. [PMID: 35437147 PMCID: PMC8872833 DOI: 10.1016/j.fertnstert.2022.02.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/04/2022]
Abstract
Objective Design Setting Patient(s) Intervention(s) Main Outcome Measure(s) Result(s) Conclusion(s)
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Orvieto R, Venetis CA, Fatemi HM, D’Hooghe T, Fischer R, Koloda Y, Horton M, Grynberg M, Longobardi S, Esteves SC, Sunkara SK, Li Y, Alviggi C. Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus. Front Endocrinol (Lausanne) 2021; 12:675670. [PMID: 34040586 PMCID: PMC8142593 DOI: 10.3389/fendo.2021.675670] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A Delphi consensus was conducted to evaluate global expert opinions on key aspects of assisted reproductive technology (ART) treatment. METHODS Ten experts plus the Scientific Coordinator discussed and amended statements plus supporting references proposed by the Scientific Coordinator. The statements were distributed via an online survey to 35 experts, who voted on their level of agreement or disagreement with each statement. Consensus was reached if the proportion of participants agreeing or disagreeing with a statement was >66%. RESULTS Eighteen statements were developed. All statements reached consensus and the most relevant are summarised here. (1) Follicular development and stimulation with gonadotropins (n = 9 statements): Recombinant human follicle stimulating hormone (r-hFSH) alone is sufficient for follicular development in normogonadotropic patients aged <35 years. Oocyte number and live birth rate are strongly correlated; there is a positive linear correlation with cumulative live birth rate. Different r-hFSH preparations have identical polypeptide chains but different glycosylation patterns, affecting the biospecific activity of r-hFSH. r-hFSH plus recombinant human LH (r-hFSH:r-hLH) demonstrates improved pregnancy rates and cost efficacy versus human menopausal gonadotropin (hMG) in patients with severe FSH and LH deficiency. (2) Pituitary suppression (n = 2 statements): Gonadotropin releasing hormone (GnRH) antagonists are associated with lower rates of any grade ovarian hyperstimulation syndrome (OHSS) and cycle cancellation versus GnRH agonists. (3) Final oocyte maturation triggering (n=4 statements): Human chorionic gonadotropin (hCG) represents the gold standard in fresh cycles. The efficacy of hCG triggering for frozen transfers in modified natural cycles is controversial compared with LH peak monitoring. Current evidence supports significantly higher pregnancy rates with hCG + GnRH agonist versus hCG alone, but further evidence is needed. GnRH agonist trigger, in GnRH antagonist protocol, is recommended for final oocyte maturation in women at risk of OHSS. (4) Luteal-phase support (n = 3 statements): Vaginal progesterone therapy represents the gold standard for luteal-phase support. CONCLUSIONS This Delphi consensus provides a real-world clinical perspective on the specific approaches during the key steps of ART treatment from a diverse group of international experts. Additional guidance from clinicians on ART strategies could complement guidelines and policies, and may help to further improve treatment outcomes.
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Affiliation(s)
- Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Raoul Orvieto,
| | - Christos A. Venetis
- Centre for Big Data Research in Health & School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- IVF Australia, Sydney, NSW, Australia
| | - Human M. Fatemi
- Assisted Reproductive Technology (ART), Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - Thomas D’Hooghe
- Global Medical Affairs, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | | | - Yulia Koloda
- Center of Reproduction “Life Line”, Moscow, Russia
- Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Marcos Horton
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | - Michael Grynberg
- Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Antoine Béclère, Clamart, France
| | - Salvatore Longobardi
- Global Clinical Development, Merck Serono, Italy, an Affiliate of Merck KGaA, Darmstadt, Germany
| | - Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Center for Male Reproduction, Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Sesh K. Sunkara
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Yuan Li
- Medical Center for Human Reproduction, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
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Maged AM, Ragab MA, Shohayeb A, Saber W, Ekladious S, Hussein EA, El-Mazny A, Hany A. Comparative study between single versus dual trigger for poor responders in GnRH-antagonist ICSI cycles: A randomized controlled study. Int J Gynaecol Obstet 2020; 152:395-400. [PMID: 33011968 DOI: 10.1002/ijgo.13405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/15/2020] [Accepted: 09/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) can improve the number of retrieved oocytes and clinical pregnancy rate in poor responders undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles using a GnRH-antagonist protocol. METHODS A randomized controlled trial included poor ovarian responders indicated for ICSI using a GnRH-antagonist protocol. They were divided equally into two groups: group I received 10 000 units of hCG plus 0.2 mg of triptorelin while group II received 10 000 units of hCG only for triggering of ovulation. The primary outcome parameter was the number of oocytes retrieved. Secondary outcomes included metaphase II oocytes number, cancellation rate, number of obtained embryos, chemical and clinical pregnancy rates. RESULTS One hundred and sixty women were included in the study, with 80 women in each treatment group. Dual triggering was associated with higher number of retrieved oocytes (5.3 ± 1.9 vs 4.5 ± 2.4, P=0.014), metaphase II oocytes (3.8 ± 1.4 vs 3.1 ± 1.7, P=0.004), total and grade 1 embryos (2.7 ± 1.1 and 2.3 ± 1.0 vs 1.9 ± 1.2 and 1.1 ± 0.2, P=0.001 and 0.021 respectively), and transferred embryos (2.2 ± 0.9 vs 1.6 ± 0.9, P=0.043, and lower cancellation rate (7.5% vs 20%, P=0.037) compared with single triggering. There were significantly higher chemical (25% vs 11.3%, P=0.039) and clinical (22.5% vs 8.8%, P=0.028) pregnancy rates in women with dual triggering compared with those with single triggering. CONCLUSION Dual triggering is associated with better IVF outcome in poor responders compared with single trigger. Clinical trial registration NCT04008966.
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Affiliation(s)
- Ahmed M Maged
- Obstetrics and Gynecology Department, Kasr Alainy Hospital Cairo University, Cairo, Egypt
| | - Mohamed A Ragab
- Obstetrics and Gynecology Department, Kasr Alainy Hospital Cairo University, Cairo, Egypt
| | - Amal Shohayeb
- Obstetrics and Gynecology Department, Kasr Alainy Hospital Cairo University, Cairo, Egypt
| | - Waleed Saber
- Obstetrics and Gynecology Department, Kasr Alainy Hospital Cairo University, Cairo, Egypt
| | - Sherif Ekladious
- Clinical Pathology Department, Kasr Alainy Hospital Cairo University, Cairo, Egypt
| | - Eman A Hussein
- Obstetrics and Gynecology Department, Kasr Alainy Hospital Cairo University, Cairo, Egypt
| | - Akmal El-Mazny
- Obstetrics and Gynecology Department, Kasr Alainy Hospital Cairo University, Cairo, Egypt
| | - Ayman Hany
- Obstetrics and Gynecology Department, Kasr Alainy Hospital Cairo University, Cairo, Egypt
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Haas J, Zilberberg E, Nahum R, Mor Sason A, Hourvitz A, Gat I, Orvieto R. Does double trigger (GnRH-agonist + hCG) improve outcome in poor responders undergoing IVF-ET cycle? A pilot study. Gynecol Endocrinol 2019; 35:628-630. [PMID: 30810400 DOI: 10.1080/09513590.2019.1576621] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Many strategies are offered for the treatment of poor responders. However, no compelling advantage for one stimulation protocol over another has been hitherto established. In this study, we aimed to evaluate the role of different modes and timings of final follicular maturation trigger, on in vitro fertilization (IVF) cycle outcome of poor responder patients. In the present randomized controlled study, poor responder patients, according to the Bologna criteria, undergoing controlled ovarian hyperstimulation (COH) using the gonadotropin-releasing hormone (GnRH) antagonist protocol were randomly assigned to three different final follicular maturation trigger modes and timings: hCG 36 h before oocyte pick-up (OPU) (hCG trigger); GnRH agonist (GnRHag) 36 h before (OPU) and hCG on day of OPU (GnRHag trigger); and GnRHag and hCG, 40 and 34 h prior to OPU, respectively (double trigger). Pregnancy rate, number of oocytes, and top quality embryos (TQEs). Thirty-three poor responder patients were recruited and randomized to the different study groups. While there were no in-between groups' differences in patients' demographics and stimulation variables, patients in the double trigger group had a significantly higher number of TQE (1.1 ± 0.9 vs. 0.3 ± 0.8 and 0.5 + 0.7; p<.02) as compared to the hCG trigger and the GnRH-ag trigger groups, respectively, with an acceptable pregnancy rate. Double trigger offers an additional benefit to poor responder patients. Larger studies are required to support this new concept prior to its implementation to IVF practice.
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Affiliation(s)
- Jigal Haas
- a Department of Obstetrics and Gynecology , Sheba Medical Center , Ramat-Gan , Israel
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Eran Zilberberg
- a Department of Obstetrics and Gynecology , Sheba Medical Center , Ramat-Gan , Israel
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ravit Nahum
- a Department of Obstetrics and Gynecology , Sheba Medical Center , Ramat-Gan , Israel
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Aya Mor Sason
- a Department of Obstetrics and Gynecology , Sheba Medical Center , Ramat-Gan , Israel
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ariel Hourvitz
- a Department of Obstetrics and Gynecology , Sheba Medical Center , Ramat-Gan , Israel
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Itai Gat
- a Department of Obstetrics and Gynecology , Sheba Medical Center , Ramat-Gan , Israel
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Raoul Orvieto
- a Department of Obstetrics and Gynecology , Sheba Medical Center , Ramat-Gan , Israel
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
- c The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine , Tel-Aviv University , Tel Aviv , Israel
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Lin MH, Wu FSY, Hwu YM, Lee RKK, Li RS, Li SH. Dual trigger with gonadotropin releasing hormone agonist and human chorionic gonadotropin significantly improves live birth rate for women with diminished ovarian reserve. Reprod Biol Endocrinol 2019; 17:7. [PMID: 30609935 PMCID: PMC6320621 DOI: 10.1186/s12958-018-0451-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/27/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Diminished ovarian reserve (DOR) remains one of the greatest obstacles affecting the chance of a successful live birth after fertility treatment. The present study was set to investigate whether using a "dual trigger" consisted of human chorionic gonadotropin (hCG) plus gonadotropin releasing hormone agonist (GnRH-a) for final oocyte maturation could improve the IVF cycle outcomes for patients with diminished ovarian reserve. METHODS A total of 427 completed GnRH-antagonist downregulated IVF cycles with fresh embryo transfer (ET) were included in this retrospective analysis. DOR was defined as antral follicle count ≤5 and serum anti-Müllerian hormone level ≤ 1.1 ng/mL. The control group (n = 130) used a 6500 IU of recombinant hCG for trigger, and the study group (n = 297) used 0.2 mg of triptorelin plus 6500 IU of recombinant hCG for trigger. RESULTS The dual-trigger group had significantly higher oocyte fertilization rate (73.1% vs. 58.6%), clinical pregnancy rate (33.0% vs. 20.7%) and live birth rate (26.9% vs. 14.5%) when compared to the hCG trigger group. In addition, the abortion rate (17.4% vs. 37.0%) and embryo transfer cancellation rate (6.1% vs. 15.4%) were both significantly lower in the dual trigger group. The primary outcome measure was the live birth rate per oocyte retrieval cycle. Secondary outcome measures were embryo transfer cancellation rate, clinical pregnancy rate, implantation rate, chemical pregnancy rate and abortion rate per oocyte retrieval cycle. CONCLUSIONS Dual triggering the final oocyte maturation with GnRH-a and standard dose of hCG can significantly improve the live birth rate, clinical pregnancy rate, and fertilization rate in women with diminished ovarian reserve undergoing GnRH antagonist down-regulated IVF-ICSI cycles.
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Affiliation(s)
- Ming-Huei Lin
- 0000 0004 0573 007Xgrid.413593.9Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- 0000 0004 0573 007Xgrid.413593.9Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- 0000 0004 1762 5613grid.452449.aMackay Medical College, New Taipei City, Taiwan
| | - Frank Shao-Ying Wu
- IHMED Fertility Clinic, Taipei, Taiwan
- Taipei City Hospital, Heping-Fuyou Branch, Taipei, Taiwan
| | - Yuh-Ming Hwu
- 0000 0004 0573 007Xgrid.413593.9Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- 0000 0004 0573 007Xgrid.413593.9Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- 0000 0004 1762 5613grid.452449.aMackay Medical College, New Taipei City, Taiwan
| | - Robert Kuo-Kuang Lee
- 0000 0004 0573 007Xgrid.413593.9Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- 0000 0004 0573 007Xgrid.413593.9Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- 0000 0000 9337 0481grid.412896.0Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Ryh-Sheng Li
- 0000 0004 0573 007Xgrid.413593.9Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Sheng-Hsiang Li
- 0000 0004 0573 007Xgrid.413593.9Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
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Triggering final follicular maturation: hCG, GnRH-agonist, or both, when and to whom? J Assist Reprod Genet 2017; 34:1231-1232. [PMID: 28656537 DOI: 10.1007/s10815-017-0982-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022] Open
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11
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Triggering final follicular maturation-hCG, GnRH-agonist or both, when and to whom? J Assist Reprod Genet 2016; 33:1415-1416. [PMID: 27448022 DOI: 10.1007/s10815-016-0775-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022] Open
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