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Mohammed-Durosinlorun A, Wada I. Factors associated with oocyte recovery rates during in-vitro fertilization among Nigerian women. Pan Afr Med J 2024; 47:190. [PMID: 39092016 PMCID: PMC11293478 DOI: 10.11604/pamj.2024.47.190.38674] [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: 12/29/2022] [Accepted: 02/25/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction the availability of oocytes is fundamental to in vitro fertilization (IVF). The factors associated with optimal or suboptimal oocyte recovery rates (ORR) in low-resource settings are not well known. This study aimed to determine the factors associated with ORR by comparing demographic and IVF cycle data of women undergoing IVF in our Centre. Methods this was a prospective study of 110 infertile women undergoing IVF at Nisa Premier Hospital, Abuja Nigeria, from October 2020 to September 2021. All women had reached the stage of oocyte retrieval or further, after receiving ovarian stimulation with our routine protocols. Treatment was monitored by serial transvaginal ultrasonography. The oocyte retrieval procedures were performed under conscious sedation, 36 hours after the ovulatory trigger. Optimal ORR was when eggs were obtained from at least 80% of follicles punctured. Sub-optimal ORR was when it was less than 80%. Data analyses utilized SPSS statistical software and a p-value of < 0.05 was considered significant. Results the mean age of all women was 34.1±4.9 years. Sixty-nine women (62.7%) had sub-optimal ORR while 41 (37.3%) had optimal ORR. Six women (5.5%) had no oocytes retrieved. Significantly more women with sub-optimal ORR were obese (70.6 vs 29.4%) and had higher follicle-stimulating hormone (FSH) levels (8.11 vs 6.34 miu/ml), p-value- 0.039. Women with sub-optimal ORR had higher mean prolactin levels (17.10 ± 13.93 miu/ml) than women with optimal ORR 11.43 ± 6.65 miu/ml), p-value- 0.019). Significantly more oocytes (5.99 vs 10.37, p-value 0.001), and MII oocytes (5.78 vs 7.56, p-value 0.035) were retrieved in women with optimal than sub-optimal ORR. The duration of stimulation, total amounts of gonadotropins administered, and fertilized oocytes were not significantly different among both groups (p-value >0.05). Conclusion this study has shown the factors associated with ORR in our setting to be basal FSH, prolactin, and obesity.
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Affiliation(s)
- Amina Mohammed-Durosinlorun
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University/Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Ibrahim Wada
- Nisa Premier Hospital/Institute of Medical Sciences, Abuja, Nigeria
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Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1026448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dabbagh Rezaeiyeh R, Mehrara A, Mohammad Ali Pour A, Fallahi J, Forouhari S. Impact of Various Parameters as Predictors of The Success Rate of In Vitro Fertilization. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2022; 16:76-84. [PMID: 35639653 PMCID: PMC9108295 DOI: 10.22074/ijfs.2021.531672.1134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022]
Abstract
A woman who is infertile is defined as a woman who is unable to conceive after having unprotected sex for more than one year. 20-25% of couples worldwide suffer from infertility each year (60 to 80 million couples). In vitro fertilization (IVF) plays a significant role in the treatment of various types of infertility, including fallopian tube defects, endometriosis, immunity, and male causes. IVF is a complex procedure that can be used to aid fertility or prevent genetic problems in the fetus. The objective of this review is to investigate factors that affect IVF failure and success rates. Need for this review is predicated on the different results obtained from previous studies, the high prevalence of infertility, and the lack of a similar study in this field. Articles were regarded as suitable if they evaluated the association between any factor and IVF outcome. A comprehensive search of databases was completed from their inception until March 2021. Our search resulted in 1278 articles. After assessing the titles and abstracts, we selected 70 articles for further reading. Our review shows that the effectiveness of IVF treatment depends on many factors. These include the physical environment, genetics, psychological factors, serum levels of certain hormones, sperm characteristics, as well as the age and body mass index of couples. Based on the results of our study, nutrient supplementation maybe beneficial for the enhancement of semen quality. For better IVF outcome, it is better for obese women to balance their body mass index (BMI) before IVF procedure initiation.
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Affiliation(s)
| | - Arian Mehrara
- Student Research Committee, Ramsar International Branch, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Jafar Fallahi
- Department of Molecular Medicine, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedighe Forouhari
- Infertility Research Center, Research Center of Quran, Hadith and Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,
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Sahin G, Akdogan A, Aydın MH, Tekindal MA, Göker ENT, Tavmergen E. In-Vitro Fertilization Outcome Predictors in Women With High Baseline Follicle-Stimulating Hormone Levels: Analysis of Over 1000 Cycles From A Tertiary Center. JBRA Assist Reprod 2021; 25:235-241. [PMID: 33710840 PMCID: PMC8083852 DOI: 10.5935/1518-0557.20200088] [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] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate reproductive outcomes and determine the predictors of clinical pregnancy and live birth in women with elevated baseline follicle-stimulating hormone (FSH) levels, who have undergone intracytoplasmic sperm injection (ICSI) treatment. METHODS This retrospective study included 1011 ICSI cycles of women with high baseline FSH levels (> 10 IU/L), from a tertiary university IVF center between 2010 and 2015. Logistic regression analysis was performed to evaluate the prognostic factors of clinical pregnancy and live birth. RESULTS Among the 1011 ICSI cycles, the clinical pregnancy and live birth rates per oocyte retrieval were 19.5% and 14.3%, respectively. The live birth rates were 21.1% and 1.7% in women aged ≤30 years and those aged ≥40 years, respectively. In addition, the live birth rate was 1.47-fold higher in women from whom >3 oocytes were retrieved, compared to those from whom ≤3 oocytes were retrieved (p=0.047). Logistic regression analysis indicated that the age categories ≤30y, 36-39y and ≥40y, level of baseline FSH (≥20 IU/L) and the ovarian response (≤3 or >3 oocytes retrieved) were significantly associated with live birth. CONCLUSIONS Our study indicated that age, baseline FSH level, and ovarian response are independent predictive factors for clinical pregnancy and live birth among women with baseline FSH levels >10 IU/L.
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Affiliation(s)
- Gülnaz Sahin
- Ege University Family Planning and Infertility Treatment and Research Center, Ankara cad., 35100 Bornova, Izmir, Turkey
| | - Aysin Akdogan
- Ege University Family Planning and Infertility Treatment and Research Center, Ankara cad., 35100 Bornova, Izmir, Turkey
| | - Murat Hakan Aydın
- Deparment of Obstetrics and Gynecology, Ege University Faculty of Medicine, Ankara cad., 35100, Bornova, Izmir, Turkey
| | - Mustafa Agah Tekindal
- Selcuk University, Veterinary Faculty, Department of Biostatistics 42003 Selçuklu, Konya, Turkey
| | - Ege Nazan Tavmergen Göker
- Ege University Family Planning and Infertility Treatment and Research Center, Ankara cad., 35100 Bornova, Izmir, Turkey
- Deparment of Obstetrics and Gynecology, Ege University Faculty of Medicine, Ankara cad., 35100, Bornova, Izmir, Turkey
| | - Erol Tavmergen
- Ege University Family Planning and Infertility Treatment and Research Center, Ankara cad., 35100 Bornova, Izmir, Turkey
- Deparment of Obstetrics and Gynecology, Ege University Faculty of Medicine, Ankara cad., 35100, Bornova, Izmir, Turkey
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Zhang W, Zhang L, Liu Y, Li J, Xu X, Niu W, Xu J, Sun B, Guo Y. Higher chromosomal aberration frequency in products of conception from women older than 32 years old with diminished ovarian reserve undergoing IVF/ICSI. Aging (Albany NY) 2021; 13:10128-10140. [PMID: 33819190 PMCID: PMC8064218 DOI: 10.18632/aging.202772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/02/2021] [Indexed: 12/22/2022]
Abstract
Infertile women with diminished ovarian reserve (DOR) confront an increased miscarriage rate in assisted reproductive technology (ART). Genetic abnormality is the most important factor. However, the effects of DOR and female age on the molecular karyotype of products of conception (POCs) remain unknown. We analyzed POCs using a single nucleotide polymorphism (SNP) microarray from women with DOR who experienced first-trimester miscarriage in IVF/ICSI cycles. The SNP microarray revealed chromosomal abnormalities in 74.6% (47/63) of POCs, including trisomy in 83.0% (39/47). Chromosomal aberrations were more frequent in women older than 32 years old with DOR than in young women aged 20-32 years old (86.7% vs. 44.4%, P = 0.001). Univariate and multivariable analyses identified advanced age as a risk factor for chromosomal aberration-related miscarriage in women with DOR, with odds ratios of 8.125 (95% CI: 2.291-28.820, P = 0.001) and 5.867 (95% CI: 1.395-24.673, P = 0.016), respectively. The results showed that older women (older than 32 years old) with DOR had a high risk of miscarrying a chromosomally aberrant embryo/fetus, regardless of basal follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC) and previous reproductive history. This finding indicates a novel cut-off value of age for women with DOR related to chromosomal aberration-related miscarriage.
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Affiliation(s)
- Wanyu Zhang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Linghan Zhang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Yu Liu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Jing Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Xiaolu Xu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Wenbin Niu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China.,Department of Preimplantation Genetic Diagnosis, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiawei Xu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China.,Department of Preimplantation Genetic Diagnosis, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
| | - Yihong Guo
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.,Henan Province Key Laboratory of Reproduction and Genetics, Henan, China
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Qin L, Sitticharoon C, Petyim S, Keadkraichaiwat I, Sririwichitchai R, Maikeaw P, Churintaraphan M, Sripong C. Roles of kisspeptin in IVF/ICSI-treated infertile women and in human granulosa cells. Exp Biol Med (Maywood) 2020; 246:996-1010. [PMID: 33327782 DOI: 10.1177/1535370220981006] [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] [Indexed: 11/16/2022] Open
Abstract
Kisspeptin, a crucial central regulator of reproduction, has been used as a trigger in in vitro fertilization (IVF) treatment. This study aimed to investigate the roles of kisspeptin in IVF treatment in infertile females (n = 30); and in steroidogenesis in human granulosa-like tumor cell line (KGN). In the human study, blood was collected at three time points including (1) the beginning of gonadotropin stimulation (Phase I), (2) around eight days after gonadotropin stimulation (Phase II), and (3) on the day of ovum pick-up (Phase III). Follicular fluid (FF) was collected at Phase III. Serum human chorionic gonadotropin (hCG) was measured 15 days after embryo transfer and fetal heart beats were determined around 42 days of menstrual cycle to classify the subjects into successful and unsuccessful groups. FF kisspeptin levels were higher in successful compared with unsuccessful subjects (P < 0.01). Kisspeptin levels were significantly higher in FF than in serum in successful subjects (P < 0.05) but were comparable in unsuccessful subjects. Serum kisspeptin was comparable among three phases in the successful group but its levels in Phase III were significantly lower compared with Phase I in the unsuccessful group (P < 0.01). Serum kisspeptin in Phase II/III had positive correlations with serum E2 in Phases II and III and the outcomes of IVF/intracytoplasmic sperm injection (ICSI) treatment including serum hCG levels. For the cell experiment (n = 3), kisspeptin treatment in the presence of FSH together with IGF-1 enhanced CYP19A1 (aromatase) mRNA expression compared with control. FSH alone increased aromatase concentrations in the supernatant compared with control and kisspeptin at the dose of 10-2 mmol/L with FSH enhanced aromatase concentrations in the supernatant compared with FSH alone (P < 0.001 all). In conclusion, kisspeptin enhanced aromatase expression and secretion and was associated with positive outcomes of IVF/ICSI treatment. Further studies regarding supplementation of kisspeptin could reveal its beneficial effects on IVF/ICSI treatment.
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Affiliation(s)
- Lixian Qin
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chantacha Sitticharoon
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Somsin Petyim
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Issarawan Keadkraichaiwat
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Rungnapa Sririwichitchai
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pailin Maikeaw
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Malika Churintaraphan
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chanakarn Sripong
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Steiner N, Ates S, Shaulov T, Shrem G, Volodarsky-Perel A, Dahan SY, Tannus S, Son WY, Dahan MH. A comparison of IVF outcomes transferring a single ideal blastocyst in women with polycystic ovary syndrome and normal ovulatory controls. Arch Gynecol Obstet 2020; 302:1479-1486. [PMID: 32671545 DOI: 10.1007/s00404-020-05699-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effects PCOS on live birth rates when transferring a single fresh ideal blastocyst. METHODS A retrospective cohort study performed at the university-affiliated reproductive center. Women with PCOS and a control group of normal ovulatory women who underwent their first fresh embryo transfer with single ideal grade blastocyst were included in the study. Demographic, stimulation information and pregnancy outcomes were collected and analysed. The primary outcome was live birth rates, and secondary outcomes included pregnancy and clinical pregnancy rates. RESULTS 71 Women with PCOS and 272 normal ovulatory controls underwent their first embryo transfer and met the inclusion and exclusion criteria. PCOS patient were younger (31.0 ± 3.7 vs. 33.1 ± 3.2, p = 0.0001), with higher AFC (40.0 ± 9.3 vs. 13.3 ± 4.6, p = 0.0001), required lower dose of gonadotropins to stimulate (1198 ± 786 vs. 1891 ± 1224, p = 0.0001), and had higher serum testosterone levels (2.3 ± 0.7 vs. 1.1 ± 0.3, p = 0.0001). No significant difference was found between the two groups regarding the number of previous pregnancies, the number of previous full-term pregnancies, the level of basal serum FSH, estradiol level at triggering and the BMI. When compared by Chi squared testing pregnancy rates, clinical pregnancy rates and live birth rates did not differ. However, when controlling (with multivariate stepwise logistic regression) for confounders, live birth rates were lower among the women with PCOS (p = 0.035, CI: 0.18-0.92). CONCLUSION After controlling for confounders, when transferring a fresh single ideal blastocyst, live birth rates were lower among the women with PCOS than normal ovulatory controls.
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Affiliation(s)
- Naama Steiner
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada.
- MUHC Reproductive Center, McGill University, Montreal, QC, Canada.
| | - Senem Ates
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
| | - Talya Shaulov
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
| | - Guy Shrem
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
- MUHC Reproductive Center, McGill University, Montreal, QC, Canada
| | - Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
- MUHC Reproductive Center, McGill University, Montreal, QC, Canada
| | - S Yehuda Dahan
- High School Student Performing a Research Rotation at the MUHC, Montreal, QC, Canada
| | - Samer Tannus
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
| | - Weon-Young Son
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
- MUHC Reproductive Center, McGill University, Montreal, QC, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada
- MUHC Reproductive Center, McGill University, Montreal, QC, Canada
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Chang Y, Li J, Li X, Liu H, Liang X. Egg Quality and Pregnancy Outcome in Young Infertile Women with Diminished Ovarian Reserve. Med Sci Monit 2018; 24:7279-7284. [PMID: 30310048 PMCID: PMC6195787 DOI: 10.12659/msm.910410] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background This study investigated the quality and quantity of eggs and embryos as well as the clinical pregnancy outcome in young infertile women with diminished ovarian reserve (DOR) after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Material/Methods We retrospectively reviewed records of 4285 infertile women and divided them into 3 groups according to age and ovarian reserve: young women with normal ovarian reserve (n=1695), young women with DOR (n=1121), and older women with DOR (n=1469). Results In young women with DOR, the proportion of high-quality embryos was significantly higher than in older women with DOR and lower than in young women with normal ovarian reserve (P<0.01). The proportions of ovulation cancellation, ovulation without egg acquisition, and ovulation without available embryos in young women with DOR were significantly higher than in young women with normal ovarian reserve. The rates of biochemical pregnancy, clinical pregnancy, and embryo implantation in young women with DOR were significantly higher than in older women with DOR, and lower than in young women with normal ovarian reserve. The miscarriage rate was 19.17% in young women with DOR, significantly lower than in older women with DOR (33.90%), and higher than in young women with normal ovarian reserve. Conclusions Young women with DOR have ovarian hypo-response and low numbers of acquired eggs and embryos, but the possibilities of high-quality embryo and good clinical pregnancy are higher once eggs are acquired. The indications to IVF/ICSI can be widened and active treatments should be administered for these women.
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Affiliation(s)
- Yajie Chang
- Reproductive Center, Sixth Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jingjie Li
- Reproductive Center, Sixth Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Xiaolan Li
- Reproductive Center, Sixth Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Hong'e Liu
- Department of Obstetrics and Gynecology, Guangzhou Development District Hospital, Guangzhou, Guangdong, China (mainland)
| | - Xiaoyan Liang
- Reproductive Center, Sixth Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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Does ovarian reserve affect outcomes in single ideal blastocyst transfers in women less than 40 years of age? Arch Gynecol Obstet 2017; 297:233-239. [PMID: 29082421 DOI: 10.1007/s00404-017-4571-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE There is much debate whether diminished ovarian reserve is purely a quantitative issue, or if quality as determined by pregnancy potential of the ensuing oocytes is also affected. The purpose of this study was to determine whether diminished ovarian reserve, as established by one of three ways described below, affects pregnancy outcomes of women under 40 years old undergoing a single ideal blastocyst transfer. MATERIALS AND METHODS This was a retrospective cohort study, including 507 women undergoing an ideal quality single embryo transfer between August 2010 and March 2014. Logistic regression was used to control for age, duration of infertility, parity, body mass index, and smoking status. For analysis, women were stratified for: antral follicle counts (≤ 5 vs. > 5), basal serum FSH levels (< 13 vs. ≥ 13 IU/L), and quartile of total FSH dose required for stimulation. RESULTS In stratifying women by antral follicle count (AFC) ≤ 5 vs. > 5, the pregnancy rate (40 vs. 53%, p = 0.04), clinical pregnancy rate (29 vs. 46%, p = 0.02), and live birth rate (13 vs. 43%, p = 0.001) were superior with AFC > 5. Using FSH levels (< 13 vs. ≥ 13 IU/L), the pregnancy rate (50 vs. 31%, p = 0.27), clinical pregnancy rate (40 vs. 13%, p = 0.45), and live birth rate (38 vs. 13%, p = 0.48) were similar. Examining quartiles of FSH stimulation, the pregnancy rates were similar (from lowest to highest: 45, 52, 54, 41%, p = 0.13); however, clinical pregnancy rate (36, 43, 47, 25%, p = 0.003) and live birth rate (32, 38, 44, 20%, p = 0.005) were superior in lower quartiles vs. the highest quartile. CONCLUSION Ovarian reserve may affect embryo pregnancy potential and outcomes when measured by AFC and exogenous stimulation but not by basal FSH levels.
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