Are There Ovarian Responsive Indexes That Predict Cumulative Live Birth Rates in Women over 39 Years?

The impact of resveratrol on the outcome of the in vitro fertilization: an exploratory randomized placebo-controlled trial

BACKGROUND

Resveratrol is a natural polyphenolic compound present in plants and red wine with many potential health benefits. This compound has various anti-inflammatory and anti-tumor properties and can improve cellular mitochondrial activity. This trial was designed to evaluate the effect on the outcome of IVF of Resveratrol supplementation in women > 35 years with good ovarian reserve (AMH > 1.2 ng/ml). Women were randomized to receive or placebo or Resveratrol (150 mg per day) for three months preceding the ovarian stimulation (OS). All patients were stimulated with a starting dose of recombinant FSH ranging between 150 and 300 IU according to age and ovarian reserve. GnRH antagonist flexible protocol was adopted for pituitary suppression. Triggering was performed with urinary hCG (10.000 IU).

RESULTS

The study was conducted between January 2019 and December 2022 with aa total of 37 cases and 33 controls were recruited. No statistically significant differences in the number of oocytes retrieved, biochemical pregnancy, clinical pregnancy and live birth rates were observed between women treated with resveratrol and control group. A statistically significant increase in the follicle output rate (FORT) and follicle-to oocyte index (FOI) was observed in women treated with resveratrol-based nutraceutical (0.92 versus 0.77 [p = 0.02], and 0.77 versus 0.64 [p = 0.006], respectively).

CONCLUSIONS

Preliminary results from this study indicate that pre-treatment with resveratrol may improve ovarian sensitivity to exogenous FSH, which in turn may decrease the risk of hypo-response to OS in advanced reproductive age women.

Comparison of Cumulative Live Birth Rates between Flexible and Conventional Progestin-Primed Ovarian Stimulation Protocol in Poor Ovarian Response Patients According to POSEIDON Criteria: A Cohort Study

RESEARCH QUESTION

To compare the cumulative live birth rate (CLBR) per oocyte retrieval cycle of a conventional progestin-primed ovarian stimulation (cPPOS) regimen with a flexible progestin-primed ovarian stimulation (fPPOS) regimen in poor ovarian response patients, according to POSEIDON criteria.

DESIGN

Poor ovarian response women, according to POSEIDON criteria, who underwent the first PPOS protocol for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) between January 2018 and December 2020 were included. The fPPOS group involved 113 participants, and the cPPOS group included 1119 participants. In the cPPOS group, medroxyprogesterone acetate (MPA) (10 mg/d) was administrated on the gonadotropin injection the same day as gonadotropin injections in the cPPOS group, while MPA was started either on the day when the leading follicle with mean diameter > 12mm was present and/or serum E2 was >300 pg/mL in the fPPOS protocol group. The primary outcome was CLBR.

RESULTS

The fPPOS protocol had higher CLBR per oocyte retrieval cycle compared to the cPPOS group, even without a statistically significant difference (29.6% vs. 24.9%, p = 0.365). The fPPOS group had fewer numbers of retrieved oocytes (2.87 ± 2.03 vs. 3.76 ± 2.32, p < 0.001) but a higher MII oocyte rate (89.8% vs. 84.7%, p = 0.016). In addition, the number of available embryos in the two groups was comparable (1.37 ± 1.24 vs. 1.63 ± 1.38, p = 0.095). There were five women in the fPPOS group, and 86 women in the cPPOS group had a premature LH surge (4.2% vs. 6.8%, p = 0.261). In the fPPOS group, there was one instance of premature ovulation, while in the cPPOS group, there were six occurrences of premature ovulation (0.8 vs. 0.5%, p = 1.000).

CONCLUSION(S)

The novel fPPOS protocol appears to achieve higher CLBR even without significant differences and with MPA consumption compared with cPPOS protocol in low-prognosis patients.

The average gonadotrophin dosage per follicle is predictive of ovarian response and cumulative live birth chances after in vitro fertilization: a retrospective cohort study

BACKGROUND

With the development of assisted reproduction technology (ART), many indicators have been proposed to evaluate ovarian response, and then predict pregnancy outcomes. In general, the predictive values remain limited.

OBJECTIVE

To further explore the indicators to evaluate ovarian sensitivity to gonadotrophin (Gn) stimulation more accurately.

METHODS

This retrospective cohort study included 330 women who underwent an entire ART cycle. We aimed to assess whether a new index, termed as average Gn dosage per follicle, could be used as a marker for ovarian response and pregnancy outcomes. It was calculated as the ratio of total Gn dose during ovarian stimulation and the number of pre-ovulatory follicles (PFC) on the trigger day. Patients were divided into three subgroups according to the average Gn dosage per follicle: below the 33rd percentile (Group A), between 33rd and 67th percentiles (Group B), and above the 67th percentile (Group C). Then stimulation data, laboratory and clinical outcomes were compared among the groups.

RESULTS

The results showed patients in Group A had the best ovarian response, the number of retrieved oocytes was significantly higher than in Group B and C. A multivariate regression analysis showed that average Gn dosage per follicle was an independent predictor of cumulative live birth rates (CLBRs) [adjusted odds ratio (OR): 0.96, 95% confidence interval (CI): 0.95-0.98, P < 0.01].

CONCLUSIONS

The present study showed that average Gn dosage per follicle appears to be a highly reliable index of ovarian response to exogenous Gn and can be useful to estimate CLBR.

Association of follicle-to-oocyte index and clinical pregnancy in IVF treatment: A retrospective study of 4,323 fresh embryo transfer cycles

OBJECTIVE

The aim of this study is to investigate whether the follicle-to-oocyte index [FOI: (number of retrieved oocytes/antral follicle count) × 100] was associated with clinical pregnancy after fresh cleavage transfer.

DESIGN

The framework used to organize this study is retrospective cohort analysis.

SETTING

The study was performed in a single in vitro fertilization center in a public hospital.

PATIENTS

In total, 4,323 fresh embryo transfer cycles from 1 August 2011 to 31 January 2022 were retrospectively analyzed. Data were designated into three groups according to FOI tertile values.

INTERVENTIONS

There are no interventions in this study.

MAIN OUTCOME MEASURE

The primary outcome measure is the clinical pregnancy rate (CPR).

RESULTS

A total of 4,323 patients were included in the study. According to their FOI, patients were divided into low (FOI ≤ 0.70, n = 1,434), medium (FOI = 0.71-0.95, n = 1,070), and high (FOI = 0.96-1.00, n = 1,819) tertile groups. A significant statistical increase in the CPR from the lowest to the highest tertile FOI group was detected (47.28%, 51.78%, and 51.57%; P =0.026). After adjusted for potential confounders, multivariate logistic regression analysis revealed a positive association between FOI and CPR [odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18-2.11]. Each standard deviation increments in FOI (SD = 0.24) corresponded to a 20% increase in the CPR. Trend analysis also showed that FOI tertile groups were positively associated with CPR (P for trend = 0.010). Smooth curve fitting indicated the existence of a linear relationship across the entire range of FOI. No optimal cutoff value of FOI for prognosing CPR was found in smooth curve fitting analysis. Moreover, subgroup analyses suggested that the association was significantly stronger in the single cleavage transfer cycle (OR = 2.04; 95% CI: 1.14-3.65).

CONCLUSIONS

FOI is an independent variable in prediction for CPR in fresh embryo transfer cycle, especially in the single cleavage transfer cycle.